IMPROVING PSYCHOSOCIAL PROBLEM ADDRESS IN PRIMARY CARE

据估计，25%到80%的患者在

It is estimated that between 25% and 80% of patients seen in primary care practice have some significant psychosocial problem deserving of physician attention, yet problems of this kind are largely neglected. The purpose of this research is to intervene with aspects of physicians' interviewing style which are likely to have a positive effect on the discussion, diagnosis, and management of patients' psychosocial problems with consequences for a variety of patient effects and health services utilization in primary care. There are two aspects of physicians' interviewing style we plan to explore. The first is task-focused behaviors which include such activities as question-asking (both close and open-ended), counseling, patient education, and compliance monitoring. The second is relationship-handling or socioemotional behavior conveyed through exchanges such as statements of partnership, reassurance, empathy, support, and legitimation. The distinction between these will be made primarily through two experimental interventions embedded in a CME program addressing psychosocial problems in primary care. Three groups of 20 physicians (N=60) will participate in this program; by random assignment, 2 groups will recive an experimental intervention related to either task-focused skills or relationship-handling skills and a third group will serve as a control. Our primary sources of data will be analysis of tape recordings of these 60 physicians with 5 of their actual patients (n=300), and 2 simulated patients (n=120) following completion of the CME interventions. In addition, patient and physician interviews, one year retrospective and prospective chart reviews, and a cognitive and additudinal assessment of the physicians will be made. Our main questions fall within four broad categories: 1) the relative effects of the interventions on both patient and physician interaction; 2) the effect of the intervention on patient satisfaction, recall of information provided during the visit, compliance with recommendations, symptom alleviation, and utilization; 3) the effect of the intervention on physicians' attitudes, knowledge, and practices related to identification, discussion, diagnosis, chart notation, and management of psychosocial problems; and 4) effect of the interventions on physicians' clinical proficiency in handling psychosocial material based on simulated patient interviews.