IMPROVING PSYCHOSOCIAL PROBLEM ADDRESS IN PRIMARY CARE

据估计，25%至80%的患者在 初级保健实践存在一些重大的心理社会问题 值得医生注意，但这种问题是 基本上被忽视了。 这项研究的目的是干预 医生的面试风格可能会 对讨论、诊断和 处理病人的心理社会问题及其后果 对于各种患者影响和卫生服务利用， 初级保健. 有两个方面的医生的采访风格，我们计划， 探索. 第一种是以任务为中心的行为，包括 提问活动（封闭式和开放式）， 咨询、患者教育和合规性监测。 的 第二是人际关系处理或社会情感行为 通过伙伴关系声明等交流来传达， 安慰、同情、支持和合法化。 的区别 这将主要通过两个实验来实现。 在继续医学教育计划中嵌入的干预措施， 初级保健中的社会心理问题。 三组，每组20人 医生（N=60）将参与该计划;随机 分配，2组将接受实验干预 与以任务为中心的技能或关系处理技能有关 第三组作为对照。 我们的主要来源 数据将分析这60名医生的磁带记录 5名实际患者（n=300）和2名模拟患者 （n=120）完成CME干预后。 在 此外，患者和医生访谈，1年回顾性 和前瞻性的图表审查，以及认知和补充 将对医生进行评估。 我们的主要问题分为四大类： 干预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， 依从建议，症状缓解，以及 利用; 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，图表符号和管理 心理社会问题;以及4）干预措施对 医生在处理心理社会材料方面的临床熟练程度 基于模拟病人访谈

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.