Factors affecting physicians' responses to patients' requests for antidepressants: focus group study.
Factors affecting physicians' responses to patients' requests for antidepressants: focus group study.
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影响医生对患者抗抑郁药请求反应的因素：焦点小组研究。
DOI：
10.1007/s11606-007-0441-8
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发表时间：
2008
影响因子：
5.7
通讯作者：
Epstein,RonaldM
中科院分区：
文献类型：
--
作者：
Tentler,Aleksey;Silberman,Jordan;Paterniti,DeboraA;Kravitz,RichardL;Epstein,RonaldM
目的描述医生对标准化患者（SP）抗抑郁药需求的情感和认知反应，以及影响处方行为的态度和背景因素。所有参加了以前的RCT的影响，病人的要求对医生的prescribing.MeasurementsIterative审查的采访成绩单，涉及定性编码和专题analysis.ResultsPhysicians参与焦点小组往往不知道，并否认他们的思想是有偏见的程度，由病人的要求，但能够认识到这种偏见后，促进反思。常见的情感反应包括烦恼和同情。常见的认知反应导致进一步的诊断询问或默许病人的要求，以节省时间或建立病人与临床医生的关系。患者的药物要求促使参与者在过度治疗方面犯错误，而不是仔细审查临床适应症。缺乏时间和参与者的态度，对病人和药品广告的作用，也影响了他们的反应，促使他们解释病人的要求作为诊断线索或机会的efficiency.ConclusionsThis研究提供了一个分类的情感和认知反应，病人的药物和潜在的态度和上下文因素的要求影响他们。在临床推理过程中，提高即时自我意识的能力可能会增加处方的适当性。
BackgroundThe ways in which patients’ requests for antidepressants affect physicians’ prescribing behavior are poorly understood.ObjectiveTo describe physicians’ affective and cognitive responses to standardized patients’ (SPs) requests for antidepressants, as well as the attitudinal and contextual factors influencing prescribing behavior.DesignFocus group interviews and brief demographic questionnaires.ParticipantsTwenty-two primary care physicians in 6 focus groups; all had participated in a prior RCT of the influence of patients’ requests on physicians’ prescribing.MeasurementsIterative review of interview transcripts, involving qualitative coding and thematic analysis.ResultsPhysicians participating in the focus groups were frequently unaware of and denied the degree to which their thinking was biased by patient requests, but were able to recognize such biases after facilitated reflection. Common affective responses included annoyance and empathy. Common cognitive reactions resulted in further diagnostic inquiry or in acquiescing to the patient’s demands to save time or build the patient–clinician relationship. Patients’ requests for medication prompted the participants to err on the side of overtreating versus careful review of clinical indications. Lack of time and participants’ attitudes—toward the role of the patient and the pharmaceutical ads—also influenced their responses, prompting them to interpret patient requests as diagnostic clues or opportunities for efficiency.ConclusionsThis study provides a taxonomy of affective and cognitive responses to patients’ requests for medications and the underlying attitudes and contextual factors influencing them. Improved capacity for moment-to-moment self-awareness during clinical reasoning processes may increase the appropriateness of prescribing.