IMPROVING PSYCHOSOCIAL PROBLEM ADDRESS IN PRIMARY CARE

据估计，25%到80%的患者在 初级保健实践存在一些严重的心理社会问题 值得医生注意，但这类问题 基本上被忽视了。这项研究的目的是干预 医生的面谈风格很可能会 对讨论、诊断和 患者心理社会问题的处理及其后果 针对不同的患者影响和医疗服务利用率 初级保健。 我们计划从两个方面探讨医生的面试风格 探索。第一种是以任务为中心的行为，包括 提问活动(包括封闭式和开放式)， 咨询、患者教育和遵从性监测。这个 第二种是人际关系处理或社会情绪行为 通过诸如合伙声明之类的交换传达， 安心、同理心、支持和合法化。区别在于 在这之间将主要通过两个试验性的 在继续医学教育计划中嵌入的干预措施 初级保健中的心理社会问题。三组，每组20人 医生(N=60人)将随机参加这项计划 分配，两组将接受实验干预 与专注于任务的技能或处理关系的技能有关 第三组将作为对照。我们的主要来源是 将对这60名医生的磁带录音进行数据分析 有5名实际患者(n=300)和2名模拟患者 (n=120)在继续医学教育干预完成后。在……里面 此外，患者和医生的访谈，一年的回顾 和前瞻性图表回顾，以及认知和纵向 将对医生进行评估。 我们的主要问题分为四大类：1) 干预措施对患者和医生的相对影响 互动；2)干预对患者的影响 满意度、对访问期间提供的信息的回忆、 遵守建议、缓解症状和 利用情况；3)干预对医生的影响 与身份识别相关的态度、知识和实践， 讨论、诊断、图表标记和管理 心理社会问题；4)干预的效果 医生在处理心理材料方面的临床熟练程度 基于模拟的病人面谈。

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.