Richardson J P, Fredman L, Daly M P
Department of Family Medicine, University of Maryland School of Medicine, Baltimore.
Fam Med. 1993 Jun;25(6):377-81.
The goal of this research was to study the relationship between family practice residency training in geriatrics and subsequent postresidency geriatric practice patterns.
We surveyed all graduates of the University of Maryland Family Practice Residency Program through 1990 to determine their attitudes toward their geriatric training and the extent of their geriatric practice. Logistic regression analysis was used to identify factors associated with 1) making house calls, 2) making weekly nursing home visits, and 3) having a practice in which more than 25% of patients were older than age 65.
The responses of 143 graduates were analyzed. Most respondents (58.8%) made house calls, and the majority (51%) saw nursing home patients weekly. Older respondents and those possessing Certificates of Added Qualifications in Geriatric Medicine (CAQGMs) were more likely to treat patients older than age 65. Respondents with larger nursing home practices rated their geriatric training more favorably. Multivariate logistic regression analysis found that the following factors were associated with making house calls: working in a group family practice (odds ratio [OR] = 3.88, 95% confidence interval [CI] = 2.58-5.84) and a rural practice location (OR = 2.71, 95% CI = 1.77-4.17). Physicians who had additional training after residency (OR = 0.16, 95% CI = 0.10-0.25) were less likely to make house calls. Factors associated with making weekly nursing home visits were: additional training after residency (OR = 0.31, 95% CI = 0.19-0.50) and working in a group family practice (OR = 2.43, 95% CI = 1.63-3.65). Attainment of a CAQGM was the only factor associated with having more than 25% geriatric patients in the office practice (OR = 6.00, 95% CI = 2.72-13.24).
Most graduates of the University of Maryland Family Practice Residency Program maintain significant geriatric practices and value geriatric training, but whether favorable training experiences influence graduates' practices is unknown. Prospective studies of family practice residents are needed to clarify the influence of geriatric curricula on residents' future clinical practices.
本研究的目的是探讨老年医学家庭医疗住院医师培训与住院医师培训后的老年医疗实践模式之间的关系。
我们对马里兰大学家庭医疗住院医师项目截至1990年的所有毕业生进行了调查,以确定他们对老年医学培训的态度以及他们老年医疗实践的程度。采用逻辑回归分析来确定与以下因素相关的因素:1)进行上门问诊;2)每周进行养老院探访;3)拥有一个老年患者(年龄超过65岁)占比超过25%的医疗业务。
对143名毕业生的回复进行了分析。大多数受访者(58.8%)进行上门问诊,大多数(51%)每周看望养老院患者。年龄较大的受访者以及拥有老年医学附加资格证书(CAQGM)的受访者更有可能治疗年龄超过65岁的患者。在养老院有更多业务的受访者对他们的老年医学培训评价更高。多变量逻辑回归分析发现,以下因素与上门问诊相关:在团体家庭医疗中工作(比值比[OR]=3.88,95%置信区间[CI]=2.58 - 5.84)和在农村地区执业(OR = 2.71,95% CI = 1.77 - 4.17)。住院医师培训后接受额外培训的医生(OR = 0.16,95% CI = 0.10 - 0.25)进行上门问诊的可能性较小。与每周进行养老院探访相关的因素有:住院医师培训后接受额外培训(OR = 0.31,95% CI = 0.19 - 0.50)和在团体家庭医疗中工作(OR = 2.43,95% CI = 1.63 - 3.65)。获得CAQGM是与门诊业务中老年患者占比超过25%相关的唯一因素(OR = 6.00,95% CI = 2.72 - 13.24)。
马里兰大学家庭医疗住院医师项目的大多数毕业生保持着大量的老年医疗业务并重视老年医学培训,但良好的培训经历是否会影响毕业生的实践尚不清楚。需要对家庭医疗住院医师进行前瞻性研究,以阐明老年医学课程对住院医师未来临床实践的影响。