Stewart M, Brown J B, Donner A, McWhinney I R, Oates J, Weston W W, Jordan J
Centre for Studies in Family Medicine, The University of Western Ontario, London, Canada.
J Fam Pract. 2000 Sep;49(9):796-804.
We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization.
We selected 39 family physicians at random, and 315 of their patients participated. Office visits were audiotaped and scored for patient-centered communication. In addition, patients were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1) patients' health, assessed by a visual analogue scale on symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by chart review. The 2 measures of patient-centeredness were correlated with the outcomes of visits, adjusting for the clustering of patients by physician and controlling for confounding variables.
Patient-centered communication was correlated with the patients' perceptions of finding common ground. In addition, positive perceptions (both the total score and the subscore on finding common ground) were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.
Patient-centered communication influences patients' health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.
我们设计了这项观察性队列研究，以评估初级保健就诊中以患者为中心的沟通与后续健康状况及医疗服务利用之间的关联。
我们随机选择了39名家庭医生，他们的315名患者参与了研究。对门诊就诊进行录音，并对以患者为中心的沟通进行评分。此外，询问患者对就诊以患者为中心程度的看法。结果包括：（1）通过视觉模拟量表评估患者的症状不适和担忧程度来衡量患者健康状况；（2）使用医学结局研究简表36进行健康状况自评；（3）通过查阅病历评估诊断检查、转诊以及看家庭医生等医疗服务利用变量。对以患者为中心的两种测量方法与就诊结果进行相关性分析，对患者按医生进行聚类调整，并控制混杂变量。
以患者为中心的沟通与患者对找到共同立场的看法相关。此外，积极的看法（包括总分和在找到共同立场方面的子分数）与患者从不适和担忧中更好地恢复、两个月后更好的情绪健康状况以及更少的诊断检查和转诊相关。
以患者为中心的沟通通过患者认为就诊是以患者为中心的这种认知来影响患者健康，特别是通过患者认为与医生达成了共同立场的这种认知。以患者为中心的医疗实践通过减少诊断检查和转诊改善了健康状况并提高了医疗效率。
