Behavioral Indices in Medical Care Outcome: The Working Alliance, Adherence, and Related Factors
Behavioral Indices in Medical Care Outcome: The Working Alliance, Adherence, and Related Factors
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DOI：
10.1007/s11606-008-0841-4
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发表时间：
2009-01-01
影响因子：
5.7
通讯作者：
Fontanella, Jessie A.
中科院分区：
文献类型：
--
作者：
Fuertes, Jairo N.;Boylan, Laura S.;Fontanella, Jessie A.
工作联盟已被证明是一个一致的预测病人的结果和满意度的心理治疗。本研究探讨了工作联盟和相关行为指标在预测医疗结果中的作用，研究了医患关系的认知和情感维度与患者对医生同理心、医生多元文化能力、治疗效用感知和患者依从性自我效能的关系。这些因素随后作为理论框架的一部分进行了研究，使用路径分析来解释患者自我报告的治疗依从性和满意度。该研究基于事后现场相关设计。来自纽约市一家大型市立医院贝尔维尤医院神经科诊所的152名成人门诊患者参加了研究。对参与者进行了调查。我们使用了以下测量方法：医生-患者工作联盟量表、感知效用量表、治疗依从性自我效能量表、医疗结果研究依从性量表、医生共情问卷、医生多元文化能力问卷、医疗患者满意度问卷。依从性的效应量在0.07和0.21之间，满意度的效应量在0.10和> 0.50之间。回归和路径分析表明，医生的多元文化能力和患者的依从性自我效能信念的评级预测患者的依从性（SB = 0.34）和（SB = 0.30）和满意度（SB = 0.18）和（SB = 0.12），分别。工作联盟评分也预测病人的满意度（SB = 0.49）。心理和人际关系的医疗服务的维度与病人的依从性和满意度。医疗保健提供者可以使用这些维度来定位和改善医疗保健结果。
The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome.Cognitive and emotional dimensions of the physician-patient relationship were examined in relation to patients' ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients' adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment.The study was based on an ex-post facto field correlation design.One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study.Surveys given to participants.We used the following measurements: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire.The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to > 0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49).Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes.