医生医患环境感知与防御性医疗行为倾向关联研究  

Study on the correlation between doctors’perception of the doctor-patient environment and defensive medical behavior tendencies

作　　者：张环宇 赵娟 王晨 邹丹丹 冯亚杰 刘俊萍 刘智新 梁立波[1] ZHANG Huanyu;ZHAO Juan;WANG Chen;ZOU Dandan;FENG Yajie;LIU Junping;LIU Zhixin;LIANG Libo(School of Health Management,Harbin Medical University,Harbin,Heilongjiang Province,150081,PRC)

机构地区：[1]哈尔滨医科大学卫生管理学院,黑龙江省哈尔滨市150081 [2]陆军军医大学第一附属医院(西南医院),重庆市400030 [3]重庆市妇幼保健院,重庆市401147 [4]复旦大学附属金山医院,上海市201500 [5]北京大学,北京市100871

出　　处：《中国医院》2024年第3期44-48,共5页Chinese Hospitals

基　　金：国家自然科学基金(71974049,72274047)。

摘　　要：目的:了解医生防御性医疗行为倾向现状,探索医生的医患环境感知与防御性医疗行为倾向之间的关系。方法:对黑龙江省27家公立医院的医生进行问卷调查,采用因子分析法提取医生的防御性医疗行为倾向类型,运用Amos26.0构建医生医患环境感知与防御性医疗行为倾向关系的结构方程模型。结果:医生积极防御性医疗行为倾向平均得分为14.98±5.24,消极防御性医疗行为倾向得分为16.37±7.62。医生积极防御性医疗行为倾向与医患互动(β=0.435,P<0.001)、制度环境(β=0.146,P<0.001)和文化环境(β=0.132,P=0.012)存在正相关关系,与对患者行为态度评价无关(P>0.1)。消极防御性医疗行为倾向与医患互动(β=-0.279,P<0.001)、对患者行为态度评价(β=-0.210,P=0.012)和文化环境(β=-0.042,P<0.001)存在负相关关系,与制度环境(β=0.078,P=0.007)存在正相关关系。结论:提升医生对患者行为及态度的评价,加强医患互动以及改善外部的制度和文化环境将有利于医生正确认识防御性医疗行为,减少消极防御性医疗行为的发生。Objective:To comprehend the current state of doctors'tendency toward defensive medical behavior and to explore the relationship between doctors'perceptions of the doctor-patient environment and their inclination towards defensive medical behavior.Methods:A questionnaire survey was conducted among doctors in 27 public hospitals in Heilongjiang Province,and factor analysis was used to extract the types of defensive medical behavior tendencies of doctors,and Amos 26.0 was used to construct a structural equation model of the relationship between doctors'perceptions of doctor-patient environments and their tendencies to engage in defensive medical behavior.Results:The average score for doctors'positive defensive medical behavior tendency was(14.98±5.24),while the score for negative defensive medical behavior tendency was(16.37±7.62).The positive tendency in doctors'defensive medical behavior was found to be positively correlated with doctor-patient interaction(β=0.435,P<0.001),institutional environment(β=0.146,P<0.001),and cultural environment(β=0.132,P=0.012),but not with the evaluation of patients'behavioral attitude(P>0.1).Conversely,negative defensive medical behavior tendency was negatively correlated with doctor-patient interaction(β=-0.279,P<0.001),evaluation of patient behavior attitude(β=-0.210,P=0.012),and cultural environment(β=-0.042,P<0.001),and positively correlated with institutional environment(β=0.078,P=0.007).Conclusion:Enhancing physicians'evaluation of patients'behaviors and attitudes,strengthening physician-patient interactions as well as improving the external institutional and cultural environments will facilitate physicians'correct understanding of defensive medical behaviors and reduce the occurrence of negative defensive medical behaviors.

关 键 词：医患关系感知 防御性医疗 结构方程模型 

分 类 号：R197.3[医药卫生—卫生事业管理]