Association between Cognitive Decline in Older Adults and Use of Primary Care Physician Services in Pennsylvania.
Association between Cognitive Decline in Older Adults and Use of Primary Care Physician Services in Pennsylvania.
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DOI：
10.1177/2150131911434204
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发表时间：
2012-07-01
影响因子：
3.6
通讯作者：
Saxton JA
中科院分区：
文献类型：
--
作者：
Fowler NR;Morrow LA;Tu LC;Landsittel DP;Snitz BE;Rodriquez EG;Saxton JA
评估老年患者（≥65岁）认知能力下降与24个月以上初级保健医生（PCP）服务利用率之间的关系。回顾性分析从2006年至2010年进行的前瞻性聚类随机试验收集的数据，调查初级保健中正式神经心理学评估与患者预后之间的关系。在宾夕法尼亚州西南部的11个实践中有24个pcp。大多数实践都在郊区，包括5个以上的pcp。样本为423名65岁或以上的初级保健患者。PCP就诊次数与认知状态下降之间的关系，通过控制患者水平、医生水平和执业水平因素（例如，患者年龄、合并症和抑郁症状；执业地点和规模；PCP年龄和性别）的多变量分析确定，并使用具有随机截距的线性混合模型来调整聚类。在两年的随访中，199例患者（47.0%）出现认知状态下降。认知能力下降的患者就诊次数比无认知能力下降的患者平均多0.69次（P<0.05）。认知能力下降的早期迹象可能是更多地利用初级保健的一个指标。鉴于人口趋势，可能需要更多的公共服务提供者，以应付老年人口日益增加的需要。
To assess the relationship between cognitive decline of older patients (≥65 years) and utilization of primary care physician (PCP) services over 24-months. Retrospective analysis of prospectively collected data from a cluster randomized trial that took place from 2006 to 2010 and investigated the relationship between formal neuropsychological evaluation and patient outcomes in primary care. Twenty-four PCPs in 11 practices in southwestern Pennsylvania. Most practices were suburban and included more than 5 PCPs. A sample of 423 primary care patients 65 years or older. The association between the number of PCP visits and a decline in cognitive status, as determined by multivariable analyses that controlled for patient-level, physician-level, and practice-level factors (e.g., patient age, comorbidities, and symptoms of depression; practice location and size; PCP age and sex) and used a linear mixed model with a random intercept to adjust for clustering. Over a two year follow-up, 199 patients (47.0%) experienced a decline in cognitive status. Patients with a cognitive decline had a mean of 0.69 more PCP visits than did patients without a cognitive decline (P<0.05). Early signs of cognitive decline may be an indicator of greater utilization of primary care. Given the demographic trends, more PCPs are likely to be needed to meet the increasing needs of the older population.