Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations
Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations
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DOI：
10.1136/bmj.323.7318.908
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发表时间：
2001-10-20
影响因子：
--
通讯作者：
Payne, S
中科院分区：
文献类型：
--
作者：
Little, P;Everitt, H;Payne, S
目的测量患者对以患者为中心的认知及其与结果的关系。采用问卷调查法设计观察性研究。设置3种全科实践。865名连续参加实践的患者。主要结果衡量患者的使用性、满意度和症状负担。结果因素分析确定了5个因素。这些因素是沟通和伙伴关系(对患者的担忧和期望感兴趣，并讨论并同意问题和治疗的同情心医生，Cronbach‘sα=0.96)；个人关系(医生了解患者及其情感需求，α=0.89)；健康促进(α=0.87)；积极的方法(明确问题以及何时解决，α=0.84)；以及对患者生活的兴趣(α=0.89)。满意度与沟通和伙伴关系(调整后的Beta=19.1；95%可信区间17.7至20.7)和积极的方法(4.28；2.96至5.60)有关。对生活的影响(0.55；0.25到0.86)、促进健康(0.57；0.30到0.85)和积极的方法(0.82；0.52到1.11)的兴趣更大。积极的治疗方法也与一个月后症状负担的减轻有关(β=-0.25；-0.41至-0.10)。如果患者认为自己与医生有私人关系，转诊次数较少(优势比为0.70；0.54至0.90)。结论患者知觉的组成部分可以可靠地测量并预测不同的结果。如果医生不提供一种积极的、以患者为中心的方法，患者将会更不满意，能力更差，可能会有更大的症状负担和更高的转诊率。
Objective To measure patients' perceptions of patient centredness and the relation of these perceptions to outcomes.Design Observational study using questionnaires.Setting Three general practices.Participants 865 consecutive patients attending the practices.Main outcome measures Patients' enablement, satisfaction, and burden of symptoms.Results Factor analysis identified five components. These were communication and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronbach's alpha = 0.96); personal relationship (a doctor who knows die patient and their emotional needs, alpha = 0.89); health promotion (alpha = 0.87); positive approach (being definite about the problem and when it would settle, alpha = 0.84); and interest in effect on patient's life (alpha = 0.89). Satisfaction was related to communication and partnership (adjusted beta = 19.1; 95% confidence interval 17.7 to 20.7) and a positive approach (4.28; 2.96 to 5.60). Enablement was greater with interest in die effect on life (0.55; 0.25 to 0.86), health promotion (0.57; 0.30 to 0.85), and a positive approach (0.82; 0.52 to 1.11). A positive approach was also associated with reduced symptom burden at one month (beta = -0.25; -0.41 to -0.10). Referrals were fewer if patients felt they had a personal relationship with their doctor (odds ratio 0.70; 0.54 to 0.90).Conclusions Components of patients' perceptions can be measured reliably and predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and higher rates of referral.