title: The effect of diagnosing Alzheimer's disease on frequency of physician visits: a case-control study.
abstract: 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.
authors.affiliation: Division of Geriatrics, University of Washington, Seattle 98195, USA.
authors.forename: W C
authors.initials: WC
authors.lastname: McCormick
authors.forename: W A
authors.initials: WA
authors.lastname: Kukull
authors.forename: G
authors.initials: G
authors.lastname: van Belle
authors.forename: J D
authors.initials: JD
authors.lastname: Bowen
authors.forename: L
authors.initials: L
authors.lastname: Teri
authors.forename: E B
authors.initials: EB
authors.lastname: Larson
mesh_terms: 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