Overwhelmed Patients A videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters
Overwhelmed Patients A videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters
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DOI：
10.2337/dc11-1082
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发表时间：
2012-01-01
期刊：
影响因子：
16.2
通讯作者：
Montori, Victor M.
中科院分区：
文献类型：
--
作者：
Bohlen, Krista;Scoville, Elizabeth;Montori, Victor M.
目的-糖尿病患者可能会经历高治疗负担(BOT)，包括与治疗相关的效果和自我护理需求。我们调查了2型糖尿病患者和他们的临床医生是否讨论BOT，他们讨论的特点，以及他们在访问期间试图解决BOT的问题。研究设计和方法：两名编码者独立审查了在基于实践的试验中获得的46次初级保健访问的视频，并识别了与BOT有关的话语，按主题和是否涉及BOT进行分类(即是否出现旨在缓解BOT的声明)。结果-在46次访问中，43次(93.5%)包含BOT讨论。两位编码者确定了83项讨论：12项涉及监测，28项涉及治疗管理，19项涉及获取，24项涉及治疗效果。BOT只有30%的时间被明确地解决了。结论-BOT讨论通常发生在访问期间，但很少产生解决问题的努力。这些讨论错过了减少糖尿病患者生活中与治疗相关的干扰的机会，这些干扰可能会影响患者的依从性和幸福感。
OBJECTIVE-Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits.RESEARCH DESIGN AND METHODS-Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT).RESULTS-Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time.CONCLUSIONS-BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being.