Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review.
Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review.
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DOI：
10.1186/1472-6963-8-179
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发表时间：
2008-08-21
影响因子：
2.8
通讯作者：
Bower P
中科院分区：
文献类型：
--
作者：
Cheraghi-Sohi S;Bower P
提高初级保健质量是国际卫生政策的一个重点。当前的质量改进工作主要集中在技术和临床质量方面，但全面的质量改进方法还应包括人际关怀。提出了两种提高初级保健中人际护理质量的方法。一个是将病人对人际护理的评估反馈给医生，另一个是简短的培训和教育计划。因此，本研究回顾了（i）人际护理技能的真实的患者评估反馈，（ii）以改善人际护理为重点的简短培训，（iii）结合（i）和（ii）随机对照试验的系统评价的干预措施的有效性。检索了三个电子数据库（CENTRAL、Medline和Embase），并通过检索检索到的文章的参考书目进行了扩充。研究的质量进行了评估，结果总结在叙述的形式。纳入了9项研究（2项基于患者的反馈研究和7项简短的培训研究）。在两项反馈研究中，一项报告了显著的积极效果。只有一项培训研究报告了显著的积极效果。关于基于患者的反馈的影响的证据有限。有合理的证据表明，目前提供的简短培训是无效的，尽管由于试验数量少以及培训方法和目标的变化，证据并不确定。这些方法缺乏效力可能反映出一些问题，例如，有经验的从业人员和接受培训的从业人员的干预措施效力不同，缺乏将反馈与行为改变联系起来的理论，未能提供充分的培训或使用全面的行为改变技巧。在常规引入这些干预措施以提高患者对初级保健中人际护理的满意度之前，需要进一步研究反馈和简短的培训干预措施。在未来的研究中进行测试的干预措施应考虑使用更广泛的文献中关于初级保健以外的沟通的见解，可能会受益于更清晰的理论基础，并应检查结合简短的培训和反馈的使用。
Improving quality of primary care is a key focus of international health policy. Current quality improvement efforts place a large focus on technical, clinical aspects of quality, but a comprehensive approach to quality improvement should also include interpersonal care. Two methods of improving the quality of interpersonal care in primary care have been proposed. One involves the feedback of patient assessments of interpersonal care to physicians, and the other involves brief training and education programmes. This study therefore reviewed the efficacy of (i) feedback of real patient assessments of interpersonal care skills, (ii) brief training focused on the improvement of interpersonal care (iii) interventions combining both (i) and (ii) Systematic review of randomised controlled trials. Three electronic databases were searched (CENTRAL, Medline and Embase) and augmented by searches of the bibliographies of retrieved articles. The quality of studies was appraised and results summarised in narrative form. Nine studies were included (two patient based feedback studies and seven brief training studies). Of the two feedback studies, one reported a significant positive effect. Only one training study reported a significant positive effect. There is limited evidence concerning the effects of patient based feedback. There is reasonable evidence that brief training as currently delivered is not effective, although the evidence is not definitive, due to the small number of trials and the variation in the training methods and goals. The lack of effectiveness of these methods may reflect a number of issues, such as differences in the effectiveness of the interventions in experienced practitioners and those in training, the lack of theory linking feedback to behaviour change, failure to provide sufficient training or to use a comprehensive range of behaviour change techniques. Further research into both feedback and brief training interventions is required before these interventions are routinely introduced to improve patient satisfaction with interpersonal care in primary care. The interventions to be tested in future research should consider using insights from the wider literature on communication outside primary care, might benefit from a clearer theoretical basis, and should examine the use of combined brief training and feedback.
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影响因子：
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通讯作者：
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