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PART
1:
TEN
SCREENING
PROGRAMMES
The
use
of
trained
volunteers
in
a
screening
programme:
an
evaluative
study
Dr
D.
L.
Beales
MRCP,
MRCGP
General
Practitioner,
Cirencester
PHOENIX
House
Surgery
has
a
population
of
7300
patients
within
a
7-mile
radius
of
Cirencester,
of
whom
500
are
over
the
age
of
75.
The
practice
has
five
principals
who
operate
small
personal
lists
complemented
by
clinical
sessions
at
the
Cirencester
Memorial
and
Querns
Hospitals,
which
include
inpatient
responsibility
in
geriatric
medicine.
Up
till
now
the
health
visitor
has
been
fully
occupied
with
her
work
in
child
care
and
has
not
carried
out
any
preventive
work
with
the
elderly.
Aim
We
wished
to
develop
a
preventive
approach
to
the
elderly
within
the
practice
and
in
February
1986
set
up
a
programme
to
evaluate
the
use of
trained
lay
volunteers
to
detect
patients
over
the
age
of
75
at
risk
of
medical
and
social
breakdown.
The
aim
was
to
reduce
the
amount
of
time
spent
by
members
of
the
primary
care
team
in
'social
visiting'.
The
volunteers
The
volunteers
use
the
Winchester
Disability
questionnaire,
which
consists
of
5-point
rating
scales
for
the
following
activities:
walking,
dressing/undressing,
washing,
bathing,
eating,
sleeping,
toileting,
hearing
and
sight
(page
12).
There
are
similar
rating
scales
for
overall
health
anxiety/depression/confusion,
companionship,
support
and
home
conditions.
The
questionnaire
takes
on
average
30
minutes
to
complete.
The
volunteers
receive
a
5-week
training,
which
covers
the
aims
of
the
scheme
and
role
of
the
volunteers,
the
format
of
the
questionnaire
and
its
completion,
a
review
of
local
services
for
the
elderly
and
of
national
benefits
and
entitlements,
and
an
introduction
to
counselling
skills.
Meetings
co-ordinated
by
the
health
visitor
continued
throughout
the
study
period.
The
evaluative
study
In
order
to
assess
the
effects
of
using
volunteers
the
following
study
design
has
been
adopted
(Figure
1).
Patients
aged
75+
have
been
stratified
by
age
and
sex
into
three
groups.
Group
A:
200
controls-non-intervention
by
health
visitor
and
volunteer.
Group
B:
150
patients
visited
by
a
trained
volunteer
who
helps
them
complete
the
questionnaire.
If
problems
are
identified
a
full
assessment
will
be
carried
out
by
the
health
visitor
or
doctor
and
appropriate
action
taken.
It
is
intended
that
the
questionnaire
will
be
repeated
at
3-monthly
intervals,
but
this
may
be
amended
to
a
6-
monthly
review
if
the
scoring
indicates
low
risk.
Group
C:
150
patients
interviewed
by
the
health
visitor
alone
in
her
traditional
health
visiting
role.
The
recommended
policy
for
visiting
the
over
75s
in
the
Cheltenham
and
District
Health
Authority
suggests
that
"there
will
be
an
initial
assessment
made
by
the
health
visitor,
unless
it
is
known
that
the
person
is
already
receiving
regular
surveillance
from
the
general
practitioner
or
district
nurse".
Any
needs
that
are
highlighted
by
this
visit
should
be
dealt
with
appropriately.
It
is
suggested
that
follow-up
visits
should
then
be
made
every
6
months.
Records
of
problems
identified
will
be
kept
and
an
attempt
will
be
made
to
monitor
'the
interaction
of
volunteers
and
other
members
of
the
practice
team.
Services
resulting
from
contact
will
be
recorded
as
will
outcome.
A
longer
account
of
this
project
will
appear
later
this
year
in
the
Practitioner.
PATIENTS
AGED
75
YEARS
AND
OVER
(500)
RANDOM
SELECTION
'A'
GROUP
'B'
GROUP
INTERVETONU(50
NON-INTERVENTION
INTERVENTION
(150)
INTERVENTION
(150)
CONTROL
(200)
VOLUNTEER
VISITING
ROULTIN
VISITING
[
C
v_
~~~~~~~~~~ROUTINE
VISITING
ACTION-GENERAL
PRACTITIONER
-OTHER
INTRODUCTORY
LETTER
FROM
GENERAL
PRACTITIONER
TO
PATIENT
I
VOLUNTEER
HELPS
CLIENT
WITH
COMPLETION
OF
ACTION-GENERAL
PRACTITIONER
QUESTIONNAIRE
-OTHER
j
WITH
AID
OF
VOLUNTEER
ANALYSIS-_
OF
QUESTIONNAIRE
SCORING
BY
HEALTH
VISITOR
SCORE
HIGH
SCORE
SCORE
LOW
-
REPEAT
MEDIUM
QUESTIONNAIRE
1
6
MONTHS
HEALTH
VISITOR
HOME
VISIT
ASSESSMENT
REPEAT
QUESTIONNAIRE
3
MONTHS
REPEAT
QUESTIONNAIRE
I
MONTH
Figure
1.
Phoenix
House
Elderly
Research
Project.
4
Article
To show that the elderly at risk rating scale (EARRS) satisfies the requirements of an assessment tool for routine health checks in people over 75 and would also be suitable as a method of collecting epidemiological data on the needs of the elderly in a locality. Development and validation of a questionnaire based on a modification of the Winchester rating scale, by a series of prospective, comparative studies before the use of the instrument in a community survey. Elderly care day hospital and the community. Elderly patients referred to an elderly care day hospital; population survey of subjects over 75 living at home. Reliability of responses using the kappa statistic; comparison of the scale with the Barthel index of daily living. EARRS has satisfactory validity and reliability when repeated by the same observer or a different observer, with a mean weighted kappa score above 0.80 in both instances. As a measure of disability in the community, it is better than the Barthel score in that it avoids the ceiling effect. The score is correlated with age, social situation, and receipt of support services, and individual questions scale appropriately to adverse outcomes. The EARRS satisfies the requirements of an assessment tool for health checks in the elderly, It is suitable for both population surveys and routine practice in primary care, has proved popular with practice nurses, and is easy to complete.
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