Do older patients and their family caregivers agree about the quality of chronic illness care?
Do older patients and their family caregivers agree about the quality of chronic illness care?
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老年患者及其家庭护理人员是否同意慢性病护理的质量？
DOI：
10.1093/intqhc/mzt052
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Boyd,CynthiaM
中科院分区：
文献类型：
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作者：
Giovannetti,ErinR;Reider,Lisa;Wolff,JenniferL;Frick,KevinD;Boult,Chad;Steinwachs,Don;Boyd,CynthiaM
家庭照顾者经常陪同患者就医;然而，目前还不清楚照顾者对患者护理质量的评价是否与患者相似。本研究旨在（1）量化患者和护理人员报告的患者护理质量之间的一致性水平，（2）确定护理人员和患者特征之间的一致性水平如何变化。设计横断面分析。（65岁及以上）成人及其家庭照顾者（n= 247）方法采用慢性病护理患者评估量表（PACIC），由患者及其护理人员分别对护理质量进行评定。协议的水平进行了检查，使用加权kappa统计（Kw）。结果协议的照顾者和患者的PACIC评分低（Kw= 0.15）。与每天服用5种或更少药物的患者相比，每天服用10种或更多药物的患者与其护理人员对护理质量的一致性更低（Kw分别为0.03和0.34，P< 0.05）。与报告没有困难的照顾者相比，报告协助患者完成医疗保健任务困难较大的照顾者与患者对所提供的护理质量的一致性较低（Kw分别为-0.05和0.31，P<0.05）。患者-照顾者二人组在客观问题上的一致性高于主观问题（Kw分别为0.25和0.15，P> 0.05）。结论患者-照顾者二人组在更复杂的治疗计划（即服用许多药物）或更难以遵循治疗计划（即难以完成医疗保健任务）后的一致性较低。未来的定性研究需要阐明的根本原因，病人和照顾者率不同的护理质量。
ObjectiveFamily caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics.DesignCross-sectional analysis.ParticipantsMultimorbid older (aged 65 and above) adults and their family caregivers (n= 247).MethodsQuality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw).ResultsAgreement of caregivers' and patients' PACIC scores was low (Kw= 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw= 0.03 and 0.34, respectively,P< 0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw= −0.05 and 0.31, respectively,P< .05). Patient–caregiver dyads had greater agreement on objective questions than on subjective questions (Kw= 0.25 and 0.15, respectively,P> 0.05).ConclusionPatient–caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.