Shah P N, Maly R C, Frank J C, Hirsch S H, Reuben D B
Department of Family Medicine, East Carolina University School of Medicine, Greenville, North Carolina, USA.
J Am Geriatr Soc. 1997 Apr;45(4):413-9. doi: 10.1111/j.1532-5415.1997.tb05164.x.
To evaluate the responses of primary care physicians and patients to recommendations from a community-based comprehensive geriatric assessment (CGA) program for management of four target conditions: falls, depression, urinary incontinence, and functional impairment.
Case series.
Senior centers, meal sites, senior housing, and other community sites as screening locations; and a community-bases academic practice as the location for CGA.
A total of 150 older patients living in the community who have one or more of the four target conditions and who received CGA.
Physician implementation and patient adherence rates were ascertained during a face-to-face structured interview with the patient 3 months after CGA.
Two hundred twelve of 528 (40%) CGA recommendations were clearly or possible related to the target or target-related conditions. Of these 212 recommendations, 59% required a physician's order for implementation. The remaining 41% were patient self-care recommendations. Overall physician implementation across conditions was 70%; implementation rates were highest for falls and lowest for functional impairment. Overall patient adherence rate was 85% for physician-implemented recommendations and 46% for self-care recommendations. Patient adherence to recommendations for counseling or support groups and exercise programs was particularly low.
When examining the process of care of community-based CGA, patient as well as physician adherence must be considered. Although patient adherence to physician-initiated recommendations was high for all conditions, it varied substantially across target conditions and types of recommendations for self-care recommendations.
评估基层医疗医生和患者对基于社区的综合老年评估（CGA）项目针对跌倒、抑郁、尿失禁和功能障碍这四种目标病症管理建议的反应。
病例系列研究。
以老年中心、用餐场所、老年住宅及其他社区场所作为筛查地点；以一个基于社区的学术机构作为CGA实施地点。
共有150名居住在社区且患有四种目标病症中一种或多种并接受了CGA的老年患者。
在CGA后3个月与患者进行的面对面结构化访谈中确定医生的实施情况和患者的依从率。
528条CGA建议中有212条（40%）与目标病症或与目标相关的病症明确相关或可能相关。在这212条建议中，59%需要医生下达医嘱才能实施。其余41%是患者自我护理建议。总体而言，各病症的医生实施率为70%；跌倒方面的实施率最高，功能障碍方面最低。医生实施的建议总体患者依从率为85%，自我护理建议的依从率为46%。患者对咨询或支持小组以及锻炼项目建议的依从性特别低。
在审视基于社区的CGA护理过程时，必须考虑患者和医生的依从性。尽管患者对医生提出的所有建议的依从性都很高，但在目标病症和自我护理建议类型方面差异很大。
