General practitioners' knowledge of their patients' psychosocial problems: Multipractice questionnaire survey
General practitioners' knowledge of their patients' psychosocial problems: Multipractice questionnaire survey
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DOI：
10.1136/bmj.314.7086.1014
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发表时间：
1997-04-05
影响因子：
--
通讯作者：
Fugelli, P
中科院分区：
文献类型：
--
作者：
Gulbrandsen, P;Hjortdahl, P;Fugelli, P
目的：评估全科医生对患者的一系列心理社会问题的认识，并探索医生对心理社会问题的认知是否依赖于先前对患者或问题类型的一般知识，或取决于医生或患者的某些特征。设计：对连续咨询全科医生的成年患者进行多实践调查。地点：挪威巴斯克鲁德县。研究对象：1995年3月，1401名成年人在一个正常工作日内看89名全科医生。主要观察指标：医生对患者中9个预先定义的心理社会问题的了解；这些问题在就诊当天由患者评估为影响他们的健康；医生对每个问题的认识的优势比，根据患者、医生和实践的特点进行调整；结果：医生对这些问题的知晓率从53%(108/203)的患者存在压力大的工作环境到19%(12/63)的患者存在暴力或威胁史。对病人的充分了解增加了医生识别“悲伤”、“暴力或威胁”、“在亲密的朋友或亲戚中滥用药物”以及“与亲密的朋友或亲戚之间的艰难冲突”的几率。医患双方的年龄、性别、患者的文化程度和生活状况、行医地点等因素影响医生的知晓率。结论：患者沟通能力的差异、暴露亲密问题前对医患关系的信心需求以及医生被期望所困的倾向可能解释了这些发现。
Objectives: To evaluate general practitioners' knowledge of a range of psychosocial problems among their patients and to explore whether doctors' recognition of psychosocial problems depends on previous general knowledge about the patient or the type of problem or on certain characteristics of the doctor or the patient.Design: Multipractice survey of consecutive adult patients consulting general practitioners. Doctors and patients answered written questions.Setting: Buskerud county, Norway.Subjects: 1401 adults attending 89 general practitioners during one regular working day in March 1995.Main outcome measures: Doctors' knowledge of nine predefined psychosocial problems in patients; these problems were assessed by the patients as affecting their health on the day of consultation; odds ratios for the doctor's recognition of each problem, adjusted for characteristics of patients, doctors, and practices; and the doctor's assessment of previous general knowledge about the patient.Results: Doctors' knowledge of the problems ranged from 53% (108/203) of ''stressful working conditions' to 19% (12/63) of a history of ''violence or threats.'' Good previous knowledge of the patient increased the odds for the doctor's recognition of ''sorrow,'' ''violence or threats,'' ''substance misuse in close friend or relative,'' and ''difficult conflict with close friend or relative.'' Age and sex of doctor and patient, patient's educational level and living situation, and location of practice influenced the doctor's awareness.Conclusions: Variation in the patients' communication abilities, the need for confidence in the doctor-patient relationship before revealing intimate problems, and a tendency for the doctors to be entrapped by their expectations may explain these findings.