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目的目前,人们的寿命有所增加,而残疾问题可能会影响到增加寿命年的生活质量。本研究对病例主动发现能否减少老年初级保健患者的残疾率进行评价。方法采用老年用简短健康风险识别工具(BRIGHT)在新西兰的60家初级卫生保健诊所进行随机对照试验。将该60家初级卫生保健诊所分为干预组和对照组,干预组诊所的老年人在生日当天进行BRIGHT问卷调查,将得分≥3分的老年人转至当地老年服务中心进行评估,并提供相应服务;对照组诊所的老年人采用常规照顾。采用诺丁汉日常生活能力量表(NEADL)和WHO生存质量测定量表简表(WHOQOL-BREF),以盲评方式进行生活质量评估,主要结果为居家照顾和住院治疗,次要结果为残疾。结果年龄≥75岁的8 308例社区患者中,有3 893例(47%)参加了试验,其中有3 010例(77%)完成了试验。参加试验患者的平均年龄为(80.3±4.5)岁,女性占55%。干预组的BRIGHT问卷回收率为88%,转诊患者数为546例。36个月后,两组患者选择居家照顾的比例分别为8.4%和6.2%,干预组高于对照组〔HR=1.32,95%CI(1.04,1.68),P=0.02〕;干预组的躯体健康相关生活质量得分降低较少(1.6%比2.9%,P=0.007),心理健康相关生活质量得分降低也较少(1.1%比2.4%,P=0.005);但两组住院率、残疾率及就诊率比较,差异无统计学意义。结论病例主动发现能有效提高残疾老年人识别率,但其对治疗结果的改善作用证据不足,进一步研究应尝试更为有效的初级保健综合策略。
Objectives At present, people’s life expectancy has increased, while disability issues may affect the quality of life that increases life expectancy. This study evaluated whether the initiative to detect cases can reduce the rate of disability in elderly primary health care patients. Methods A randomized controlled trial was conducted in 60 primary health care clinics in New Zealand using geriatric short-term health risk identification tools (BRIGHT). The 60 primary health care clinics were divided into the intervention group and the control group. The elderly in the intervention group conducted a bright questionnaire survey on the birthday, and transferred the elderly people with the score ≥3 points to the local elderly service center for evaluation. Service; control group of elderly clinics using conventional care. The quality of life was assessed blindly using the Nottingham Daily Living Power Scale (NEADL) and the WHO Quality of Life Scale (WHOQOL-BREF). The primary outcomes were home-based care and hospitalization, and the secondary outcome was disability. Of the 8,308 community-based patients ≥75 years of age, 3,893 (47%) participated in the trial, of which 3,010 (77%) completed the trial. The average age of patients participating in the trial was (80.3 ± 4.5) years and women were 55%. The response rate of the questionnaire in the intervention group was 88% and the number of referral patients was 546. After 36 months, the rates of home care in both groups were 8.4% and 6.2%, respectively, and the intervention group was higher than the control group [HR = 1.32, 95% CI (1.04, 1.68), P = 0.02] Health-related quality of life scores decreased less (1.6% vs 2.9%, P = 0.007), and mental health-related quality of life scores decreased less (1.1% vs 2.4%, P = 0.005) And the rate of visits, the difference was not statistically significant. Conclusion The positive findings of cases can effectively improve the recognition rate of the elderly with disabilities, but there is not enough evidence to improve the treatment outcome. Further research should try more effective primary health care comprehensive strategy.