Brown K, Boot D, Groom L, Williams E
Department of General Practice, University of Nottingham.
Br J Gen Pract. 1997 Jan;47(414):31-5.
Research into the health of elderly people has found problems unknown to their general practitioners. It was anticipated that annual checks, as required by the 1990 general practitioner contract, would help to detect these problems, yet the value of these checks has been questioned.
To investigate the problems found by general practice contractual annual checks of the over-75s and the consequent actions taken; to identify patient, demographic or practice characteristics associated with the discovery of problems.
In 40 practices, information was collected on patients over 75 years of age receiving a health check during a 3-month period. Practices used their normal methods of recruitment and assessment. Practice staff were interviewed to find how assessments were organized.
Practices saw a mean of 12% of their over-75s during the study; 44% were found to have at least one problem. Action was taken to help resolve problems in 82% of patients with a problem. The most prevalent problems related to physical condition, and fewer functional problems than expected were found. There were large differences between practices in the proportions of elderly patients seen for a check and the proportion found to have problems; these were not attributable to practice size or demography. Multivariate analysis showed that practice or patient characteristics were poor predictors of finding problems.
The argument in favour of conducting annual checks is supported by the finding that nearly half the patients assessed were found to have problems for which some action was taken. Some practices could increase their rate of uptake by modifying the organization of invitations for checks. More problems may be found by adopting a more functionally based assessment.
对老年人健康状况的研究发现了一些其全科医生未知的问题。预计1990年全科医生合同所要求的年度检查将有助于发现这些问题，但这些检查的价值受到了质疑。
调查全科医生对75岁以上老人进行合同规定的年度检查所发现的问题以及随后采取的行动；确定与发现问题相关的患者、人口统计学或诊所特征。
在40家诊所中，收集了在3个月期间接受健康检查的75岁以上患者的信息。诊所采用其常规的招募和评估方法。对诊所工作人员进行访谈，以了解评估是如何组织的。
在研究期间，诊所平均检查了其75岁以上患者的12%；发现44%的患者至少有一个问题。在有问题的患者中，82%采取了行动来帮助解决问题。最普遍的问题与身体状况有关，发现的功能问题比预期的少。不同诊所之间，接受检查的老年患者比例和发现有问题的患者比例存在很大差异；这些差异不能归因于诊所规模或人口统计学因素。多变量分析表明，诊所或患者特征对发现问题的预测能力较差。
支持进行年度检查的观点得到了以下发现的支持，即近一半接受评估的患者被发现有问题并采取了一些行动。一些诊所可以通过调整检查邀请的组织方式来提高参与率。采用更基于功能的评估可能会发现更多问题。
