Effects of provider practice on functional independence in older adults.
Effects of provider practice on functional independence in older adults.
复制标题
提供者实践对老年人功能独立性的影响。
DOI：
10.1111/j.1532-5415.2004.52350.x
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发表时间：
2004
影响因子：
6.3
通讯作者：
Wagner,EdwardH
中科院分区：
文献类型：
--
作者：
Phelan,ElizabethA;Williams,Barbara;LaCroix,AndreaZ;Grothaus,Lou;LoGerfo,JamesP;Wagner,EdwardH
目的：研究社区老年人日常生活基本活动（ADL）中新发残疾的提供者决定因素。设计：观察性研究。设置：华盛顿州金郡。参与者：随机抽取800名65岁及以上的健康维护组织（HMO）登记者，参与痴呆和正常老化的前瞻性纵向队列研究，他们的56名初级保健提供者形成了研究人群。测量：事件ADL残疾定义为在随访评估时难以进行任何基本ADL的任何新发事件，使用logistic回归和调整病例组合，检查与提供者特征和实践方式的关系，结果：在2年或4年的随访中，无论是护理大量老年患者的提供者经验，还是拥有老年医学附加资格证书的提供者，都与患者ADL残疾无关（经验的调整优势比（AOR）= 1.29，95%可信区间（CI）= 0.81 - 2.05;附加资格的AOR = 0.72，95% CI = 0.38 - 1.39; 4年的结果类似）。在4年的随访中，体现传统老年护理原则的实践方式与ADL残疾的可能性降低无关（未开具高危药物的AOR = 0.56，95% CI = 0.16 - 1.94;管理老年综合征的AOR = 0.94，95% CI = 0.40 - 2.19;结论：照顾大量老年患者，获得老年医学附加资格证书，并以传统的老年医学方向执业，似乎不会影响老年人，社区居住HMO登记者ADL残疾的发展。
Objectives:To examine provider determinants of new‐onset disability in basic activities of daily living (ADLs) in community‐dwelling elderly.Design:Observational study.Setting:King County, Washington.Participants:A random sample of 800 health maintenance organization (HMO) enrollees aged 65 and older participating in a prospective longitudinal cohort study of dementia and normal aging and their 56 primary care providers formed the study population.Measurements:Incident ADL disability, defined as any new onset of difficulty performing any of the basic ADLs at follow‐up assessments, was examined in relation to provider characteristics and practice style using logistic regression and adjusting for case‐mix, patient and provider factors associated with ADL disability, and clustering by provider.Results:Neither provider experience taking care of large numbers of elderly patients nor having a certificate of added qualifications in geriatrics was associated with patient ADL disability at 2 or 4 years of follow‐up (adjusted odds ratio (AOR) for experience=1.29, 95% confidence interval (CI)=0.81–2.05; AOR for added qualifications=0.72, 95% CI=0.38–1.39; results at 4 years analogous). A practice style embodying traditional geriatric principles of care was not associated with a reduced likelihood of ADL disability over 4 years of follow‐up (AOR for prescribing no high‐risk medications=0.56, 95% CI=0.16–1.94; AOR for managing geriatric syndromes=0.94, 95% CI=0.40–2.19; AOR for a team care approach=1.35, 95% CI=0.66–2.75).Conclusion:Taking care of a large number of elderly patients, obtaining a certificate of added qualifications in geriatrics, and practicing with a traditional geriatric orientation do not appear to influence the development of ADL disability in elder, community dwelling HMO enrollees.