OUTCOME-BASED DOCTOR-PATIENT INTERACTION ANALYSIS .2. IDENTIFYING EFFECTIVE PROVIDER AND PATIENT BEHAVIOR
OUTCOME-BASED DOCTOR-PATIENT INTERACTION ANALYSIS .2. IDENTIFYING EFFECTIVE PROVIDER AND PATIENT BEHAVIOR
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DOI：
10.1097/00005650-198206000-00002
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发表时间：
1982-01-01
期刊：
影响因子：
3
通讯作者：
HAIGH, VH
中科院分区：
文献类型：
--
作者：
CARTER, WB;INUI, TS;HAIGH, VH
本研究采用三种互动分析（IA）系统（Bales、Roter改进的Bales和Stiles的“言语反应模式”）对101例普通门诊新就诊患者的医患对话行为要素进行表征。在之前的一篇文章中，我们比较了这些IA系统的解释力。在这篇文章中，特定的提供者和患者的行为在部分的遭遇（介绍历史，体检和结论），这被证明是与知识，依从性和满意度的遭遇结果相关，进行了检查。对相互作用行为的回顾进入回归分析，具有显著的F-to-enter （p≤0.05）和补充的背景分析表明，医生和患者行为的几个类别的重要性。表现紧张的行为与结果之间有着重要而复杂的关系。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，而被解释为紧张释放的患者表达与满意度和依从性均呈正相关。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用药要求，这种行为与随后的患者满意度呈正相关。然而，如果它们出现在结尾部分，则会产生负相关。最后，几个关系综合起来表明，在结论部分的医生教学可能是重要的。虽然应用当前可用的人工智能技术可能会产生有用的观察结果，但所得到的信息最好被描述为假设生成。这些IA系统有许多局限性，需要研究以获得更多临床导向的系统，以允许更一致地证明关键过程-结果关系。
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.