THE EFFECT OF DIAGNOSING ALZHEIMERS-DISEASE ON FREQUENCY OF PHYSICIAN VISITS - A CASE-CONTROL STUDY

被引：28

作者：

MCCORMICK, WC

KUKULL, WA

VANBELLE, G

BOWEN, JD

TERI, L

LARSON, EB

机构：

[1] Division of Geriatrics ZA-87, University of Washington, Seattle, 98195, WA

[2] the Department of Epidemiology, University of Washington, Seattle, Washington

[3] Department of Environmental Health, University of Washington, Seattle, Washington

[4] Department of Medicine, University of Washington, Seattle, Washington

[5] Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1995年 / 10卷 / 04期

关键词：

ALZHEIMERS DISEASE; DEMENTIA; HEALTH SERVICES RESEARCH; AMBULATORY CARE;

D O I：

10.1007/BF02600253

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

OBJECTIVE: Two groups of elderly subjects were studied to see whether patterns of visits to physicians changed after one group received the diagnosis of Alzheimer's disease. DESIGN: Case-control study. SETTING: Health maintenance organization (HMO). PATIENTS/PARTICIPANTS: Two groups of ambulatory subjects (mean age 77 years) were enrolled from an HMO population for this case-control study: 120 cases had probable Alzheimer's disease diagnosed at enrollment, and another 120 cognitively intact controls with similar comorbidity were enrolled after being frequency-matched for age and gender. Exclusion criteria were nursing home admission and death during the study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were examined for a four-year period: two years prior to and two years following enrollment and diagnosis. Physician visits declined slightly after enrollment for the persons receiving the diagnosis of Alzheimer's disease [17.5/2 years prior vs 16.5/2 years after (NS)], whereas visits increased over time for the controls [13.7/2 vs 16.3/2 (p < 0.05)], hence the rates were similar after enrollment [16.5 vs 16.3 (NS)]. The proportion of subjects with fewer visits during the period after enrollment was higher among the cases than it eras among the controls [54% vs 37%;odds ratio = 2.0 (95% confidence interval = 1.6, 3.1)]. Hospitalizations and emergency department use did not change significantly after enrollment. CONCLUSIONS: Physician visit frequency was high before, then decreased after, demented patients received their diagnosis, approaching the frequency in a control population without dementia. This phenomenon cannot be accounted for by nursing home placement, comorbidity, or mortality. Increased hospitalization and emergency department use did not ensue after diagnosis.

引用

页码：187 / 193

页数：7

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