基于患者信任度的患者分类与管理策略探讨

医患信任在医患知识转移中起十分重要的作用.作者对患者基本特征和信任表现进行调查研究,把医院的信任、医生的信任、知识转移认知度、依从度四个因素作为分类标准,通过聚类分析将患者分为四类群体,即理性多疑型、被动依从型、盲目自信型和盲信盲从型;并根据每类患者的行为特点提出不同的知识转移与沟通策略.以期为医护人员进行有效的医患沟通与知识转移、赢得患者信任提供参考.     

中药注射剂抗肿瘤治疗的医患偏好及共同决策比较分析

目的 对中药注射剂抗肿瘤治疗的医患偏好及共同决策现状进行比较分析,为相关研究和临床实践提供参考。方法 于2020年10月—12月对上海市9家三级医院的肿瘤治疗相关科室的185名医生及347名住院肺癌患者开展问卷调查,通过离散选择实验调查医患对中药注射剂抗肿瘤治疗方案的偏好属性,并采用条件Logit模型及混合Logit模型对医患的偏好属性进行分析,采用医患共同决策测量工具对决策行为进行现状描述与比较分析。结果 医生更加关注恶心呕吐及其他毒副反应,患者更加关注疾病控制率及自付治疗费用。而在偏好差异的基础上,78.4%的医生以及90.2%的患者认为其参与的临床决策模式为共同决策模式。结论 医患之间的偏好属性及决策模式存在差异,并会在一定程度上影响患者满意度及和谐医患关系。建议激发医生医疗服务积极性,促进医患共同决策。     

基于医生视角的医患知识转移行为模式研究

医患纠纷频发、医患关系紧张等问题已成为社会热点之一。为了解决当前医患关系紧张,寻找医患间信息不对称、医患知识转移行为不匹配的影响因素,本文从医生与患者两方面出发,通过访谈与问卷调查,研究医生知识转移行为的特点,以及医生与患者对于医患知识转移内容认知标准的差异。最终得出医患知识转移行为模式的研究结论：医患双方对于医患知识转移内容的选择、需求标准存在差异;医生知识转移行为显著低于其转移意愿;并提出了基于患者需求的医患知识转移内容偏好匹配矩阵。     

基于认知理论的医患知识转移愿望与需求研究

目的 研究比较医生知识转移意愿与患者医疗知识需求之间的差异,进而提出医患知识转移行为匹配模型.方法 通过问卷调查进行实证分析,采用统计软件SPSS18.0对数据进行信度分析检验问卷的有效性,方差分析检验医患间知识转移意愿与需求差异的显著性,均值比较分析比较医生知识转移意愿与患者知识转移需求间差异的具体高低比较关系.结果 显示医患知识转移中,患者信息需求明显强于医生知识转移意愿.根据双方意愿与需求的高低,对医患知识转移内容分成了四类:高医生意愿-高患者需求、高医生意愿-低患者需求、低医生意愿-高患者需求、低医生意愿-低患者需求.结论 医患双方知识转移愿望与需求不匹配是导致医患信息不对称的主要障碍,进而从患者与医疗机构两方面提出对应的管理策略.     

医患共同决策影响因素及对患者结果的影响

文章从医患共同决策的相关研究趋势与评价工具、医患共同决策相关影响因素以及医患共同决策对患者结果的影响等方面进行了综述,以期为后期理论研究和临床实践提供参考。     

药物涂层支架技术临床应用中的患者参与决策研究

目的:研究药物涂层支架技术临床应用中的患者参与决策现况,分析患者在治疗决策中的参与及其对患者技术使用行为的影响,为相关理论研究和临床实践提供参考。方法:采用横断面设计和多阶段分层抽样方法,选取上海市、福建省、四川省医院心内科冠心病患者进行问卷调查。结果:冠心病患者参与决策量表总得分为32.93±8.235,聚类分析显示92位(61.33%)患者量表得分为"较高";患者量表得分对患者治疗技术选择有显著影响(P0.05),对患者决策满意度有显著影响(P0.05),患者决策满意度对患者治疗技术选择也有显著影响(P0.05),此三者间两两相关。结论:冠心病患者多偏好医患共同决策,但其参与决策的实际程度仍有待提高;患者参与决策正向影响冠心病患者决策满意度,并影响患者是否选择应用药物支架;应当鼓励医患共同决策模式,提升患者满意度并改善医患关系;建议加强技术全方位监督管理,促进药物支架技术的适宜推广。     

我国医患共同决策问题及优化路径

随着公民权利意识的增强和健康需求的提升，以患者为中心的医患共同决策模式日益受到医疗领域的关注。域外研究和实践经验表明，医患共同决策可以有效改善医患关系、缓和医患矛盾。我国医患共同决策研究起步较晚，对其进行系统研究是必须面对的课题。从医患共同决策的概念、界定入手，阅读并梳理国内外相关文献，检索英国国家医疗服务网站及国内网站，分析我国面临的问题，并介绍英国医患共同决策的实践经验，以期为我国医患共同决策的理论研究和优化路径提供有益参考。     

基于知识转移的医患关系管理

将知识转移的理念和方法引入医患关系管理系统中,建立基于知识转移的医患关系管理系统,一方面．能够利用知识转移为患者提供良好的医疗服务并使其增值;另一方面,利用知识为患者增值会导致更深层次的医患关系．提高患者忠诚度和社会信任度,提升医院的核心竞争力。     

住院患者对医生的信任水平及自我效能与医疗决策行为的关系研究——以医患互动为中介

目的：通过调查杭州市住院患者参与医疗决策行为现状,分析其主要影响因素和机制,为提高杭州市住院患者参与医疗决策积极性、有效性提出建议。方法：采用分层随机抽样的方法,参考成熟量表后自行设计的调查问卷,对杭州市二、三级医院的750名住院患者进行调查;用结构方程模型分析住院患者对医生的信任水平、参与决策自我效能、医患互动与其参与医疗决策行为的作用机制。结果：不同家庭月收入、住院科室、过去一年住院次数、本次入院决策方案制定方式的患者参与医疗决策行为得分有显著性差异(均P＜0.05)。患者参与医疗决策行为与其对医生的信任水平呈负相关;与其自我效能和医患互动呈正相关(P＜0.01)。患者对医生的信任水平和自我效能直接影响患者参与医疗决策行为,直接效应值分别为-0.373、0.358(P<0.001);医患互动在对医生的信任水平、自我效能与患者参与医疗决策行为之间的关系中起较显著的中介作用,中介效应值分别为-0.089、0.328(P<0.001)。结论：医患互动的中介效应可以促进患者参与医疗决策行为的积极性和有效性,医疗卫生机构应以患者为中心,优化住院患者参与医疗决策的途径,加强对医务人员医患互动能力和意识的培训,切实提高患者参与医疗决策行为的主动性和有效性。     

患者对医患共享决策和医疗价值的感知分析

目的 分析上海市公立医疗机构门诊和住院患者对医患共享决策和医疗价值的感知。方法 通过对2022年和2021年上海市公立医疗机构门诊和住院患者的问卷调查，分析患者对医患共享决策和医疗价值的感知，并采用多层广义线性混合模型分析影响患者对医患共享决策和医疗价值评价的因素。结果 2022年和2021年，上海市公立医疗机构门诊患者相比于医疗服务的医疗费用合理性评分均值分别为4.79分和4.71分，住院患者对医患共享决策和医疗价值总体评分均值分别为4.46分和4.50分。但2022年81.87%和80.55%的住院患者认为自费外购药物或器械会增加医疗不便和经济负担，比2021年（74.85%和72.43%）显著增加。此外，多层广义线性混合模型分析显示，患者对医患共享决策和医疗价值的感知受患者社会人口特征、健康状况、门诊就诊时间和诊疗状况等因素影响。结论 医疗服务的提供不能忽略患者的社会属性，应更多考虑患者的期望与偏好，以体现高质量发展和价值竞争的核心。     

School Gardens: An Experiential Learning Approach for a Nutrition Education Program to Increase Fruit and Vegetable Knowledge,Preference, and Consumption among Second-grade Students

ObjectiveTo examine the effects of a school garden on children's fruit and vegetable knowledge, preference, and consumption.DesignSelf-report questionnaires, interview-style taste and rate items, lunchroom observations.SettingAn elementary school.ParticipantsSecond-grade students (n = 115).InterventionParticipants were assigned to one of 3 groups: (1) nutrition education and gardening (NE+G) treatment group, (2) nutrition education only (NE) treatment group, or (3) control group (CG). Both treatment groups received classroom instruction, and the NE+G group also received a school gardening experience.Main Outcome MeasuresFruit and vegetable knowledge, preference, and consumption.AnalysisAnalyses of variance (α = .05).ResultsParticipants in the NE+G and NE treatment groups exhibited significantly greater improvements in nutrition knowledge and taste ratings than did participants in the CG. Moreover, the NE+G group was more likely to choose and consume vegetables in a lunchroom setting at post-assessment than either the NE or CG groups.Conclusions and ImplicationsSchool gardens as a component of nutrition education can increase fruit and vegetable knowledge and cause behavior change among children. These findings suggest that school administrators, classroom teachers, and nutrition educators should implement school gardens as a way to positively influence dietary habits at an early age.     

A qualitative analysis of reasons for leaving, or not attending, a cancer support group

Factors that influence participation and long-term retention in cancer support groups were examined, through a study of 87 individuals who had dropped out of a cancer support group, and 26 individuals who had never attended such groups, using a combination of interviews and open-ended questionnaire responses. Support group attrition or non-attendance was positioned as resulting from both individual and group factors. Individual factors included resisting or leaving behind a cancer patient identity, presence of existing support, practical issues, and styles of coping. Group factors included mismatches between the group and the individual, lack of knowledge or nonreferral to groups, and problems within individual groups. These disparate factors underlying support group non-attendance need to be taken into consideration when planning support services, when developing programs of education, or when referrals to cancer support groups are made.     

A Qualitative Analysis of Reasons for Leaving,or Not Attending,a Cancer Support Group

ABSTRACT

Factors that influence participation and long-term retention in cancer support groups were examined, through a study of 87 individuals who had dropped out of a cancer support group, and 26 individuals who had never attended such groups, using a combination of interviews and open-ended questionnaire responses. Support group attrition or non-attendance was positioned as resulting from both individual and group factors. Individual factors included resisting or leaving behind a cancer patient identity, presence of existing support, practical issues, and styles of coping. Group factors included mismatches between the group and the individual, lack of knowledge or nonreferral to groups, and problems within individual groups. These disparate factors underlying support group non-attendance need to be taken into consideration when planning support services, when developing programs of education, or when referrals to cancer support groups are made.     

锦州市某医院老年贫血相关因素回顾性调查

目的筛选发生老年贫血的相关因素,为合理预防提供依据。方法回顾性收集2015-2019年锦州市中心医院收治的老年贫血患者432例作为贫血组;另选同期于我院进行体检的健康老年人200例作为对照组。比较两组对象的各项资料,并进一步以单因素和多因素Logistic回归分析方法筛选发生老年贫血的相关因素。结果多因素Logistic回归分析显示,年龄、饮茶偏好、蛋白质偏好、有效运动、伴消化系统疾病是老年贫血发生的相关因素(P<0.05)。结论蛋白质偏好和有效运动是老年贫血的保护因素,而年龄、饮茶偏好和伴消化系统疾病是老年贫血的危险因素。     

‘It’s Hard to Make Good Choices and It Costs More’: Adolescents’ Perception of the External School Food Environment

Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent’s perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with ‘deli’ counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents’ perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.     

Are professional attitudes related to gender and medical specialty?

OBJECTIVES: The importance of professional attitudes in medical care has long been recognized; however, medical training has not stressed attitude development until recently. In previous studies among medical students, we found that gender and specialty preference are important factors in attitudes. In this study, patient-centredness of trainees in general practice and surgery and of final-year clerks preferring one of these specialties was assessed in one medical school in The Netherlands. The effect of gender, specialty and training level on attitude was investigated. DESIGN: In 1995, attitudes of 37 general practice trainees, 31 surgery trainees and 120 clerks were measured anonymously using questionnaires containing the Doctor-Patient Scale. This attitude scale measures patient-centredness vs. doctor-centredness. Response rates were 78%, 58% and 84%, respectively. SETTING: University of Utrecht. SUBJECTS: Medical students. RESULTS: Attitudes were related to specialty. General practice trainees showed more patient-centredness than surgery trainees. In accordance with previous findings among younger students, no differences were found between final-year clerks and vocational trainees. In contrast to previous studies, gender was not related to patient-centredness. CONCLUSIONS: Professional attitudes, in particular patient-centredness, seem to be related to specialty preference in the final year of graduate medical training and specialty as a career choice. It remains unclear whether professional socialization reinforces existing attitudes or whether existing attitudes result in specialty preference.     

对高血压人群进行健康教育干预的效果评估

目的探索在社区高血压人群中控制血压的健康教育干预方法。方法在一个有5万多居民的成熟社区,选择4个居委,以其中2个居委的高血压人群作为干预组,另外2个居委的高血压人群作为对照组,开展健康教育干预活动。结果174名研究对象都存在不同程度的高血压相关行为危险因素。干预后,干预组病人6项高血压相关核心知识的知晓率与血压控制率都有明显的提高,并明显高于对照组;干预组病人6项高血压相关行为危险因素的水平明显下降,并明显低于对照组。结论针对性的健康教育干预,能有效地促进高血压人群控制血压。组织动员社区高血压人群开展健康教育活动,是社区高血压综合防治的重要方法,     

Grandparents raising grandchildren: a response to a nutrition and physical activity intervention

This pilot study explored the impact of an educational program on nutrition and physical activity knowledge of urban African-American grandparents raising their grandchildren. The program was integrated into a community-based intervention, Project Healthy Grandparents, and was implemented during the first 15 minutes of 10 grandparent support groups and parenting classes. Subjects included 22 grandparents who attended at least six sessions and completed pre- and posttests of nutrition and physical activity knowledge. Participants' posttest scores were significantly higher than their pretest scores (P<0.05), indicating an increase in knowledge. Eighteen grandparents provided insights about diet and physical activity and barriers to lifestyle changes during an audiotaped focus group. Based on analysis of the focus group's discussion, three major influences on healthful eating and physical activity emerged, including financial considerations, presence of grandchildren in the home, and preference for traditional cultural foods. Themes from the focus group were consistent with responses on the nutrition and physical activity knowledge test. Satisfaction with the program was very high and no specific recommendations for improvements were made. Results can guide future nutrition interventions for this target group and potentially contribute to grandparents' improved health and ability to care for their grandchildren.     

A curriculum based on social learning theory emphasizing fruit exposure and positive parent child-feeding strategies: a pilot study

This study examined the effectiveness of a nutrition intervention program to enhance children's knowledge, preference, and intake of whole fruit and to decrease parents' use of controlling child-feeding behaviors. Subjects were fifth- and sixth-grade students (children aged 10-12 years) from Cincinnati, Ohio. Nine parent-child pairs completed the study. Seventeen parent-child pairs who expressed interest but were unable to attend more than one session served as controls. Based on the Social Learning Theory, the curriculum combined child-focused interactive lessons and skill-building activities with parent-focused lessons on child-feeding strategies to increase the fruit intake of children. Change in children's knowledge, preference, and intake of fruit and parents' use of controlling child-feeding strategies were measured in a pretest/posttest manner using validated questionnaires. There was a significant increase in knowledge scores and fruit intake by children in the experimental vs the control group. Fruit preference scores were similar between groups. Additionally, there was a significant decrease in use of controlling child-feeding strategies by parents in the intervention vs the control group.