van Dam Henk A, van der Horst Frans, van den Borne Bart, Ryckman Rick, Crebolder Harry
Department of General Practice, Maastricht University, Maastricht, The Netherlands.
Patient Educ Couns. 2003 Sep;51(1):17-28. doi: 10.1016/s0738-3991(02)00122-2.
A systematic review of the research literature using Medline, Embase, Psyclit/Psycinfo and the Cochrane Library files 1980 through 2001, identified only eight publications based on well-designed studies involving randomised controlled trials (RCTs)--testing the effects of modification of provider-patient interaction and provider consulting style on patient diabetes self-care and diabetes outcomes, in general practice or hospital outpatient settings. Review of these publications leads to the tentative conclusion that focusing on patient behaviour--directly enhancing patient participation i.e. by assistant-guided patient preparation for visits to doctors, empowering group education, group consultations, or automated telephone management--is more effective than focusing on provider behaviour to change their consulting style into a more patient-centred one. The latter proves hard to sustain, needs intensive support, and is not very effective in improving patient self-care and health outcomes when executed alone. Patient behaviour focused interventions show good efficacy and efficiency, and improve patient self-care and diabetes outcomes. More well-designed intervention studies focusing on enhancing patient participation in primary and hospital outpatient diabetes care are needed.
一项利用医学在线数据库（Medline）、荷兰医学文摘数据库（Embase）、心理学文摘数据库（Psyclit/Psycinfo）以及考克兰图书馆文件，对1980年至2001年期间的研究文献进行的系统综述，仅发现了八篇基于设计良好的研究（涉及随机对照试验，即RCT）的出版物，这些研究在全科医疗或医院门诊环境中，测试了改变医患互动及医生咨询方式对患者糖尿病自我护理及糖尿病治疗结果的影响。对这些出版物的综述得出初步结论：关注患者行为——直接增强患者参与度，即通过助手指导患者就诊准备、赋权小组教育、小组咨询或自动化电话管理——比关注医生行为以将其咨询方式转变为更以患者为中心的方式更为有效。事实证明，后者难以持续，需要大力支持，且单独实施时在改善患者自我护理和健康结果方面效果不佳。以患者行为为重点的干预措施显示出良好的疗效和效率，并改善了患者的自我护理和糖尿病治疗结果。需要更多设计良好的干预研究，以增强患者在基层和医院门诊糖尿病护理中的参与度。
