Adams R J, Smith B J, Ruffin R E
Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia.
Ann Allergy Asthma Immunol. 2001 Mar;86(3):263-71. doi: 10.1016/S1081-1206(10)63296-6.
To identify factors associated with asthma patients' perceptions of the propensity of pulmonologists to involve them in treatment decision-making, and its association with asthma outcomes.
Cross-sectional observational study performed from June 1995 to December 1997.
Pulmonary unit of a university teaching hospital.
Adult patients with asthma (n = 128).
By patient self-report, mean physician's participatory decision-making (PDM) style score was 72 (maximum 100, 95% CI 65, 79). PDM scores were significantly correlated (P < .0001) with the duration of clinic visits (r = .63), patient satisfaction (r = .53), duration of tenure of doctor-patient relationship (r = .37), and formal education (r = .22, P = .023). Significantly higher PDM style scores were reported when visits lasted longer than 20 minutes and when a patient had a >6-month relationship with a particular doctor. PDM scores were also significantly correlated with possession of a written asthma action plan (r = .54, P < .0001), days affected by asthma (r = .36, P = .0001), asthma symptoms (r = .23, P = .017), and preferences for autonomy in asthma management decisions (r = .28, P = .0035). Those with PDM scores <50 reported significantly lower quality of life for all domains of a disease-specific instrument and the Short-Form 36 health survey version 1.0. In multiple regression analysis, PDM style was associated with the length of the office visit and the duration of tenure of the physician-patient relationship (R2 = 0.47, P = .0009). The adjusted odds ratio, per standard deviation decrease in PDM scores, for an asthma hospitalization was 2.0 (95% CI 1.2, 3.2) and for rehospitalization was 2.5 (95% CI 1.2, 4.2).
Patients' report of their physician's PDM style is significantly associated with health-related quality of life, work disability, and recent need for acute health services. Organizational factors, specifically longer visits and more time seeing a particular physician, are independently associated with more participatory visits. This has significant policy implications for asthma management.
确定与哮喘患者对肺科医生让其参与治疗决策倾向的认知相关的因素，以及这种认知与哮喘治疗结果之间的关联。
1995年6月至1997年12月进行的横断面观察性研究。
一所大学教学医院的肺病科。
成年哮喘患者（n = 128）。
根据患者自我报告，医生参与式决策（PDM）风格的平均得分为72分（满分100分，95%置信区间为65至79）。PDM得分与门诊就诊时长（r = 0.63）、患者满意度（r = 0.53）、医患关系持续时间（r = 0.37）以及正规教育程度（r = 0.22，P = 0.023）显著相关（P < 0.0001）。当就诊时间超过20分钟以及患者与特定医生的关系超过6个月时，报告的PDM风格得分显著更高。PDM得分还与拥有书面哮喘行动计划（r = 0.54，P < 0.0001）、受哮喘影响的天数（r = 0.36，P = 0.0001）、哮喘症状（r = 0.23，P = 0.017）以及哮喘管理决策中的自主偏好（r = 0.28，P = 0.0035）显著相关。PDM得分<50的患者在疾病特异性量表的所有领域以及简短健康调查问卷1.0版中的生活质量得分显著更低。在多元回归分析中，PDM风格与门诊就诊时长以及医患关系持续时间相关（R2 = 0.47，P = 0.0009）。PDM得分每降低一个标准差，哮喘住院的调整优势比为2.0（95%置信区间为1.2至3.2），再次住院的调整优势比为2.5（95%置信区间为1.2至4.2）。
患者对医生PDM风格的报告与健康相关生活质量、工作残疾以及近期对急性医疗服务的需求显著相关。组织因素，特别是更长的就诊时间和与特定医生相处的更多时间，与更具参与性的就诊独立相关。这对哮喘管理具有重要的政策意义。
