COMPLIANCE WITH MEDICAL REGIMENS: A PANEL STUDY.
COMPLIANCE WITH MEDICAL REGIMENS: A PANEL STUDY.
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遵守医疗方案：小组研究。
DOI：
10.2307/2948830
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发表时间：
1963
期刊：
影响因子：
--
通讯作者：
R. Eichhorn
中科院分区：
文献类型：
--
作者：
M. S. Davis;R. Eichhorn
在过去的十年里，社会科学家和医生对医患关系的差异如何导致患者依从性的变化这一问题表现出越来越大的兴趣。正如越来越多的文献所证明的那样，相关的理论表述并不缺乏；然而，提供数据支持现有分析的实证研究相对较少。此外，很少注意确定其他影响因素，这些因素连同医患之间的相互作用，可能在决定患者是否遵循医生的指示方面发挥作用。事实上，医患关系有时被认为是在真空中运作的，其中*节选和修改自弥尔顿·s·戴维斯的一份更大的报告，题为“影响医生为心脏病患者制定的医疗方案的感知依从性的因素”，未发表的博士论文，普渡大学，1962年。本报告中使用的数据是作为普渡农场心脏项目的一部分收集的，该项目由普渡大学、印第安纳心脏协会、美国心脏协会、印第安纳州卫生委员会和国家心脏研究所共同主办。对该项目更完整的描述载于1958年9月《普渡农场心脏研讨会论文集》，W. H. M. Morris，编辑，普渡大学农业实验站，印第安纳州拉斐特。作者感谢G. J.卡拉斯、W. H. M.莫里斯、D. C.里德尔和L.特尔金在收集、分析或呈现这些数据方面的协助。康奈尔大学医学院：普渡大学社会学系早在1935年，l·j·亨德森就呼吁把医患关系作为一种社会系统来关注。（“作为社会系统的医生和病人”，新英格兰医学杂志，212,1935，第819-825页）。最近，帕森斯在他关于医学社会学的各种文章中描述了病人（《社会系统》，伊利诺伊州格伦科：自由出版社，1951年）、医生（《疾病和医生的角色》，《美国骨科精神病学杂志》，1951年21日，425-460页）和家庭在疾病中扮演的角色（塔尔科特·帕森斯和蕾妮·福克斯，《疾病、治疗和现代城市家庭》，《社会问题杂志》，1952年8日，31-44页）。贝尔斯指出，社会结构因素导致社会关系的变化，使某种冷漠、客观和情感中立成为特定角色（包括医生对病人的角色）的明确义务而制度化。（Robert F. Bales，《小群体：社会互动研究》，编辑，A. Paul Hare等人，纽约：Alfred A. Knopf出版社，1955年）。艾略特·弗雷德森（病人对医疗实践的看法，纽约：拉塞尔·塞奇基金会，1961年）和r·h·布鲁姆（医患关系的管理，纽约：麦格劳·希尔公司，1960年）讨论了医患关系中的困境。Lois Pratt， Arthur Seligman和George Reader（“医生对患者医疗信息水平的看法”，《美国公共卫生杂志》，1957年第47期，第1277-1283页）对50种医患关系进行了深入研究，重点关注互动中的给予和接受。特别令人感兴趣的是门诊病人和医生之间的信息交流问题。Gene Levine,（“好医生：医患互动的研究”，工作论文3号，康奈尔综合护理和教学项目的评估研究，哥伦比亚大学应用社会研究局，1957），在另一项对医患关系的深入研究中，确定了一些控制执业医生的角色属性和义务。亨利·伦纳德和阿诺德·伯恩斯坦（《心理治疗解剖学》，纽约：哥伦比亚大学出版社，1961年）在对来自8种个体心理治疗的500次治疗进行深入分析后，运用社会科学的概念和方法来描述相互作用和关系系统，目的是理解治疗沟通的结构。2. 其他调查人员则直接关注医疗方案的依从性。Harold Roth和David Berger（“患者在溃疡治疗中的合作研究，I.观察医院病房实际服用与处方抗酸剂服用的比较”，《胃肠病学》，1960年第38期，第630-633页）发现消化性溃疡患者
During the past decade social scientists as well as physicians have shown increased interest in the problem of how differences in doctor-patient relationships1 may lead to variations in compliance2 on the part of patients. As the growing literature attests, there is no dearth of relevant theoretical formulations; however, empirical studies which present data to support existing analyses are relatively sparse. Moreover, little attention has been given to identification of other sources of influence which, along with the interaction between the doctor and patient, may play a part in determining whether or not patients follow their physicians' instructions. Indeed, the doctor-patient relationship has sometimes been approached as if it operated within a vacuum in which *Abridged and revised from part of a larger report by Milton S. Davis entitled "Factors Affecting Perceived Compliance with the Medical Regimens Established for Heart Patients by Their Physicians," unpublished Ph.D. dissertation, Purdue University, 1962. The data used in this report were collected as part of the Purdue Farm Cardiac Project co-sponsored by Purdue University, Indiana Heart Association, American Heart Association, Indiana State Board of Health and the National Heart Institute. A more complete description of the project is contained in Proceedings of the Purdue Farm Cardiac Seminar, W. H. M. Morris, editor, Purdue University, Agricultural Experiment Station, Lafayette, Indiana, September, 1958. The authors are indebted to G. J. Kallas, W. H. M. Morris, D. C. Riedel, and L. Turgeon for their assistance in either the collection, analysis or presentation of these data. tCornell University Medical College :Department of Sociology, Purdue University 1. As early as 1935 L. J. Henderson called attention to the doctor-patient relationship as a social system. ("Physician and Patient as a Social System," New England Journal of Medicine, 212, 1935, pp. 819-825). More recently, Parsons in his various articles dealing with medical sociology has characterized the patient (The Social System, Glencoe, Illinois: The Free Press, 1951), the physician ("Illness and the Role of the Physician," American Journal of Orthopsychiatry, 21, 1951, pp. 425-460), and the role which the family plays in illness (Talcott Parsons and Renee Fox, "Illness, Therapy and the Modern Urban Family," Journal of Social Issues, 8, 1952, pp. 31-44). Bales points out that socio-structural factors lead to changes in social relationships in such a way that a certain indifference, impersonality and emotional neutrality become institutionalized as explicit obligations in the performance of particular roles, including that of the doctor with his patient. (Robert F. Bales, Small Groups: Studies in Social Interaction, editor, A. Paul Hare, et al., New York: Alfred A. Knopf, 1955). Dilemmas in the doctor-patient relationship have been discussed by Eliot Freidson (Patients' Views of Medical Practice, New York: Russell Sage Foundation, 1961) and R. H. Blum (The Management of the DoctorPatient Relationship, New York: McGraw Hill Company, 1960). In an intensive study of 50 doctorpatient relationships, Lois Pratt, Arthur Seligman and George Reader ("Physician's View of the Level of Medical Information Among Patients," American Journal of Public Health, 47, 1957, pp. 1277-1283) focus on the give and take in the interaction. Of particular interest is the question of communication of information between clinic patients and physicians. Gene Levine, ("The Good Physician: A Study of Physician-Patient Interaction," Working Paper No. 3, Evaluation Studies of the Cornell Comprehensive Care and Teaching Program, Bureau of Applied Social Research, Columbia University, 1957) in another intensive study of doctor-patient relationships, identified a number of role attributes and obligations which govern the practicing physician. Henry Lennard and Arnold Bernstein (The Anatomy of Psychotherapy, New York: Columbia University Press, 1961) in an intensive analysis of 500 sessions from eight individual psychotherapies applied social science concepts and methods to describe interaction and systems of relationships for the purpose of understanding the structure of therapeutic communication. 2. Other investigators have been directly concerned with compliance in the medical regimens. Harold Roth and David Berger ("Studies of Patient Cooperation in Ulcer Treatment, I. Observation of Actual as Compared to Prescribed Antacid Intake on a Hospital Ward," Gastroenterology, 38, 1960, pp. 630-633) found that patients with peptic ulcer