PATIENT PERCEPTION OF INVOLVEMENT IN MEDICAL-CARE - RELATIONSHIP TO ILLNESS ATTITUDES AND OUTCOMES
PATIENT PERCEPTION OF INVOLVEMENT IN MEDICAL-CARE - RELATIONSHIP TO ILLNESS ATTITUDES AND OUTCOMES
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DOI：
10.1007/bf02599549
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发表时间：
1989-11-01
影响因子：
5.7
通讯作者：
CAPUTO, GC
中科院分区：
文献类型：
--
作者：
BRODY, DS;MILLER, SM;CAPUTO, GC
本研究的目的是探讨患者对就诊期间所扮演角色的看法、随后对疾病和治疗的态度以及自评改善之间的关系。患者在就诊前、一天后和一周后以及就诊后的医生完成了问卷调查。背景：该研究是在普通内科教职人员实践中进行的，该实践为大部分 HMO 人群提供成人初级保健（美国宾夕法尼亚州费城）。参与者是有新症状或症状加重的成年患者，他们能够阅读和理解研究问卷。 55 名患者 (47%) 报告发挥了积极作用； 62 名患者 (53%) 报告扮演被动角色。在调整年龄、性别、基线疾病评级和医生评价的预后后，“积极”患者在就诊一周后报告的不适感更少（p = 0.04），症状缓解程度更大（p = 0.008），一般医疗状况改善更多（p = 0.04）。这些差异不受患者希望扮演的角色的影响。活跃的患者还表示，在就诊一天后，他们对自己的疾病的担忧较少（p = 0.04），对疾病的控制感更强（p = 0.04），并且对医生的满意度更高（p = 0.02）。就诊后功能障碍评级与患者的角色认知无关。患者对参与护理的看法似乎与他们对疾病和康复的态度有关。然而，还需要进一步的研究来确定影响这些角色认知的因素，并确定最有可能实现主动角色认知益处的患者类型、疾病和环境。
The purpose of this study was to explore the relationships among patients'' perceptions about the roles they played during medical visits, their subsequent attitudes about their illnesses and treatments, and their self-rated improvement. Questionnaires were completed by patients before, one day after, and one week after their medical visits, and by their physicians following the visits. Setting: The study was conducted in a general internal medicine faculty practice that provided adult primary care to a largely HMO population (Philadelphia, Pennsylvania, USA). The participants were adult patients with new or increased symptoms who were capable of reading and understanding the study questionnaire. Fifty-five patients (47%) reported playing an active role; 62 patients (53%) reported playing a passive role. After adjusting for age, sex, baseline illness ratings, and physician-rated prognosis, "active" patients reported less discomfort (p = 0.04), greater alleviation of symptoms (p = 0.008), and more improvement in their general medical condition (p = 0.04) one week after the visits than did "passive" patients. These differences were not influenced by the roles patients desired to play. Active patients also reported less concern with their illnesses (p = 0.04), a greater sense of control of their illnesses (p = 0.04), and more satisfaction with their physicians (p = 0.02) one day after the visit. Post-visit dysfunction rating were not related to patients'' role perceptions. Patients'' perceptions about their involvement in care appeared to be related to their attitudes about their illnesses as well as to recovery. Further research is needed, however, to determine the factors that influence these role perceptions and to define the types of patients, illnesses, and settings in which the benefits of active-role perceptions are most likely to be realized.