The 'silver-haired' general medical services patient. Clinical activity of the non-means tested over-70's during their first six months.

摘要

The objective was to examine the impact on general practice clinical activity of the granting of medical cards to all patients over 70 years of age on 01.07.01 under the General Medical Services (GMS) scheme. Retrospective case-control study. Chart review of 50 "new GMS" patients who received medical cards on 01.07.01 compared with 50 "old GMS" patients with means tested medical cards on this date. Single-handed mixed urban/rural general practice in Ireland. 1. Attendance rates. 2. Health status as measured by total number of chronic diseases, prevalence of hypertension, diabetes and cardiovascular disease. 3. Quality of preventive care comprising influenza and pneumococcal vaccine uptake rates; hypertension control; hyperlipidaemia control; level of screening activity for hypertension, diabetes, hyperlipidaemia, prostate specific antigen (among men) and smoking behaviour. Comparisons were made both before and after free GMS care for all between the "old GMS" and "new GMS" patient groups. Behaviour of the "new GMS" group was also compared, both before and after GMS eligibility. Prior to universal eligbility "old GMS" patients attended more often (p=0.0002), had more documented chronic illness (p=0.0002), consumed more medications (p=0.0002), were more likely to be diagnosed hypertensive (p=0.0336) and to have prostate specific antigen (PSA) measurement (men only) (p=0.048) than "new GMS" patients. Within the first 6 months of free GMS care for all, the "new GMS" patients attended significantly more often than before with the percentage of high consulters increasing from 24% to 52% (p=0.0039), took more medications (from 1.72 to 2.2), showed improvement in all quality of care parameters (with the exception of PSA screening which remained static) and had improved attendance for influenza 40% to 62% (p=0.0277) and pneumococcal vaccines 2% to 26% (p=0.00054). More "new GMS" patients were diagnosed as hypertensive (24% to 38%) to a prevalence no longer significantly different from the "old GMS" group. Free general practice care has impacted positively on this "new GMS" patient group of over 70's. Our data suggests that the low consultation rate of this group when fee paying may have resulted in less exposure to practice screening activities. The apparent better health status among this group may in fact be a facade masking undiagnosed chronic disease, notably hypertension.