医患双方对医疗服务状况的认知差异研究

通过问卷调查温州市某三甲医院的医患双方对医疗服务现状、满意度影响因素等方面进行认知对比分析,探讨差异原因,并结合现状阐述完善对策,为构建和谐医患关系提供积极有效的建议。     

Communication Accommodation and Managing Musculoskeletal Disorders: Doctors' and Patients' Perspectives

This study examined the ways in which health care providers (general practitioners and specialists) and patients communicate with each other about managing musculoskeletal (MSK) disorders, a major cause of long-term pain and physical disability. In managing their illness, patients must interact closely with health care providers, who play a large role in transferring knowledge to them. In-depth interviews with patients, general practitioners, and specialist rheumatologists in Australia and Canada were analyzed using Leximancer (a text-mining tool). Results indicated that, in their communication, doctors subtly emphasized accepting and adjusting to the illness (“new normal”), whereas patients emphasized pain relief and getting “back to normal.” These results suggest that doctors and patients should accommodate in their communication across subtle and often unexpressed differences in the priorities of provider and patient, or they are likely to be at cross purposes and thus less effective.     

Cancer Patients' Desires for Communication of Prognosis Information

A mail survey was sent to cancer patients to determine how often they want, request, and receive a qualitative prognosis (i.e., will they die from the disease?) and a quantitative estimate (how long they will survive). The survey included measures of social and psychological characteristics that were hypothesized to be associated with their desire for and willingness to request prognosis information (N = 352). Major findings are as follows: (a) Whereas about 80% of patients wanted a qualitative prognosis, only about one half wanted a quantitative one; (b) over 90% of those who wanted a qualitative prognosis were given one, but only about one half of those who wanted a quantitative prognosis were given one; and (c) about 15% of those who wanted a qualitative prognosis failed to ask for it, and over one third of those who wanted a quantitative prognosis failed to ask for it. Multivariate analyses indicate that the effects of education on wanting, asking for, and receiving prognosis information are slight, and the effects of sex are essentially nil. Older people were significantly less likely to request and to be given prognosis information. Those who had greater anxiety and who needed to avoid thinking about death wanted, requested, and received significantly less information. Fear had significant nonlinear effects on desire, request, and receipt of quantitative information. Those whose prognosis was worse were less likely to want, ask for, and receive quantitative information. Those least likely to want, request, and be given qualitative information were those who combined a bad prognosis with a need to avoid thinking about death.     

Communication During Pediatric Intensive Care Unit Family Conferences: A Pilot Study of Content,Communication, and Parent Perceptions

While there is a robust literature describing family conferences (FCs) in adult intensive care units (ICUs), less information exists about FCs in pediatric ICUs (PICUs). We conducted a pilot study to describe the focus of discussion, communication patterns of health care team members (HTMs) and parents, and parents’ perspectives about clinician communication during PICU FCs. We analyzed data from 22 video- or audiorecorded PICU FCs and post-FC questionnaire responses from 27 parents involved in 18 FCs. We used the Roter Interaction Analysis System (RIAS) to describe FC dialogue content. Our questionnaire included the validated Communication Assessment Tool (CAT). FCs were focused on care planning (n = 5), decision making (n = 6), and updates (n = 11). Most speech came from HTMs (mean 85%; range, 65–94%). Most HTM utterances involved medical information. Most parent utterances involved asking for explanations. The mean overall CAT score was 4.62 (using a 1–5 scale where 5 represents excellent and 1 poor) with a mean of 73.02% “excellent” responses. Update and care-planning FCs had lower CAT scores compared to decision-making FCs. The lowest scoring CAT items were “Involved me in decisions as much as I wanted,” “Talked in terms I could understand,” and “Gave me as much information as I wanted.” These findings suggest that while health care providers spend most of their time during FCs relaying medical information, more attention should be directed at providing information in an understandable manner. More work is needed to improve communication when decision making is not the main focus of the FC.     

病人信息与影像处理系统的设计与实现

本文介绍了病人信息与影像处理系统的网络结构、体系结构设计;功能设计及实现方法。系统运行后性能稳定,达到了预期目的。     

The Impact of Patient Participation on Physicians' Information Provision During a Primary Care Medical Interview

This study investigated the impact of patients' participation on physicians' information provision during a primary care medical interview. When communicating with high-participation patients, physicians provided significantly more information overall, more information in response to patients' questions, and volunteered more information than when interacting with low-participation patients. The most significant differences with respect to volunteered information involved communication about treatment and tests or procedures. These results were interpreted to suggest that high-participation patients' communication style promotes better alignment of patients' and physicians' goals and agendas.

Overall, the results suggest that patients' style of participation during a medical interview significantly influenced the extent and type of information physicians provided. Given that patients' biggest complaint about physicians often is a lack of desired information, this study has important implications for physician–patient communication.     

高血压患者遵医用药与并发症发生的相关调查

目的了解高血压患者遵医用药情况以及与高血压并发症的相互关系。方法通过对本市某社区130例患高血压病3年以上患者进行问卷调查来了解患者遵医服药情况,以及对高血压病的认识、血压拉制与并发症发生情况。结果大部分患者(87．7％)能做到定期或不定期测量血压,能按医,口服药者仅为55．4％,有44．6％的患者随意服药或不服药。大部分患者知道高血压患者需长期坚持服药,但仅有约1／3的患者知道如何预防降压药的副作用。90％以上患者所获得的高血压相关知识来源于医护人员的指导、媒体及病友。有56．9％的高血压患者通过服药使血压降至正常。3年中发生心脑肾并发症者,血压拉制不满意者发生的比例为血压拉制正常者的1倍．结论拉制血压可以降低严重并发症的发生,提高患者对高血压危害性的认识,加强对高血压的干预与治疗,是社区卫生服务的重点工作之一。     

农村居民慢性病患者的就医选择行为研究

为进一步了解农村居民慢性病患者的就医选择行为,通过对农村居民慢性病患者在各机构的就医选择情况进行调查发现,新型农村合作医疗制度的实施对农村慢性病患者的就医行为产生了一定影响,在乡、村两级医疗机构确诊和治疗的患者比例逐步提高,但是慢性病患者的治疗费用并没有得到很好的控制,经济困难依然是慢性病患者不进行治疗的重要原因。应该通过新型农村合作医疗制度进一步规范慢性病患者的就医行为,将慢性病的经常性治疗落实在基层医疗机构。     

Developing Psychiatric Competence During Medical Education and Internship: Contributing Factors

The study describes the learning process in psychiatry of medical students through their clerkship and internship, It focused upon the development of students’ attitudes to psychiatry, subjective psychiatric competence and self-confidence. The relationships between the participants’ background, aspects of the learning environment, their attitudes to psychiatry, psychiatric competence and psychiatric self-confidence were explored in order to develop an empirical model of the learning process. The participants were medical students at the University of Tromsoe, Norway. The study was prospective and based on students’ self-reports, Structural panel modelling and growth curve analyses were used to explore the complex interactions between the variables over time and to create a model of the learning processes. The medical students significantly increased their subjective competence and psychiatric self-confidence during their clerkship in psychiatry and maintained them during their internship. Previous psychiatric experience, attitudes towards psychiatry and current psychiatric experience contributed to subjective psychiatric competence, Competence in turn had a positive effect on self-confidence. Interestingly, those with greater subjective competence also appeared to have more psychiatric experience during their internship. An empirical model of the important aspects of the learning process was developed.     

医生对患者参与治疗决策的认知和实践现状

目的了解我国三级公立医院医生对患者参与治疗决策的认知和实践现状,为进一步提高患者治疗决策参与度提出建议。方法依托第5次“全国改善医疗服务行动第三方评估”项目,选取全国31个省（自治区、直辖市）及新疆生产建设兵团共136家三级公立医院医生进行问卷调查。结果共收回22 836份有效问卷。其中,认为有必要让患者参与治疗决策和鼓励患者说出对于治疗方案意见的医生分别有18 405名（占比80.6%）和18 353名（占比80.4%）,面对不同治疗方案时倾向于尊重患者意见的医生有12 040名（占比52.7%）。除职称外,不同特征医生认为有必要让患者参与治疗决策的比例和鼓励患者说出对于治疗方案意见的比例具有统计学意义（P＜0.05）。除职称和地区外,不同特征医生面对不同治疗方案倾向于尊重患者意见的比例具有统计学意义（P＜0.05）。结论我国三级公立医院医生对患者参与治疗决策持积极态度,但在治疗过程中受多种因素影响未有效落实。各医院可结合自身实际,制定鼓励患者参与治疗决策的相关措施。     

医疗实践中患方医疗风险认识研究

本文通过对某大型医院103例非医疗过失性医疗纠纷进行研究,发现对治疗结果不满意是引发纠纷的主要原因;而对治疗结果不满意主要是因为患方经常对疾病抱有不切实际的高期望,高期望又源于患方对医疗风险的认识不足。根据研究结果,结合医院管理中实际存在的薄弱环节,提出了增强与患方沟通的有效性、注意倾听患方的声音、注意改善服务态度等建议。     

Sex Differences in Health Care Provider Communication During Genital Herpes Care and Patients' Health Outcomes

Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.     

基于情境技术的医方处理方法对患者处置行为影响因素的探讨

目的了解患者在遭遇医疗纠纷时的应对行为,并探讨院方的处理策略。方法使用自行设计的案例调查工具（Vignette问卷）,对北京市5家医院的500名患者进行问巷调查。结果患者在处理医疗纠纷时多选择向医院投诉解决,并希望得到尽快回复。在医疗纠纷中,医院“承担部分责任”的回复最令患者满意;当责任主要在医院时,患者更倾向于向法院投诉寻求解决;2个场景中选择“找家人朋友来医院讨公道”的比例不足5％,且差异不具有统计学意义（P〈0．05）;患者接受医院回复的原因在于医院做出的解释合理且态度诚恳。肿瘤误诊案例中,患者期望的赔偿金额高于病人摔倒骨折案例。结论医院的态度及处理方式对患者应对医疗纠纷的行为有重要影响;患者期望的赔偿金额与患者遭遇的严重程度和医院责任的比例有关。     

Patients' Perceptions of Medical Encounters in Great Britain: Variations With Health Loci of Control and Sociodemographic Factors

The purpose of this research was to examine how patients' perceptions of their medical encounters varied by patients' health loci of control and their sociodemographic characteristics. Each of 68 general practitioners agreed to have between 40 and 60 patients fill out a questionnaire immediately after an encounter. Patients were asked to evaluate how well the doctors accomplished seven consultation tasks; to indicate their internal, fate, and doctor health loci of control; and to provide sociodemographic information. Based on the responses of more than 3,000 patients, we found a pattern of significant results that link patients' perceptions of the doctors' information and responsibility sharing with patients' perceived control, social status, and concern.     

A Qualitative Study of Patient and Family Perceptions of Chaplain Presence During Post-Trauma Care

Improving the provision of spiritual care to hospitalized patients requires understanding what patients look for from a hospital chaplain, and why. This qualitative study uses grounded theory methodology to analyze data from 25 interviews with adult patients and/or adult family members who received spiritual care in a large tertiary care hospital. Analysis reveals three key themes in chaplaincy care: the attributes valued in the chaplain’s presence, the elements necessary to form relationship with the chaplain, and the role of the chaplain in helping patients to discover and express meaning in their experiences. The authors weave these three themes together into a grounded theory and propose an assessment model that incorporates psychological theory about human motivation, faith development, and the development of autonomy. An understanding of the proposed assessment model can guide chaplain interventions and benefit all members of the clinical care team.     

医师执业的注意义务

根据"身份决定义务"的原理,医师因其职业的特殊性,事关病人的生老病死等人生大事,所以必然决定医师在执业时必须对患者负有不同于对一般人的注意义务.文章从医师执业的注意义务的概念、渊源、判断标准、履行以及医师违反注意义务应承担的责任等角度予以阐述,以有利于公平、合理地解决医患纠纷.     

康复期精神分裂症患者自尊、自我效能感状况及其干预研究

目的探讨系统性干预对康复期精神分裂症患者自尊、自我效能感状况的影响。方法选取我院诊治的康复期精神分裂症患者120例,所有患者在系统的抗精神分裂症药物治疗、常规护理的基础上均给予针对性的系统性干预。系统性干预治疗12周后,观察与比较患者干预治疗前与干预治疗后的自尊量表(SES)评分、一般自我效能感量表(GSES)评分及阳性与阴性症状量表(PANSS)评分。结果系统性干预治疗12周后,患者的PANSS评分显著降低,而SES评分和GSES评分均显著升高,比较差异具有统计学意义(P<0.05)。结论康复期精神分裂症患者自尊、自我效能感状况均较差,在康复期精神分裂症患者的治疗中实施针对性的系统性干预能显著提高患者自尊及自我效能感,改善患者症状,促进患者功能康复,提高患者生活质量,值得临床应用推广。     

Comprehending Care in a Medical Home: A Usual Source of Care and Patient Perceptions about Healthcare Communication

Objective: To examine whether having a usual source of care (USC) is associated with positive patient perceptions of health care communication and to identify demographic factors among patients with a USC that are independently associated with differing reports of how patients perceive their involvement in health care decision making. METHODS: Cross-sectional analyses of nationally representative data from the 2002 Medical Expenditure Panel Survey. Among adults with a health care visit in the past year (n = approximately 16,700), we measured independent associations between having a USC and patient perceptions of health care communication. Second, among respondents with a USC (n = approximately 18,000), we assessed the independent association between various demographic factors and indicators of patients' perceptions of their autonomy in making health care decisions. RESULTS: Approximately 78% of adults in the United States reported having a USC. Those with a USC were more likely to report that providers always listened to them, always explained things clearly, always showed respect, and always spent enough time with them. Patients who perceived higher levels of decision-making autonomy were non-Hispanic, had health insurance coverage, lived in rural areas, and had higher incomes. CONCLUSIONS: Patients with a USC were more likely to perceive positive health care interactions. Certain demographic factors among the subgroups of Medical Expenditure Panel Survey respondents with a USC were associated with patient perceptions of greater decision-making autonomy. Efforts to ensure universal access to a USC must be partnered with broader awareness and training of USC providers to engage patients from various demographic backgrounds equally when making health care decisions at the point of care.     

Therapists' and Clients' Perceptions of the Occupational Performance History Interview

SUMMARY

The Occupational Performance History Interview-Second Version (OPHI-II) is a semi-structured interview that gathers life history information. The interview data is used to score three rating scales and complete a narrative slope. Previous research has primarily examined the validity of the scales. This qualitative study sought to understand from the perspectives of therapists and clients how they experienced the interview process and narrative slope of the OPHI-II. Clients and therapists agreed that the OPHI-II interview built rapport, generated insights into the client's life experiences, and was helpful in planning goals and services and both groups generally found the narrative slope valuable. Both therapists and clients indicated the importance of tailoring the interview process and the narrative slope to each client's unique perspective and needs. Study findings both support the usefulness of the OPHI-II and provide suggestions for how it can be used most effectively.