年齡與預防保健服務利用之關係－－以美國德州五醫院老年門診病患為例

Age and Utilization of Preventive Health Services among the Elderly in Five Texas Sites

本研究推估美國德州「Put Prevention Into Practice」預防保健公共衛生計畫是否應加老人的預防保健服務量，並探討年齡與接受預防保健服務之關係。以查閱病人病歷為資料來源，為一為期三年的縱貫性研究，於三所家庭醫學科和兩所社區衛生中心的老年病患為研究對象。於第一年至第二年間，肺炎和流行性感冒疫苗和吸菸、運動和營養評估的服務量皆有顯著增加。於第二年和第三年間，破傷風－－白喉混合疫苗的服務量則有顯著增加。所有病患幾乎皆接受定期血壓測量（每兩年至少一次）。此外，在三年間所研究的10項預防保健服務，其中的共有9次(9／30)顯示出老人的年齡與接受的服務量有顯著的負向關係。研究結果顯示老人仍未全面性的接受預防保健服務，雖然老人並未被建議必須例行性的接受部分預防保健服務，這些預防保健服務的提供必須因人而異。而老人被建議接受的預防服務項目，建議醫師應該於門診中例行提供，以促進老年人的身體健康。本研究經驗可供台灣未來推行預防保健服務之參考。

Objectives: This paper explores the relationship between age and the receipt of selected preventive health services (PHS) among the elderly and determines whether the implementation of the 'Put Prevention into Practice' office-based system would increase the delivery rates of PHS among the elderly. Method: The population consisted of a representative sample of elderly aged 65 years and older who had presented at three specific time points at two community health centers and three family practice residency programs in Texas. Results: Overall, significant age-related inverse relationships among the elderly were shown in 9 of the 30 time/PHS pairs examined. The delivery rates of pneumococcal immunization and assessment of tobacco/smoking, physical activity, and nutrition significantly increased from time 1 to time 2 for the elderly. Tetanus-Diphtheria immunization was the only service to significantly increase from time 2 to time 3. Discussion: We found that PHS were not universally delivered to all older adults. For those PHS that are recommended for routine use among older adults, the clinician is required to deliver individualized PHS based on the patient's risk status. Other services, however, should be systematically provided for high-risk patients.