McEwan R T, Forster D P
Department of Epidemiology and Public Health, School of Health Care Sciences, University of Newcastle upon Tyne, UK.
Fam Pract. 1993 Mar;10(1):55-62. doi: 10.1093/fampra/10.1.55.
The 1990 contract for general practitioners made annual health checks for people aged 75 and over compulsory. We review the costs and effects of different approaches to the health check, focusing on the method advised in the 1990 contract. This involves an annual home-based functional assessment by a member of the primary health care team, known as a blanket assessment. Our review of published randomized controlled trials shows such assessments have few consistent benefits. Data on the costs of assessment are usually reported in summary form, with little or no information on which costs are included. In studies where average costs are given for assessments, because of salary and travel expenses, the costs are high. Several promising methods for reducing costs in assessment, and a method with potential to improve effectiveness, are currently outside the terms of the 1990 contract. These methods are described. Revision of the 1990 contract should incorporate the flexibility to encourage more cost-effective approaches to assessing the elderly such as a two-stage assessment or using volunteers. A monitoring group is needed to establish how health checks are being implemented. This group could co-ordinate and advise on standardized criteria for methods of costing and assessing effectiveness in assessment programmes.
1990年签订的全科医生合同规定，75岁及以上老人的年度健康检查为强制性检查。我们审视了不同健康检查方式的成本与效果，重点关注1990年合同中建议的方法。这包括由基层医疗团队成员进行的年度居家功能评估，即全面评估。我们对已发表的随机对照试验的审查表明，此类评估几乎没有一致的益处。评估成本数据通常以汇总形式报告，几乎没有或根本没有关于包含哪些成本的信息。在给出评估平均成本的研究中，由于薪资和差旅费，成本很高。目前，1990年合同条款未涵盖几种降低评估成本的可行方法以及一种有可能提高效果的方法。本文对这些方法进行了描述。1990年合同的修订应具备灵活性，以鼓励采用更具成本效益的方法来评估老年人，比如两阶段评估或使用志愿者。需要一个监督小组来确定健康检查的实施方式。该小组可以就评估方案中成本核算和效果评估方法的标准化标准进行协调并提供建议。
