Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.
Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.
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DOI：
10.3389/fpubh.2016.00190
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发表时间：
2016
影响因子：
5.2
通讯作者：
Casey CM
中科院分区：
文献类型：
--
作者：
Phelan EA;Aerts S;Dowler D;Eckstrom E;Casey CM
对于有跌倒史的老年人，建议采用多因素方法评估和管理可改变的危险因素。有限的研究表明，这种方法在临床实践中并不常见，但大多数相关研究都是基于提供者的自我报告，美国实践的最后一次图表审计发表于十多年前。我们进行了一项回顾性图表回顾，以评估65岁以上有重复跌倒史或与跌倒相关的医疗保健使用史的患者接受多因素风险评估和干预的程度。实验地点是太平洋西北地区的一个学术性初级保健诊所。在符合纳入标准的116例患者中，48%的患者进行了某种形式的书面评估。平均年龄79±8岁；68%是女性，10%是非白人。在指数下降后的12个月里，他们平均去了6次初级保健。评估跌倒危险因素的频率从24%（家庭安全）到78%（维生素D）不等。平均有73%的时间建议对已确定的危险因素采取循证干预。有两个风险因素很少被提及：药物（21%）和家庭安全（24%）。使用结构化就诊记录模板独立预测跌倒风险因素的评估（p = 0.003）。老年病专家比普通内科医生更有可能使用结构化笔记模板（p = 0.04），并进行更多的跌倒风险因素评估（4.6比3.6,p = 0.007）。这些结果提示了在初级保健中改进多因素跌倒风险评估和管理高跌倒风险老年人的机会。结构化的访问记录模板便于评估。鉴于高风险药物已被发现是导致跌倒的独立危险因素，增加对药物的关注应成为公共卫生教育工作和初级保健实践中预防跌倒的重点。
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
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作者：
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DOI：
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