Opportunistic approaches for delivering preventive care in illness visits.
Opportunistic approaches for delivering preventive care in illness visits.
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在疾病就诊中提供预防性护理的机会主义方法。
DOI：
10.1016/j.ypmed.2003.11.013
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发表时间：
2004
影响因子：
5.1
通讯作者：
Crabtree,Benjamin
中科院分区：
文献类型：
--
作者：
Cohen,Deborah;DiCicco-Bloom,Barbara;Strickland,PamelaOhman;Headley,Adrienne;Orzano,John;Levine,Jeffery;Scott,John;Crabtree,Benjamin
目的描述临床医生如何在疾病访问中创造提供预防性护理的机会，并评估这对预防性服务提供的影响。方法从18个有目的地选择的家庭诊所收集详细和描述性的现场记录，包括对53名初级保健临床医生和1620名患者的直接观察。谈话分析用于检查在疾病访问中提供四种预防服务（吸烟咨询、免疫接种、乳房x光检查和宫颈癌筛查）所采用的谈话技巧。对定性数据进行编码和分析，以评估对预防性服务提供率的影响。结果观察到两种机会性预防服务提供方式。首先，临床医生利用医疗接触的结束来安排后续的预防性护理。在第二种方法中，临床医生使用渐进式对话设备，结束对患者呈现问题的讨论，并进入相关的健康习惯建议。定量分析表明，机会主义方法很少用于在疾病访问中提供预防服务。逐步法是最常用的方法。在就诊时使用机会性技术提供预防性护理的临床医生所治疗的患者比不使用机会性方法的临床医生所治疗的患者更有可能了解最新的吸烟咨询和宫颈癌筛查。结论门诊机会性预防服务是一种高效、有效的预防服务方式。虽然不经常使用，但定量数据表明，在疾病访问期间使用机会主义方法提供预防服务可以提高预防保健率。干预措施旨在帮助临床医生制定有效的策略，在疾病访问期间提供预防性护理，这可能是对现有机械干预措施的重要补充，这些干预措施本身可能不足以改善预防性护理。
ObjectiveTo describe how clinicians create opportunities to deliver preventive care in illness visits and assess the impact this has on preventive service delivery.MethodDetailed and descriptive fieldnotes were collected from 18 purposefully selected family practices, including direct observations of 53 primary care clinicians and 1620 patient encounters. Conversation analysis was used to examine the conversational techniques employed to deliver four preventive services (smoking counseling, immunization delivery, mammography, and cervical cancer screening) in illness visits. Qualitative data was coded and analyzed to assess impact on preventive service delivery rates.ResultsTwo methods for opportunistic preventive service delivery were observed. In the first, clinicians used the close of the medical encounter to make arrangement for follow-up preventive care. In the second approach, clinicians use a stepwise conversational device to exit talk about the patient's presenting problem and enter into relevant health habit advice. Quantitative analyses show that opportunistic methods are rarely used to deliver preventive services in illness visits. The stepwise technique was the most frequently used method. Patients treated by clinicians who used opportunistic techniques to deliver preventive care in illness visits were more likely to be up-to-date on smoking counseling and cervical cancer screening than those patients who were treated by clinicians who did not use opportunistic approaches.ConclusionsOpportunistic preventive service delivery in illness visits can be an efficient and effective way to deliver preventive care. Although infrequently used, quantitative data suggest that the use of opportunistic approaches to deliver preventive services during illness visits can enhance preventive care rates. Interventions aimed at helping clinicians develop effective strategies for offering preventive care during illness visits may be an important complement to existing mechanical interventions that might, by themselves, be insufficient to improve preventive care.
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DOI：
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影响因子：
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DOI：
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