An evaluation of physicians' engagement of children with asthma in treatment-related discussions.
An evaluation of physicians' engagement of children with asthma in treatment-related discussions.
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DOI：
10.1177/1367493513489780
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发表时间：
2014-09
期刊：
影响因子：
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通讯作者：
Sleath B
中科院分区：
文献类型：
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作者：
Carpenter DM;Stover A;Slota C;Ayala GX;Yeatts K;Tudor G;Davis S;Williams D;Sleath B
我们的目标是检查是否供应商从事哮喘儿童在治疗相关的讨论，在儿童喜欢的水平（参与一致性），并确定是否参与一致性与儿童，照顾者和供应商的特点。在北卡罗来纳州的五个儿科诊所招募了296名8-16岁的哮喘儿童。使用医疗访问录音记录，我们记录了提供者询问儿童的治疗相关问题的数量。孩子们报告了他们喜欢的供应商参与程度。Logistic广义估计方程被用来确定哪些变量预测参与一致性。大多数儿童（96.6%）希望参与治疗相关的讨论。三分之一的提供者没有问孩子任何与治疗有关的问题。只有36.1%的提供者-儿童二对是一致的。大多数不和谐的二对是参与不足（83.1%）。在年龄较大的儿童（比值比（OR）= 1.19，95%置信区间（CI）（1.07，1.33））、男性儿童（OR = 1.67，95% CI（1.03，2.70））和从业年限较短的提供者（OR = 0.97，95% CI（0.94，0.99））中观察到更好的参与一致性。提供者与年幼儿童和女性进行治疗相关讨论的频率低于这些儿童的偏好。提供者应询问儿童他们希望参与治疗相关讨论的程度，然后尝试让儿童参与他们喜欢的水平。
Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8–16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider–child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.