Harrington Jane, Noble Lorraine M, Newman Stanton P
Department of Psychiatry and Behavioural Sciences, University College London, Wolfson Building, 48 Riding House Street, W1N 8AA, London, UK.
Patient Educ Couns. 2004 Jan;52(1):7-16. doi: 10.1016/s0738-3991(03)00017-x.
A systematic review of the literature examined intervention studies designed to increase patients' participation in medical consultations. Twenty-five papers describing twenty studies met the inclusion criteria. About half of the intervention studies were randomised placebo controlled experimental designs. The studies were predominantly conducted in outpatient or primary care settings, with 50% of the interventions presented in a written form. Overall, half of the interventions resulted in increased patient participation, with slightly more significant results found for bids for clarification than question-asking. However, of the 10 written interventions only two reported a significant increase in question-asking. Patient satisfaction was the most commonly measured outcome, but few significant improvements were found. However, there were significant improvements in other outcomes, including perceptions of control over health, preferences for an active role in health care, recall of information, adherence to recommendations, attendance, and clinical outcomes. Few studies examined the links between patient characteristics and the success of the interventions. Future research needs to establish which forms of intervention are most effective and practical, for which groups of patients.
一项对文献的系统综述考察了旨在提高患者参与医疗会诊程度的干预研究。描述20项研究的25篇论文符合纳入标准。约一半的干预研究采用随机安慰剂对照实验设计。这些研究主要在门诊或初级保健环境中进行，50%的干预措施以书面形式呈现。总体而言，一半的干预措施使患者参与度有所提高，其中寻求澄清比提问产生的效果略更显著。然而，在10项书面干预措施中，只有两项报告提问有显著增加。患者满意度是最常测量的结果，但几乎未发现显著改善。不过，在其他结果方面有显著改善，包括对健康的控制感、在医疗保健中积极参与的偏好、信息回忆、对建议的依从性、就诊率和临床结果。很少有研究考察患者特征与干预成功之间的联系。未来的研究需要确定哪种干预形式对哪些患者群体最有效且实用。
