van den Brink-Muinen A, Verhaak P F M, Bensing J M, Bahrs O, Deveugele M, Gask L, Mead N, Leiva-Fernandez F, Perez A, Messerli V, Oppizzi L, Peltenburg M
NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.
Fam Pract. 2003 Aug;20(4):478-85. doi: 10.1093/fampra/cmg426.
Based on differences in national health care system characteristics such as the gatekeeping role of GPs (at the macrolevel) and on diverging GP and patient characteristics (at the microlevel), communication may differ between countries. Knowledge of the influence of these characteristics on doctor-patient communication will be important for setting European health care policies.
Our objectives were (i) to compare doctor-patient communication in general practice between European countries; and (ii) to investigate the influence of the gatekeeping system and GP and patient characteristics on doctor-patient communication in general practice.
Fifteen patients per GP (in total 2825 patients) of 190 GPs in six European countries were included. Participating countries were The Netherlands, Spain, the UK (gatekeeping countries), Belgium, Germany and Switzerland (non-gatekeeping countries). Data were collected by means of patient and GP questionnaires and observation of videotaped consultations, and analysed by one-way and multilevel, multivariate analysis.
Differences in communication between countries were found in: affective and instrumental behaviour; biomedical and psychosocial talk; GPs' patient-directed gaze; and consultation length. The study showed that GPs' gatekeeping role (with registered patients) was less important for doctor-patient communication than was expected. Patient characteristics such as gender, age, having psychosocial problems, and familiarity between the doctor and the patient were the most important in explaining differences in communication.
The gatekeeping role of GPs is hardly important in explaining doctor-patient communication. The relationship is more complex than expected. Patient and GP characteristics are more important. Cultural factors should be included in future studies.
基于各国医疗保健系统特征的差异，如全科医生的把关作用（在宏观层面）以及全科医生和患者特征的不同（在微观层面），各国之间的沟通可能存在差异。了解这些特征对医患沟通的影响对于制定欧洲医疗保健政策至关重要。
我们的目的是（i）比较欧洲国家全科医疗中的医患沟通；（ii）调查把关系统以及全科医生和患者特征对全科医疗中医患沟通的影响。
纳入了六个欧洲国家190名全科医生的每位医生的15名患者（共2825名患者）。参与国家有荷兰、西班牙、英国（实行把关制度的国家）、比利时、德国和瑞士（未实行把关制度的国家）。通过患者和全科医生问卷以及对录像会诊的观察收集数据，并通过单因素和多层次多变量分析进行分析。
发现各国之间在以下方面存在沟通差异：情感和工具性表现；生物医学和心理社会话题；全科医生对患者的注视；以及会诊时长。研究表明，全科医生（针对注册患者）的把关作用对医患沟通的重要性低于预期。患者特征，如性别、年龄、有心理社会问题以及医患之间的熟悉程度，在解释沟通差异方面最为重要。
全科医生的把关作用在解释医患沟通方面几乎不重要。这种关系比预期的更为复杂。患者和全科医生的特征更为重要。未来的研究应纳入文化因素。
