Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys
Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys
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DOI：
10.1093/pubmed/23.3.179
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发表时间：
2001-09-01
期刊：
影响因子：
--
通讯作者：
Fletcher, L
中科院分区：
文献类型：
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作者：
Knight, M;Stewart-Brown, S;Fletcher, L
背景慢性病患病率估计因使用的技术不同而不同。问卷调查可能容易出现不准确，这可以通过增加一份条件清单来克服。本文介绍了在两个问卷调查中，报告个人慢性病或残疾的人的SF-36得分和NHS咨询率，其中一个使用了检查表，另一个没有使用。我们的目的是记录疾病患病率估计的差异，并确定通过清单招募的人与那些在没有清单提示的情况下自愿患有慢性病或残疾的人对生活质量的主观影响是否相同。我们利用这些数据来评估不同慢性病和残疾对社区疾病负担的贡献。方法在1991年和1997年进行的两次邮寄问卷调查中收集数据，回复率分别为72%和。这两份问卷都包括一个关于长期疾病、残疾或虚弱的问题，以及SF-36健康状况测量。1991年调查的受访者被要求在自由文本回复中详细说明他们的疾病，而1997年的调查提供了一份病情清单。计算了每种疾病的患病率，并计算了代表两次调查之间报告的特定疾病增加的“升级系数”。计算SF-36领域和组成部分的总分，以及报告个别慢性病或残疾的组的总分。结果两次调查的慢性病和残障总报告率从1991年的28%上升到1997年的42%。报告的精神健康问题水平和感觉到的心身因素的情况大幅增加，而明确定义的情况的比率相似。在两次调查中，尽管患病率非常不同，但报告慢性病或残疾的人的SF-36得分模式相似，报告慢性病的受访者使用卫生服务的水平相似。这表明，他们报告的情况对生活质量的影响程度相似。心脏病、关节炎和精神健康问题对生活质量的影响最大，哮喘和高血压至少是影响最大的。结论来自SF-36评分和NHS就诊率的证据表明，在这次社区健康调查中增加一份条件清单，鼓励真正患病的人报告疾病，而不仅仅是那些受疾病影响较轻的人。这种方法似乎比从常规数据来源获得的信息更准确地反映了卫生需求。患病率数据与对生活质量的主观评估相结合，为健康需求提供了另一种视角。这种方法突出了肌肉骨骼问题，特别是背部疼痛和心理健康问题相对于疾病负担的相对重要性，以及对哮喘等疾病的相对缺乏重要性。它与基于其他卫生需求评估方法的研究形成了对比。
Background Prevalence estimates of chronic disease vary according to the technique used. Questionnaire surveys may be susceptible to inaccuracies, which may be overcome by addition of a checklist of conditions. This paper presents SF-36 scores and NHS consultation rates for people reporting individual chronic diseases or disabilities in two questionnaire surveys, one of which employed a checklist and one of which did not. We aimed to document differences in estimates of disease prevalence, and to determine whether or not subjective impact on quality of life is the same in people recruited by a checklist as in those who volunteer that they have a chronic disease or disability without the prompt of a checklist. We use these data to estimate the contribution that different chronic diseases and disabilities make to the burden of disease in the community.Methods Data were collected in two postal questionnaire surveys conducted in 1991 and 1997 with response rates of 72 per cent and 64 per cent. Both questionnaires included a question on long-standing illness, disability or infirmity, together with the SF-36 health status measure. Respondents to the 1991 survey were asked to specify their illness in a free text response, whereas the 1997 survey offered a checklist of conditions. Prevalence rates of each condition were calculated, together with an 'escalation factor' representing the increase in reporting of specific diseases between the surveys. SF-36 domain and component summary scores were calculated overall and for the groups reporting individual chronic diseases or disabilities. Disease-specific NHS consultation rates were calculated for both surveys.Results The overall reported rate of chronic disease and disability increased from 28 per cent in 1991 to 42 per cent in 1997. Reported levels of mental health problems and of conditions with a perceived psychosomatic element increased substantially, whereas rates of well-defined conditions were similar. The pattern of SF-36 scores for those reporting chronic disease or disability was similar in the two surveys in spite of very different prevalence rates, and respondents reporting chronic disease had similar levels of health service use. This suggests that they were reporting conditions with similar levels of impact on quality of life. Heart disease, arthritis and mental health problems had the greatest impact on quality of life, and asthma and hypertension the least.Conclusions Evidence from SF-36 scores and NHS consultation rates suggests that addition of a checklist of conditions to this community health survey encouraged reporting of illnesses by the genuinely ill and not merely by those who are less severely affected by their disease. This method appears to give a more accurate reflection of health needs than information derived from routine data sources. The combination of prevalence data combined with subjective assessment of quality of life allows an alternative perspective of health needs. This approach highlights the relative importance of musculo-skeletal problems, particularly back pain, and mental health problems to the burden of disease, and the relative lack of importance of conditions such as asthma. It presents a contrast to studies based on other methods of health needs assessment.