Moral R R, Alamo M M, Jurado M A, de Torres L P
Unidad Docente de Medicina de Familia y Comunitaria de Córdoba, Spain.
Fam Pract. 2001 Feb;18(1):60-3. doi: 10.1093/fampra/18.1.60.
The aim of the present study was to find out if a training programme adapted to family physicians with several years of clinical experience changes their behaviour when they deal with fibromyalgic patients in the sense of introducing the communication skills that define the 'patient-centred' approach.
A randomized, and simple blind, educative study was carried out. Twenty full-time family physicians were invited to participate. They were allocated randomly to two groups: an intervention and a control group. A total of 110 patients were recruited from people attending physicians' surgeries for the first time and who complained of generalized pain that finally fulfilled criteria for generalized musculoskeletal chronic pain/fibromyalgia. This was done for an entire year. The intervention group received an 18 hour intensive course. One week after the course, all doctors carried out a video-recorded encounter with a patient who played the part of a typical fibromyalgia clinical case. The interviews were coded by an observer blind to the training status of the participants, using the GATHARES-CP questionnaire. All patients were contacted by telephone during a 1-2-month period by a different interviewer who was 'blinded' to the patient's experimental status. They were asked to respond to three questions that represent the key components of patient-centred style.
The average score on the GATHARES-CP questionnaire was 11.3 +/- 0.9 and 9 +/- 2.3, for doctors from the intervention and control groups, respectively (P < 0.01). For 11 items, scores were higher in the intervention group. The patients' answers to all three questions showed statistically significant differences in a positive direction for the trained doctors.
The doctors improved the use of strategies and skills for carrying out patient-centred consultations after they had received an interactive course. The doctors' behaviour appeared to have changed as much in a more experimental situation as in the actual consultations. Moreover, the gain was observed immediately after the intervention was completed, and after having run for a variable period of time up to 1 year.
本研究旨在探究一项针对有多年临床经验的家庭医生的培训项目，在引入“以患者为中心”方法所定义的沟通技巧时，是否会改变他们在诊治纤维肌痛患者时的行为。
开展了一项随机、单盲的教育性研究。邀请了20名全职家庭医生参与。他们被随机分为两组：干预组和对照组。从首次到医生诊所就诊且主诉全身疼痛并最终符合广泛性肌肉骨骼慢性疼痛/纤维肌痛标准的患者中招募了110名患者，为期一整年。干预组接受了为期18小时的强化课程。课程结束一周后，所有医生与一名扮演典型纤维肌痛临床病例的患者进行了视频记录的会诊。访谈由一名对参与者培训状态不知情的观察员使用GATHARES-CP问卷进行编码。在1至2个月的时间里，由另一名对患者的实验状态“不知情”的访谈员通过电话联系所有患者。要求他们回答代表以患者为中心风格关键要素的三个问题。
干预组和对照组医生在GATHARES-CP问卷上的平均得分分别为11.3±0.9和9±2.3（P<0.01）。对于11项内容，干预组的得分更高。患者对所有三个问题的回答显示，接受培训的医生在积极方向上存在统计学显著差异。
医生在接受互动课程后，改善了开展以患者为中心会诊的策略和技能运用。在更具实验性的情境以及实际会诊中，医生的行为似乎都有了同样程度的改变。此外，在干预完成后立即观察到了这种收获，并且在长达1年的不同时间段内都持续存在。
