Ashworth Mark, Godfrey Emma, Harvey Kate, Darbishire Lucy
GKT Department of General Practice and Primary Care, King's College London, 5 Lambeth Walk, London SE11 6SP, UK.
Fam Pract. 2003 Aug;20(4):373-5. doi: 10.1093/fampra/cmg406.
The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices.
A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined.
Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores.
Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.
本研究旨在确定全科医疗的特征与这些机构中全科医生对诊疗中心理内容的认知之间的关系。
对服务于一个有41000名居民的内城区特定社区的所有全科医生（9个机构的22名全科医生）进行了横断面调查。要求全科医生在五个工作日内完成一份日志，用4点李克特量表对每次诊疗的心理内容认知进行评分，范围从0（无心理内容）到3（内容完全是心理方面的）。研究了全科医生和机构特征对心理内容得分的影响。
在研究期间，所有22名参与的全科医生进行的每一次基于诊疗室的诊疗（n = 2206）的数据均可用。心理内容得分的平均值为0.58（标准差0.33）。64%的诊疗记录显示没有任何心理内容；6%的诊疗内容完全是心理方面的。较高的心理内容得分与年轻的全科医生、培训机构（n = 3）、团队执业机构（n = 4）、有现场心理健康工作人员（n = 5）、较高的抗抑郁药处方量以及疫苗和涂片目标的达成显著相关。培训状态具有最大的预测能力，解释了心理内容变化的51%。诊疗室的诊疗率、全科医生的患者名单规模、年度精神科转诊率以及苯二氮䓬类药物的处方量均与心理内容得分无关。
全科医生对诊疗中心理维度的认识提高可能是培训机构教育环境的一个特征。
