Meier D E, Gold G, Mertz K, Taylor B, Cammer-Paris B E, Seckler A, Mulvihill M
Department of Geriatrics, Mount Sinai School of Medicine, New York, New York, USA.
J Am Geriatr Soc. 1996 Jan;44(1):37-43. doi: 10.1111/j.1532-5415.1996.tb05635.x.
To determine the effectiveness of physician-initiated counselling on the rate of health care proxy appointment.
Observational study of an intervention in a convenience sample.
A geriatric outpatient clinic in a tertiary care teaching hospital, New York, New York.
A total of 687 patients enrolled in the geriatric clinic during the study period March 1991 through June 1993.
Physician counselling about the New York State Health Care Proxy Law, distribution of educational materials and healthcare proxy forms, and reminders in 331 of 466 eligible patients.
Rate of healthcare proxy appointment in eligible and counselled groups; predictors of appointment and non-appointment; time elapsed from counselling to appointment; reasons for non-appointment; characteristics of the proxy appointment process.
A healthcare proxy was appointed for 31.5% of patients eligible for counselling and for 44% of patients who actually received the intervention, compared with a 2.3% proxy appointment rate at baseline. Eighty-one percent of the patients completing the proxy appointment process did so at or before their third clinic return visit after the counselling intervention. Of the counselled patients who did not appoint a proxy, 25% explicitly declined, and 75% had not come to a decision by the end of the study period. Proxy completion was associated with ethnicity, education, and more frequent clinic visits. Of those who appointed a proxy, 97% had good or fair comprehension of the procedure, 92% discussed the appointment with their designees, 63% appointed a daughter or son, and 80% discussed their wishes for care at the end of life with their proxy.
Physician counselling of older outpatients is an effective means of increasing healthcare proxy appointments.
确定医生发起的咨询对医疗保健代理人指定率的有效性。
对便利样本中的干预措施进行观察性研究。
纽约市一家三级护理教学医院的老年门诊诊所。
在1991年3月至1993年6月的研究期间，共有687名患者登记参加老年诊所。
医生就纽约州医疗保健代理人法进行咨询，分发教育材料和医疗保健代理人表格，并对466名符合条件的患者中的331名进行提醒。
符合条件并接受咨询的组中医疗保健代理人指定率；指定和未指定的预测因素；从咨询到指定的时间间隔；未指定的原因；代理人指定过程的特征。
符合咨询条件的患者中有31.5%指定了医疗保健代理人，实际接受干预的患者中有44%指定了代理人，而基线时的代理人指定率为2.3%。在咨询干预后，81%完成代理人指定过程的患者在第三次门诊复诊时或之前完成。在接受咨询但未指定代理人的患者中，25%明确拒绝，75%在研究期结束时仍未做出决定。代理人指定的完成与种族、教育程度和更频繁的门诊就诊有关。在指定代理人的患者中，97%对该程序有良好或一般的理解，92%与他们指定的人讨论了指定事宜，63%指定了女儿或儿子，80%与他们的代理人讨论了他们在生命末期的护理愿望。
对老年门诊患者进行医生咨询是增加医疗保健代理人指定的有效手段。
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