老年人预防性服务的扩大覆盖范围：示范人群的反应与结果
Extended coverage for preventive services for the elderly: response and results in a demonstration population.
作者信息
German P S, Burton L C, Shapiro S, Steinwachs D M, Tsuji I, Paglia M J, Damiano A M
机构信息
Health Services Research and Development Center, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205.
出版信息
Am J Public Health. 1995 Mar;85(3):379-86. doi: 10.2105/ajph.85.3.379.
OBJECTIVES
This study was undertaken to test the acceptability of preventive services under Medicare waivers to a community-dwelling population aged 65 and over and to examine the effect of such services on health.
METHODS
Medicare beneficiaries and designated primary care providers were sampled, and beneficiaries were screened and surveyed. A total of 4195 individuals were then randomized into intervention or control groups. Those in the intervention group were offered free preventive visits (under waivers) to their physicians. A follow-up survey of the entire group was administered after completion of the intervention.
RESULTS
Sixty-three percent of the intervention group made a preventive clinical visit, and about half of them a counseling visit. For men, being married and having a solo practitioner were positively associated with accepting the intervention services, while for women, having had a mammogram, having a confidant, having a high school education, and having a female practitioner were so associated. The intervention group showed a greater health benefit than did the control group and had a significantly lower death rate: 8.3% vs 11.1%.
CONCLUSIONS
Older individuals will respond to preventive programs, and such services will result in modest health gains.
目的
本研究旨在测试医疗保险豁免下的预防服务对65岁及以上社区居住人群的可接受性，并检验此类服务对健康的影响。
方法
对医疗保险受益人和指定的初级保健提供者进行抽样，对受益人进行筛查和调查。然后将总共4195人随机分为干预组或对照组。干预组的人可以（在豁免下）免费去看医生进行预防性就诊。干预结束后对整个组进行了随访调查。
结果
干预组中有63%的人进行了预防性临床就诊，其中约一半人进行了咨询就诊。对于男性，已婚且有个体执业医生与接受干预服务呈正相关，而对于女性，进行过乳房X光检查、有知己、有高中学历以及有女性执业医生则与接受干预服务呈正相关。干预组比对照组显示出更大的健康益处，死亡率显著更低：8.3% 对11.1%。
结论
老年人会对预防项目做出反应，此类服务将带来适度的健康改善。
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