Outcome-Based Doctor-Patient Interaction Analysis: II. Identifying Effective Provider and Patient Behavior
Outcome-Based Doctor-Patient Interaction Analysis: II. Identifying Effective Provider and Patient Behavior
复制标题
基于结果的医患互动分析：II。
作者：
W. B. Carter;T. Inui;W. Kukull;Virginia H. Haigh
三个干扰分析（IA）系统（Bales的，Roter的修改后的Bales和Stiles的“言语反应模式”）被用来描述101个新病人在普通医疗诊所访问的提供者-病人对话的行为元素。在以前的文章中，1这些IA系统的解释力进行了比较。在这篇文章中，特定的供应商和患者的行为段内的遭遇（介绍历史，体检和结论），这被证明是相关的知识，遵守和满意度的遭遇结果，进行了检查。对进入回归分析的干预行为进行审查，具有显著的F-进入（p≤0.05）和补充背景分析，表明几类医生和患者行为的重要性。表现紧张的行为承担着重要而复杂的关系，以遇到结果。例如，患者和医生的紧张表达通常与患者满意度呈强烈的负相关关系，而被解释为紧张释放的患者表达与满意度和依从性呈正相关。其他行为的时机似乎对随后的结果至关重要。如果患者在就诊早期就提出药物要求，这种行为与随后的患者满意度呈正相关。然而，如果它们发生在最后一段，则会产生负相关。最后，几个关系一起表明，医生教学的结论部分可能是重要的。虽然有用的意见可能会出现从目前可用的IA技术的应用，所产生的信息是最好的特点是假设生成。这些IA系统有许多局限性，需要进行研究，以获得更多的临床导向的系统，可能允许更一致的关键过程-结果关系的演示。
Three interactional analysis (IA) systems (Bales’, Roter’s modified Bales and Stiles’ “Verbal response modes”) were used to characterize behavioral elements of provider–patient dialogues of 101 new-patient visits in a general medical clinic. In a previous article,1 the explanatory power of these IA systems was compared. In this article, specific provider and patient behaviors within segments of the encounter (introduction–history, physical examination and conclusion), which were shown to be related to encounter outcomes of knowledge, compliance and satisfaction, were examined. Review of interactional behaviors entering regression analysis with a significant F-to-enter (p≤0.05) and supplementary contextual analyses suggested the importance of several categories of physician and patient behavior. Behaviors manifesting tension bear important and complex relationships to encounter outcomes. For example, patient and physician expressions of tension generally bear strong negative relationships to patient satisfaction, while patient expressions interpreted as tension release are positively related to both satisfaction and compliance. The timing of other behaviors appears to be critical to subsequent outcomes. If patient requests for medication occur early in the encounter, this behavior is positively related to subsequent patient satisfaction. However, if they occur in the concluding segment, a negative relationship results. Finally, several relationships taken together indicate that physician teaching in the concluding segment may be important. While useful observations may emerge from application of currently available IA techniques, the resulting information is best characterized as hypothesis-generating. These IA systems have many limitations, and research is needed to derive more clinically oriented systems that may permit more consistent demonstrations of critical process-outcome relationships.