Implementation of consultative geriatric recommendations: The role of patient-primary care physician concordance
Implementation of consultative geriatric recommendations: The role of patient-primary care physician concordance
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DOI：
10.1046/j.1532-5415.2002.50358.x
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发表时间：
2002-08-01
影响因子：
6.3
通讯作者：
Reuben, DB
中科院分区：
文献类型：
--
作者：
Maly, RC;Leake, B;Reuben, DB
目的：为探讨初级保健医生的执行和病人的依从行为的影响，病人-医生一致的建议老年卫生保健。设计：病例系列，病人和他们的医生的独立访谈，他们对病人的健康和综合老年评估（CGA）的看法。设置：社区。参与者：社区居住的老年患者（n = 111）谁接受咨询门诊CGA和他们的初级保健physics.MEASUREMENTS：一致性变量使用医生和患者的反应，10个问题的健康和CGA相关的看法。通过对患者和医生同意的项目总数进行求和，得出总体一致性评分。两个因变量的测量（医生执行和患者遵守CGA的建议）是通过自我报告。在多元逻辑回归分析中，患者和医生之间的总体一致性被证明是医生实施（调整后的比值比（OR）= 2.7，95%置信区间（CI）= 1.6-4.6，P <0.001）和患者依从性（OR = 2.7，95%CI = 1.7-4.2，P <0.001）CGA建议，控制患者和医生的性别和年龄，患者的功能状态，医患关系的持续时间，上一年的访问频率。进一步的分析表明，相互病人-医生一致性的健康相关的看法是一个显着的预测这些结果，而个别病人或医生的看法是不是.CONCLUSION：老年患者和他们的初级保健医生之间的一致性是一个强大的预测医生的执行和病人坚持门诊咨询CGA的建议。未来的研究应该集中在如何医生可以评估和谈判的病人-医生协议的老年保健建议。
OBJECTIVES: To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient-physician concordance about recommended geriatric health care.DESIGN: Case-series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA).SETTING: Community.PARTICIPANTS: Community-dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians.MEASUREMENTS: Concordance variables were generated using physician and patient responses to 10 questions on health- and CGA-related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self-report.RESULTS: In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6, P < .001) and patient adherence to (OR = 2.7, 95% CI = 1.7-4.2, P < .001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient-physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient-physician concordance on health-related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not.CONCLUSION: Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient-physician agreement on geriatric healthcare recommendations.