A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow homoeopathic hospital
A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow homoeopathic hospital
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DOI：
10.1089/acm.2005.11.591
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发表时间：
2005-08-01
影响因子：
2.6
通讯作者：
Reilly, D
中科院分区：
文献类型：
--
作者：
Bikker, AP;Mercer, SW;Reilly, D
目的：将前瞻性初次咨询特征（时长、同理心和患者支持）与前往格拉斯哥顺势疗法医院 (GHH) 的患者感知的健康变化联系起来。方法：连续门诊患者在第一次咨询后立即完成咨询和关系同理心 (CARE) 测量和患者支持工具 (PEI)，再次在 3 个月时完成，PEI 也在 12 个月时完成。简短的 Form-12 是在第一次咨询之前填写的，并在第一次咨询期间填写了自我医疗结果 (MYMOP) 档案，并且在 3 个月和 12 个月时重复填写。使用格拉斯哥顺势疗法结果量表 (GHHOS) 评估主诉和幸福感的感知变化。结果：首次咨询时的同理心评分高度预测 3 个月后持续的同理心评分（Spearman's rho，0.572，p < 0.0001）。首次咨询时的同理心得分也与首次咨询时的赋能得分（rho，0.325，p < 0.0001）和 12 个月时的总体赋能得分（rho，0.281；p < 0.05）显着相关。控制后续咨询的次数后，初始同理心评分也可以预测 3 个月时主要主诉和总体幸福感的变化（rho 分别为 0.225 和 0.213；p < 0.05）。首次咨询时的赋能得分还预测了 3 个月（rho，0.255；p < 0.05）和 12 个月（rho，0.282；p < 0.05）时的总体赋能。控制咨询次数后，初始启用预测 3 个月时的 GHOSS 幸福感评分（rho，0.279；p < 0.05）。 3 个月时的同理心和赋能均预测 12 个月时的总体赋能（分别为 rho，0.327；p < 0.01 和 rho，0.577；p < 0.0001）。 3 个月时的同理心与 12 个月时的 GHHOS 得分没有显着相关，而 3 个月时的赋能得分高度预测 12 个月时的 GHHOS 主要抱怨和幸福感得分（rho 分别为 0.459 和 0.507；p < 0.0001）。在任何时间点，同理心和赋能得分与 SF-12 和 MYMOP 得分的变化均没有显着相关。第一次咨询的时间长短与初始和随后的 CARE 评分、整体支持以及 3 个月和 12 个月时的 GHHOS 评分有关。结论：同理心对于支持至关重要，而支持又与主要投诉和幸福感的感知变化密切相关。临床医生在初次咨询时与患者相处的时间似乎是过程和结果之间复杂关系的一个重要因素。
Objective: To relate prospectively initial consultation characteristics-length, empathy, and patient enablement-with perceived health changes in patients going to the Glasgow Homoeopathic Hospital (GHH).Methods: Consecutive outpatients completed the Consultation and Relational Empathy (CARE) measure and the Patient Enablement Instrument (PEI) immediately after their first consultations, again at 3 months, and the PEI also at 12 months. The Short Form-12 was completed immediately before and the Measure Yourself Medical Outcome (MYMOP) Profile during the first consultation, and both were repeated at 3 and 12 months. Perceived changes in main complaint and well-being were assessed using the Glasgow Homoeopathic Outcome Scale (GHHOS).Results: Empathy score at first consultation was highly predictive of ongoing empathy score at 3 months (Spearman's rho, 0.572, p < 0.0001). Empathy scores at first consultation also correlated significantly with enablement score at first consultation (rho, 0.325, p < 0.0001) and overall enablement at 12 months (rho, 0.281; p < 0.05). Controlling for the number of subsequent consultations, initial empathy scores were also predictive of change in main complaint, and general well-being, at 3 months (rho, 0.225, 0.213 respectively; p < 0.05). Enablement score at first consultation also predicted overall enablement at 3 months (rho, 0.255; p < 0.05) and 12 months (rho, 0.282; p < 0.05). Initial enablement predicted GHOSS well-being score at 3 months after controlling for number of consultations (rho, 0.279; p < 0.05). Both empathy and enablement at 3 months predicted overall enablement at 12 months (rho, 0.327; p < 0.01 and rho, 0.577; p < 0.0001, respectively). Empathy at 3 months was not significantly related to GHHOS scores at 12 months, whereas enablement scores at 3 months were highly predictive of both GHHOS main complaint and well-being scores at 12 months (rho, 0.459 and 0.507, respectively; p < 0.0001). Empathy and enablement scores did not correlate significantly with changes in SF-12 and MYMOP scores at any of the time points. The length of the first consultation was related to initial and subsequent CARE scores, overall enablement, and GHHOS scores at 3 and 12 months.Conclusions: Empathy is crucial for enablement, which, in turn, is strongly related to perceived change in main complaint and well-being. The length of time the clinician spends with a patient at initial consultation appears to be an important factor in these complex relationships among process and outcome.