Burton L C, Paglia M J, German P S, Shapiro S, Damiano A M
Health Services Research and Development Center, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
Prev Med. 1995 Sep;24(5):492-7. doi: 10.1006/pmed.1995.1078.
The U.S. Congress mandated evaluations, initiated in 1989, to determine whether extending Medicare benefits to include preventive services would improve health status, reduce costs of care, and improve health risk behaviors of beneficiaries.
The Johns Hopkins Medicare Preventive Services Demonstration was a randomized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care. This report describes the effect of the intervention over a period of 2 years on smoking, problem alcohol use, and sedentary lifestyle.
Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use, but none of the differences was statistically significant. The proportion of smokers who quit was higher in the intervention group than in the control group (24.2 vs 17.9%, P = 0.09). However, a higher proportion of problem drinkers in the control group improved (67.1 vs 57.0%, P = 0.183). There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle.
This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations, as well as health behavior counseling directed by the physician. Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective.
美国国会于1989年发起评估，以确定将医疗保险福利扩大至包括预防服务是否会改善健康状况、降低医疗成本并改善受益人的健康风险行为。
约翰霍普金斯医疗保险预防服务示范项目是一项随机试验，其中医疗保险受益人被分配到干预组或对照组。干预组在两年内每年接受一次预防性就诊，并可选择向其初级保健提供者进行咨询就诊；对照组接受常规护理。本报告描述了干预措施在两年内对吸烟、问题饮酒和久坐生活方式的影响。
在吸烟和问题饮酒的变化程度上，干预组和对照组之间存在差异，但这些差异均无统计学意义。干预组中戒烟的吸烟者比例高于对照组（24.2%对17.9%，P = 0.09）。然而，对照组中问题饮酒者改善的比例更高（67.1%对57.0%，P = 0.183）。在久坐生活方式改善的比例方面，干预组和对照组之间几乎没有差异。
本研究表明，当年度预防性就诊包括筛查、免疫接种以及医生指导的健康行为咨询时，在两年内每年与初级保健医生进行预防性就诊的过程中，促使老年患者改变健康行为存在困难。需要进一步研究以确定初级保健提供者针对老年人开展更强化的健康行为改变咨询项目是否有效。
