The effect of diagnosing Alzheimer's disease on frequency of physician visits: a case-control study.
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.


METHODS
Case-control study.


METHODS
Health maintenance organization (HMO).


METHODS
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.


METHODS
None.


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 was 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.
McCormick
W C
WC
Division of Geriatrics, University of Washington, Seattle 98195, USA.
Kukull
W A
WA
van Belle
G
G
Bowen
J D
JD
Teri
L
L
Larson
E B
EB
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis*; D016022:Case-Control Studies; D005260:Female; D006279:Health Maintenance Organizations; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data*; D014861:Washington