HEALTH CHECKS ON PATIENTS 75 YEARS AND OVER IN NOTTINGHAMSHIRE AFTER THE NEW GP CONTRACT
HEALTH CHECKS ON PATIENTS 75 YEARS AND OVER IN NOTTINGHAMSHIRE AFTER THE NEW GP CONTRACT
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DOI：
10.1136/bmj.305.6854.619
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发表时间：
1992-09-12
影响因子：
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通讯作者：
GROOM, L
中科院分区：
文献类型：
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作者：
BROWN, K;WILLIAMS, EI;GROOM, L
调查1990年全科医生合同要求的75岁及以上病人的年度健康检查。设计-访问实践以收集如何组织和进行评估的信息;在一个抽样月内完成对每名接受评估的患者的问卷，使用实践记录提供的信息。设置-在一个家庭卫生服务机构的20个全科诊所。对象-在20个全科诊所的75岁及以上的患者。结果-三家公司（15%）没有进行检查。13家诊所发函邀请患者接受检查。在这些做法中，有7个对无应答者进行了随访。有两个诊所未经通知就去了病人家里，还有两个诊所只是在机会主义的基础上进行检查。16项实践使用了检查表。16个诊所有实习护士参与;其中8个诊所的医生也进行了检查; 6个诊所的护士没有接受过评估老年人的培训。10家诊所在新合同的第一年评估了超过75%的老人。没有对没有回应评估邀请的患者进行随访的做法完成的检查明显较少。在样本月，331例患者进行了评估，在17个做法。在143例患者中发现了204个新问题。显着更多的问题，每个病人被发现在内城areas. Conclusions的方式进行健康检查有很大的不同，无论是在他们的组织和做法的态度。许多老年人没有回复询问他们是否想要评估的信件，但很少有人拒绝跟进。43%的被评估者有一些未得到满足的需求。如果评估成功，每名患者发现的新问题数量可能会在未来几年内减少。应不断审查年度评估的必要性，并为未发现的需要提供充足的资源。需要改进对实习护士的评估培训。必须监测检查的有效性。如果大多数未满足的需求福尔斯属于特别高风险群体，则修改年度检查以针对这些群体似乎是明智的。
Objective-To investigate annual health checks for patients of 75 years and over required by the 1990 contract for general practitioners.Design-Visits to practices to collect information on how assessments were organised and carried out; completion of questionnaires for every patient who had been assessed in a sample month, using information provided by the practice records.Setting-20 general practices in one family health services authority.Subjects-Patients of 75 years and over in 20 general practices.Results-Three practices (15%) had not performed checks. Thirteen practices sent a letter to invite patients to undergo a check. Of these practices, seven followed up non-responders. Two practices visited patients' homes unannounced, and two did checks on an opportunistic basis only. Sixteen practices used a checklist. Sixteen practices involved their practice nurses; at eight of these, doctors also performed checks; in six practices the nurses undertaking the checks had no training in assessing old people. Ten practices assessed more than 75% of their old people in the first year of the new contract. Practices that did not follow up patients who had not responded to the invitation for assessment completed significantly fewer checks. During the sample month, 331 patients were assessed in the 17 practices. 204 new problems were discovered in 143 patients. Significantly more problems per patient were found in inner city areas.Conclusions-The way health checks were performed varied greatly, both in their organisation and the practices' attitudes. Many old people did not respond to letters asking if they wanted an assessment but very few refused one if followed up. Forty three per cent of those assessed had some unmet need. The number of new problems found per patient may reduce over the next few years if the assessments are successful. The need for annual assessment should be kept under review and adequate resources made available for the needs uncovered. Improved training for practice nurses in assessment is needed. Effectiveness of the checks must be monitored. If most unmet need falls in particular high risk groups it would seem sensible to modify the annual check to target these groups.