Woolf S H, Rothemich S F, Johnson R E, Marsland D W
Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Fairfax 22033, USA.
J Fam Pract. 1998 Oct;47(4):312-5.
Research on health care quality and effectiveness often relies on global health status measures, such as functional status, but little is known about the functional status of patients in the primary care setting (without limitation to specific diseases) and even less about the function of the poor or ethnic minorities. In preparation for a planned practice-based research network, we administered a functional-status survey to patients visiting an inner-city family practice center.
Over 9 weeks, 555 established patients older than 18 years, as well as adolescents accompanied by a parent or guardian, completed a survey that included the SF-36 Health Survey and questions about demographic variables and cigarette use. The survey was self-administered in the waiting area and examination room, and patients received no assistance from staff.
Functional-status scores reported by this primary care cohort were significantly lower than those of the general population (P < .001) and comparable with those reported nationally for patients with chronic diseases (e.g., congestive heart failure, diabetes). Functional-status scores were associated with age, sex, and, most strikingly, socioeconomic status. For example, patients with a yearly income of less than $15,000 had lower mean physical function scores than those reported nationally for patients with hypertension, diabetes, depression, recent myocardial infarction, or hypertension (P < .05). Patients who currently smoked reported lower physical function (P = .004) and strikingly lower mental function (P < .001) than nonsmokers.
Although patients completing the survey included healthy persons seeking preventive care and sick patients with acute and chronic illnesses, their overall functional status resembled that reported nationally for patients with chronic disease, perhaps reflecting the influence of poverty. Few studies have reported the association we observed between smoking and lower functional status. Further longitudinal studies in the primary care setting are necessary to fully interpret these associations and to evaluate the true impact of interventions on outcomes.
医疗保健质量与效果的研究常常依赖于全球健康状况指标，比如功能状态，但对于基层医疗环境（不限于特定疾病）中患者的功能状态知之甚少，对于贫困患者或少数族裔患者的功能状况了解更少。为筹备一个计划中的基于实践的研究网络，我们对一家市中心家庭医疗中心的就诊患者进行了功能状态调查。
在9周时间里，555名18岁以上的长期患者以及由父母或监护人陪同的青少年完成了一项调查，该调查包括SF - 36健康调查以及关于人口统计学变量和吸烟情况的问题。调查在候诊区和检查室由患者自行完成，工作人员未提供任何协助。
这个基层医疗队列报告的功能状态得分显著低于普通人群（P <.001），与全国报告的慢性病患者（如充血性心力衰竭、糖尿病患者）的得分相当。功能状态得分与年龄、性别相关，最显著的是与社会经济地位相关。例如，年收入低于15,000美元的患者的平均身体功能得分低于全国报告的高血压、糖尿病、抑郁症、近期心肌梗死或高血压患者（P <.０５）。目前吸烟的患者报告的身体功能得分较低（P =.００４），且心理功能得分显著低于不吸烟者（P <.００１）。
尽管完成调查的患者包括寻求预防保健的健康人以及患有急慢性疾病的患者，但他们的总体功能状态与全国报告的慢性病患者的功能状态相似，这可能反映了贫困的影响。很少有研究报告我们所观察到的吸烟与较低功能状态之间的关联。有必要在基层医疗环境中进行进一步的纵向研究，以充分解释这些关联，并评估干预措施对结果的真正影响。
