Patient-Centered Care: The Influence of Patient and Resident Physician Gender and Gender Concordance in Primary Care
Patient-Centered Care: The Influence of Patient and Resident Physician Gender and Gender Concordance in Primary Care
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DOI：
10.1089/jwh.2011.2903
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发表时间：
2012-03-01
影响因子：
3.5
通讯作者：
Azari, Rahman
中科院分区：
文献类型：
--
作者：
Bertakis, Klea D.;Azari, Rahman
背景：以患者为中心的护理（PCC）被认为对护理过程及其结果有显著影响，并已被确定为改善我国医疗保健服务系统的综合战略的一部分。患者和医生的性别以及性别一致性可能影响PCC的提供。方法：患者（315名女性，194名男性）随机分配到初级保健住院医师（48名女性，57名男性）的护理组。在首次就诊前收集社会人口统计信息、健康风险行为史（吸烟、酗酒和肥胖）以及自我报告的全球疼痛和健康状况。在为期一年的研究期间，对那次访问以及随后患者对初级保健医生（PCP）的访问进行了录像。PCC是通过对所有录像带进行编码来测量的，使用的是一种改良版的戴维斯观察编码。结果：PCC在男性和女性患者中无显著性别差异；然而，女性医生为患者提供了更高的PCC。PCC发生率最高的是女患者-女医师性别二元组。在控制其他患者变量的回归分析中，证实女性和谐二联体与更多的PCC相关。男性患者与男性医生的一致性（vs.不一致性）无显著关系。结论：这些发现突出了性别在PCC护理和提供过程中的影响。女性患者-女性医师的性别一致性表现出更高的PCC。需要在其他临床环境中使用其他PCC测量方法进行进一步研究。提供以病人为中心的医疗服务的公共授权对医学教育有影响。
Background: Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC.Methods: Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men). Sociodemographic information, history of health risk behaviors (tobacco use, alcoholism, and obesity), and self-reported global pain and health status were collected before the first visit. That visit and subsequent patient visits to the primary care physician (PCP) were videotaped during the year-long study period. PCC was measured by coding all videotapes using a modified version of the Davis Observation Code.Results: No significant gender differences in PCC were found between the male and female patients; however, female physicians provided increased PCC to their patients. The greatest amount of PCC was seen in the female patient-female physician gender dyad. Regression analyses, controlling for other patient variables, confirmed that female concordant dyads were associated with a greater amount of PCC. There was no significant relationship for the male patient-male physician concordance (vs. disconcordance).Conclusions: These findings highlight the influence of gender in the process of care and provision of PCC. Gender concordance in female patient-female physician dyads demonstrated significantly more PCC. Further research in other clinical settings using other measures of PCC is needed. A public mandate to provide care that is patient-centered has implications for medical education.