Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward
Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward
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DOI：
10.1097/00005650-199806000-00013
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发表时间：
1998-06-01
期刊：
影响因子：
3
通讯作者：
Kogan, S
中科院分区：
文献类型：
--
作者：
Leduc, N;Tannenbaum, TN;Kogan, S
目标。制定并测试了体弱多病老年人遵守规定医疗保健服务的模式。测量了综合老年评估和治疗后出院时规定的初级保健、老年科和社区卫生中心（CLSC）服务之间的差异，以及6周间隔内实际使用的服务之间的差异（依从性）。在该模型中，依从性与老年人坚持规定服务的意愿直接相关，但这种关系被组织因素、强化因素和观察期间健康状况的变化所修正。出院前存在的个人因素和强化因素导致坚持意愿。本模型以某急症护理医院老年病病房211名出院至社区的病人为研究对象。通过与患者或护理人员的访谈以及医院、门诊和当地社区卫生中心的图表获得信息。平均而言，患者使用了56.9%的规定服务；13%的患者没有使用为他们规定的任何服务，而22%的患者使用了所有规定的服务。患者对规定服务的益处的看法以及他们对交通便利程度的看法影响了坚持的意愿。意向本身并不是全面遵守的重要决定因素。在组织因素中，让病房工作人员在出院前与患者的家庭医生和老年诊所进行随访预约，并与当地社区卫生中心进行沟通，提高了总体依从性。此外，认为自己有交通工具和陪同人员的患者更有可能遵守。结果表明，当病人出院到社区时，出院医疗保健提供者为他们采取的措施将提高依从性。
OBJECTIVES. A model of compliance by frail elderly with prescribed healthcare services was developed and tested. The discrepancy between primary care, geriatric and community health center (CLSC) services prescribed at discharge after comprehensive geriatric evaluation and treatment was measured, as were those services actually used during a 6-week interval (compliance). In this model, compliance was directly related to elders' intention to adhere to prescribed services, but this relationship was modified by organizational factors, reinforcing factors, and changes in health status during the observation period. Intention to adhere resulted from individual and reinforcing factors existing before discharge.METHODS. This model was tested on 211 patients discharged to community settings from an acute-care hospital geriatrics ward. Information was obtained through interviews with the patients or care givers and from hospital, outpatient, and local community health center charts.RESULTS. On average, patients used 56.9% of services prescribed; 13% of patients did not used any of the services prescribed for them, whereas 22% used all the services prescribed. Intention to adhere was influenced by patients' perception of the benefits of prescribed services and by their perception of the ease of access to transportation. Intention itself was not found to be an important determinant of overall compliance. Among organizational factors, having the ward staff make a follow-up appointment with the patients' family doctor and with the geriatric clinic before discharge and communication with the local community health center increased overall compliance. Moreover, patients who perceived they had access to transportation and to an accompanying person were more likely to comply.CONCLUSIONS. The results suggest that when discharging patients to the community, steps taken for them by the discharging healthcare providers will improve compliance.