THE EFFECT AMONG OLDER PERSONS OF A GENERAL PREVENTIVE VISIT ON 3 HEALTH BEHAVIORS - SMOKING, EXCESSIVE ALCOHOL-DRINKING, AND SEDENTARY LIFE-STYLE
THE EFFECT AMONG OLDER PERSONS OF A GENERAL PREVENTIVE VISIT ON 3 HEALTH BEHAVIORS - SMOKING, EXCESSIVE ALCOHOL-DRINKING, AND SEDENTARY LIFE-STYLE
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DOI：
10.1006/pmed.1995.1078
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发表时间：
1995-09-01
影响因子：
5.1
通讯作者：
ZEBLY, J
中科院分区：
文献类型：
--
作者：
BURTON, LC;PAGLIA, MJ;ZEBLY, J
背景。1989年开始，美国国会授权进行评估，以确定将医疗保险福利扩大到包括预防服务是否会改善健康状况，降低护理成本，并改善受益人的健康风险行为。约翰霍普金斯医疗保险预防服务示范是一项随机试验，其中医疗保险受益人被分配到干预组，该干预组在两年的时间里每年接受预防性检查，并可选择对其初级保健提供者进行咨询访问，或被分配到接受常规护理的对照组。本报告描述了为期2年的干预对吸烟、问题酒精使用和久坐生活方式的影响。观察到干预组和对照组在吸烟和问题酒精使用方面发生变化的程度上存在差异，但没有任何差异具有统计学意义。干预组吸烟者戒烟比例高于对照组（24.2% vs 17.9%, P = 0.09）。然而，对照组中问题饮酒者的比例较高（67.1 vs 57.0%, P = 0.183）。干预组和对照组在久坐生活方式改善的比例上几乎没有区别。本研究表明，在两年的初级保健医生的年度预防性访问过程中，当访问包括筛查和免疫接种以及由医生指导的健康行为咨询时，很难使老年患者的健康行为发生变化。需要进一步的研究来确定初级保健提供者为老年人健康行为改变提供更密集的咨询方案是否有效。(C) 1995学术出版社，Inc。
Background. The U.S. Congress mandated evaluations, initiated in 1989, to determine whether extending Medicare benefits to include preventive services would improve health status, reduce costs of care, and improve health risk behaviors of beneficiaries.Methods. The Johns Hopkins Medicare Preventive Services Demonstration was a randomized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care. This report describes the effect of the intervention over a period of 2 years on smoking, problem alcohol use, and sedentary lifestyle.Results. Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use, but none of the differences was statistically significant. The proportion of smokers who quit was higher in the intervention group than in the control group (24.2 vs 17.9%, P = 0.09). However, a higher proportion of problem drinkers in the control group improved (67.1 vs 57.0%, P = 0.183). There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle.Conclusions. This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations, as well as health behavior counseling directed by the physician. Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective. (C) 1995 Academic Press, Inc.