Frank J C, Hirsch S H, Chernoff J, Wallace S P, Abrahamse A, Maly R, Reuben D B
Multicampus Program in Geriatric Medicine and Gerontology, School of Medicine, University of California at Los Angeles, USA.
J Gerontol A Biol Sci Med Sci. 1997 Jan;52(1):M44-51. doi: 10.1093/gerona/52a.1.m44.
In consultative models of Comprehensive Geriatric Assessment (CGA), lack of implementation of CGA recommendations is well documented and appears to be a potential explanation for negative findings. The purpose of this study is to identify patient determinants of adherence to recommendations received from a community-based CGA consultative model program.
Subjects (N = 139) received self-care and/or physician-initiated CGA recommendations and were interviewed three months later to determine adherence with the most important recommendation, and health belief, communication, and social support factors associated with adherence. Independent variables were organized into the Andersen Behavioral Model for analysis.
At the bivariate level, one predisposing factor (intention) and six enabling factors (low difficulty level, high support, high utility, high self-efficacy, agreement on the importance of the recommendation and good specific communication about the recommendation) were significant determinants of adherence. Two functional health measures and seriousness of the target condition of the recommendation were significant need factors. In the final logistic regression model, one predisposing variable (intention), one enabling variable (utility), and one need factor (high functional status), and two interaction terms significantly predicted adherence.
CGA recommendations that are seen as worthwhile, not too much trouble, and able to be accomplished are the most likely to be initiated. Older adults with relatively higher functional levels are also more likely to follow through with CGA recommendations even though their needs may be lower. We found the Andersen Behavioral Model useful in the analysis of factors associated with adherence behavior to consultative CGA recommendations.
在综合老年评估（CGA）的咨询模式中，CGA建议未得到实施的情况有充分记录，这似乎是负面结果的一个潜在解释。本研究的目的是确定社区CGA咨询模式项目所提建议的患者依从性决定因素。
受试者（N = 139）接受了自我护理和/或医生发起的CGA建议，并在三个月后接受访谈，以确定对最重要建议的依从性，以及与依从性相关的健康信念、沟通和社会支持因素。将自变量纳入安德森行为模型进行分析。
在双变量层面，一个易患因素（意图）和六个促成因素（低难度水平、高支持、高效用、高自我效能、对建议重要性的认同以及关于建议的良好具体沟通）是依从性的显著决定因素。两项功能健康指标和建议目标状况的严重性是显著的需求因素。在最终的逻辑回归模型中，一个易患变量（意图）、一个促成变量（效用）、一个需求因素（高功能状态）以及两个交互项显著预测了依从性。
被视为有价值、麻烦不大且能够完成的CGA建议最有可能被执行。功能水平相对较高的老年人也更有可能贯彻CGA建议，尽管他们的需求可能较低。我们发现安德森行为模型在分析与咨询性CGA建议依从行为相关的因素方面很有用。
