Doctors' consultations with children and their parents: a model of competencies, outcomes and confounding influences
Doctors' consultations with children and their parents: a model of competencies, outcomes and confounding influences
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DOI：
10.1111/j.1365-2929.2005.02231.x
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发表时间：
2005-08-01
影响因子：
6
通讯作者：
Davies, H
中科院分区：
文献类型：
--
作者：
Crossley, J;Davies, H
临床会诊是医生角色的一个重要方面。然而，评估其质量的方法特别缺乏，其复杂性使其成为一个相当大的评估挑战。研究问题涉及儿童的咨询的关键组成部分是什么？方法(1)对相关已发表和未发表文献进行内容分析。(2)与经验丰富的儿科医生进行名义上的群体共识练习。结果：内容分析和共识练习表明，医生特征、任务和结果的相似列表是会诊的重要组成部分。医生的特征包括：临床判断、临床知识、体检、信息收集、临床询问、信息提供、以患者为中心、以家长为中心、人际交往能力、会诊管理。重要的任务包括：组织和效率、关系、信息收集、获得家庭观点、检查和程序、评估、医疗适当计划、家庭适当计划、增进理解和回忆、达成共识、分担责任、家庭知道如何获得进一步帮助以及与其他相关保健专业人员联络。重要结果包括：家庭满意度、家庭观念、依从性、健康、健康相关问题和医生满意度。文献中回顾的研究也提供了一个影响医患互动的因素目录，这些因素可能会混淆对医生表现的评估。这些因素包括医生的年龄、性别、培训、专业、收入、社会阶层和政治；患者的年龄、性别、健康状况、预后、社会阶层、教育程度、健康信念以及对控制和风险的偏好。医患相识的时间长短、临床工作量和病例组合也会影响互动。几项研究清楚地表明，医生类型和患者类型的特定组合具有特别好的或坏的相互作用。结论和进一步的工作这些组成部分综合在一个单一的模型的医患互动，以指导发展和评估的评估工具，旨在咨询涉及儿童。
CONTEXT The clinical consultation is an important aspect of the doctor's role. However, there is a particular shortage of methods for assessing its quality, and its complexity makes it a considerable assessment challenge.RESEARCH QUESTION What are the key components of consultations involving children?METHODS (1) A content analysis of relevant published and unpublished literature. (2) A nominal group consensus exercise with experienced paediatricians.RESULTS The content analysis and consensus exercise suggested similar lists of doctor's characteristics, tasks and outcomes as being important components of the consultation. Doctor's characteristics include: clinical judgement, clinical knowledge, physical examination, information gathering, clinical questioning, information giving, patient-centredness, parent-centredness, interpersonal skills, and consultation management. Important tasks include: organisation and efficiency, rapport, information gathering, getting the family perspective, examination and procedures, evaluation, medically appropriate plans, family appropriate plans, enhancing understanding and recall, achieving consensus, sharing responsibility, family knows how to get further help and liaison with other relevant health-care professionals. Important outcomes include: family satisfaction, family perceptions, compliance, health, health-related problems and doctor's satisfaction. The studies reviewed in the literature also provided a catalogue of factors that have been shown to influence the doctor-patient interaction that could potentially confound the assessment of a doctor's performance. These include the doctor's: age, gender, training, speciality, income, social class and politics; the patient's: age, gender, health, prognosis, social class, education, health beliefs and preferences about control and risk. The length of the acquaintance between doctor and patient, and the workload and case-mix in the clinic also affect the interaction. In several studies it is clear that particular combinations of doctor-type and patient-type have especially good or bad interactions.CONCLUSIONS AND FURTHER WORK These components are synthesised in a single model of the doctor-patient interaction to guide the development and evaluation of assessment instruments aimed at consultations involving children.