Caught in the act? Prevalence, predictors, and consequences of physician detection of unannounced standardized patients
Caught in the act? Prevalence, predictors, and consequences of physician detection of unannounced standardized patients
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DOI：
10.1111/j.1475-6773.2006.00560.x
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发表时间：
2006-12-01
影响因子：
3.4
通讯作者：
Kravitz, Richard L.
中科院分区：
文献类型：
--
作者：
Franz, Carol E.;Epstein, Ron;Kravitz, Richard L.
目标。在一项关于直接面向消费者的广告对抑郁症治疗的影响的研究中，检查医生发现未经宣布的标准化患者(SP)的患病率、预测因素和后果。在2003年5月至2004年5月期间，18名训练有素的SP被随机分配给美国三个城市的152名初级保健医生进行298次未经宣布的录音访问。研究设计。采用SPS的随机对照试验。SPS描绘了六个角色，通过将两种临床条件(严重抑郁或适应障碍)与三种用药请求脚本(特定品牌请求、一般抗抑郁药请求或不请求)相结合而创建。数据收集。在就诊后的两周内，医生填写了一份表格，询问他们是否在过去两周内“怀疑”与SP进行了一次办公室就诊；296份(99%)检测表被退回。医生提供背景数据，临床医生背景调查问卷。SPS为每次就诊填写一份标准化的患者报告表，并将所有书面处方和药物样本返回实验室。主要发现。根据定义，侦查率从SP访问的5%(明确检测)到23.6%(任何程度的怀疑)不等。在12.8%的就诊中，医生在就诊前或就诊期间准确地检测到了SP，但他们很少相信他们的怀疑影响了他们的临床行为。在控制角色、演员、医生和执业因素的随机效应Logistic回归分析中，可疑就诊在卫生保健组织环境中发生的频率低于单独执业环境(p
Objective. To examine the prevalence, predictors, and consequences of physician detection of unannounced standardized patients (SPs) in a study of the impact of direct-to-consumer advertising on treatment for depression.Data Sources. Eighteen trained SPs were randomly assigned to conduct 298 unannounced audio-recorded visits with 152 primary care physicians in three U.S. cities between May 2003 and May 2004.Study Design. Randomized controlled trial using SPs. SPs portrayed six roles, created by crossing two clinical conditions (major depression or adjustment disorder) with three medication request scripts (brand-specific request, general request for an antidepressant, or no request).Data Collection. Within 2 weeks following the visit, physicians completed a form asking whether they "suspected" conducting an office visit with an SP during the past 2 weeks; 296 (99 percent) detection forms were returned. Physicians provided contextual data, a Clinician Background Questionnaire. SPs filled in a Standardized Patient Reporting Form for each visit and returned all written prescriptions and medication samples to the laboratory.Principal Findings. Depending on the definition, detection rates ranged from 5 percent (unambiguous detection) to 23.6 percent (any degree of suspicion) of SP visits. In 12.8 percent of encounters, physicians accurately detected the SP before or during the visit but they only rarely believed their suspicions affected their clinical behavior. In random effects logistic regression analyses controlling for role, actor, physician, and practice factors, suspected visits occurred less frequently in HMO settings than in solo practice settings (p