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Biomedical subjects

W I Hay

Publications and source records attributed to W I Hay.

5 recordsLinked to original sources
PubMed1998

Prospective care of elderly patients in family practice. Is screening effective?

OBJECTIVE: To evaluate cost and benefits of screening for and treating health and lifestyle risks among community-dwelling elderly. DESIGN: Randomized controlled trial. SETTING: Primary care. PARTICIPANTS: An opportunistic and prompted sample of 619 rostered elderly patients presenting for treatment who screened positive. INTERVENTIONS: One third (209) of experimental subjects had screening questionnaires placed in their charts with concerns highlighted for referrals. Two control groups received usual care. MAIN OUTCOME MEASURES: Yearly assessments of health service use and multidimensional functional capacity. RESULTS: Overall, screening and treatment of functionally active, elderly, middle-class people had no significant beneficial effect. Almost half of the experimental sample was ineligible because of treatment noncompliance. Generally ineligible subjects were older and more severely impaired. Subjects 75 years and older with risk factors showed improvement in daily living activities, and those living alone were found to have improved mental health and social functions (11% and 22%, respectively). CONCLUSIONS: Screening and treatment was ineffective in improving total functional capacity of all seniors 65 years and older. Elderly people 75 years and older, however, who were living alone or lonely did benefit from screening and treatment showing an improvement in daily activities, mental health scores, and social functions. This finding has implications for selective preventive health care spending for the elderly. A 2-year follow-up period could be too brief to detect long-term effects of early intervention with younger, middle-class seniors, especially those who are already functionally active.

Activities of Daily Living↗
PubMed1995

Prospective care of elderly patients in family practice. Part 3: Prevalence of unrecognized treatable health concerns.

OBJECTIVE: To determine the prevalence of recognized and unrecognized health concerns and risks in an elderly population. DESIGN: Questionnaire survey. SETTING: Institutional primary care practice in a small southern Ontario city. PATIENTS: Volunteer sample of all patients older than 65 years (N = 1385) who were registered with the practice; were not demented, unstable, or residing in institutions at the time of contact; consented to participate; and completed a questionnaire (n = 674). MAIN OUTCOME MEASURES: Self-reported health concerns and health risks, including compliance with periodic health examinations; patient-generated concerns; and medical, lifestyle, and psychosocial issues. RESULTS: Most (92%) patients had at least one health concern or risk; 83% of these had one or more unreported or unrecognized health concerns or risks. The proportion with at least one concern or risk did not differ by sex or by age group. Many but not all complied with periodic health examinations. Loneliness was a meaningful psychosocial problem. Many patients had unreported medical concerns; the proportion rose slightly with age. Seniors with more concerns visited more frequently. CONCLUSIONS: Although most seniors had health concerns or risks, on average, each patient had only one or two concerns. These concerns are not concentrated in any particular area. Although non-attenders have fewer concerns, many have risk factors for diseases likely to progress without preventive measures, such as influenza vaccine and screening procedures for hypertension and breast, cervical, and prostate cancer.

Aged↗
PubMedDate not supplied

1965-1990: 25th anniversary of nurse practitioners. A classic manuscript reprinted in celebration of 25 years of progress. The Burlington randomized trial of the nurse practitioner. 1971-2.

From July 1971, to July 1972, in a large suburban Ontario practice of two family physicians, a randomized controlled trial was conducted to assess the effects of substituting nurse practitioners for physicians in primary-care practice. Before and after the trial, the health status of patients who received conventional care from family physicians was compared with the status of those who received care mainly from nurse practitioners. Both groups of patients had a similar mortality experience, and no differences were found in in physical functional capacity, social function or emotional function. The quality of care rendered to the two groups seemed similar, as assessed by a quantitative "indicator-condition" approach. Satisfaction was high among both patients and professional personnel. Although cost effective from society's point of view, the new method of primary care was not financially profitable to doctors because of current restrictions on reimbursement for the nurse-practitioner services.

Consumer Behavior↗