社区全科门诊慢性病患者参与治疗决策现状及影响因素研究  

Chronic Disease Patients Involved in Shared-decision Making in General Outpatient Care in the Community:Current Status and Associated Factors

作　　者：马文翰 白雪霏 陈照娟 赵亚利 MA Wenhan;BAI Xuefei;CHEN Zhaojuan;ZHAO Yali(School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China;Haidian District Shuangyushu Community Health Center,Beijing 100086,China)

机构地区：[1]首都医科大学全科医学与继续教育学院,北京市100069 [2]北京市海淀区双榆树社区卫生服务中心,北京市100086

出　　处：《中国全科医学》2022年第10期1206-1212,共7页Chinese General Practice

摘　　要：背景社区全科门诊在满足慢性病患者医疗需求方面面临日益复杂的挑战。同时以合作、彼此尊重为基础的医患共同决策(SDM)正逐步成为主流医疗决策模式。将SDM模式引入社区慢性病诊疗中,对于改善慢性病患者健康结局、提高其满意度具有重要意义。目的了解社区全科门诊慢性病患者参与治疗决策的现状和程度,并分析影响其参与治疗决策的因素,旨在为推动基层医疗卫生机构SDM的实施提供参考依据。方法采用整群抽样法,选取北京市双榆树社区全科门诊7名全科医生及其于2019年10月至2020年1月接诊的149例慢性病患者为研究对象。通过现场非参与观察,采用中文版患者参与医疗决策量表-5(OPTION-5)评估医疗咨询过程中全科医生促进患者参与治疗决策的程度,并采集患者个人特征、就诊与患病情况方面的信息及全科医生的一般资料。比较不同特征社区全科门诊慢性病患者OPTION-5得分情况,采用多重线性回归探讨影响其参与治疗决策的因素。结果149例慢性病患者平均就诊时长为(4.1±2.7)min;OPTION-5中位得分为6.00(3.00)分。不同年龄、就诊时长的慢性病患者OPTION-5得分比较,差异有统计学意义(P<0.05)。多重线性回归分析结果显示:就诊时长、就诊咨询时是否被他人打断、家属是否陪同就诊是社区全科门诊慢性病患者参与治疗决策的影响因素(P<0.05)。结论社区全科门诊慢性病患者参与治疗决策的程度较低。延长诊疗过程中的医患沟通时间,确保诊疗过程不被打断,以及诊疗时给予患者一个私密的空间,可能是提高社区全科门诊慢性病患者参与治疗决策程度的可行措施。Background The general practice clinic in community health centers is facing increasingly complex challenges to meet the medical needs of patients with chronic diseases.To improve chronic disease patients'health outcome and healthcare satisfaction,it will be of great significance to use shared decision-making(SDM)in the diagnostic and therapeutic process in the community,since SDM is a model based on doctor-patient mutual respect and cooperation and shows great promise as a possible major medical decision-making model.Objective To understand the status and associated factors of chronic disease patients involved in SDM in general outpatient care in the community,aiming to provide evidence for promoting the implementation of SDM in primary care.Methods We used cluster sampling to select seven general practitioners(GPs)in the clinic of Shuangyushu Community Health Center,Beijing,and 149 chronic disease patients seen by them between October 2019 and January 2020 as the participants.Through non-participant observation at the clinic,we used the Chinese version of the Observer OPTION 5(OPTION-5)as an assessment tool to evaluate the extent to which GPs facilitated patient participating in SDM during the consultation.We used a self-developed general demographic questionnaire to collect patients'demographics,status of illness and treatment,as well as GPs'demographics.We compared the OPTION-5 score of the patients by demographic factors,and used stepwise multiple linear regression to explore the factors affecting patients'participation in SDM.Results The mean visit length,and OPTION-5 score for the 149 patients were(4.1±2.7)minutes,and〔6.00(3.00)〕,respectively.The OPTION-5 score varied significantly across patients by age group and visit length(P<0.05).Multiple linear regression analysis showed that patient visit length,prevalence of interruption of counseling due to other people,and prevalence of family member accompaniment to medical visits were associated with patients'participation in SDM(P<0.05).Conclusion The par

关 键 词：共同决策 医生病人关系 社区卫生服务 全科医生 慢性病 

分 类 号：R395[哲学宗教—心理学] R197.1[医药卫生—医学心理学]