Scherwitz Larry W, Cantwell Michael, McHenry Pamela, Wood Claudia, Stewart William
Institute for Health and Healing, California Pacific Medical Center, San Francisco, CA, USA.
J Altern Complement Med. 2004 Aug;10(4):651-9. doi: 10.1089/acm.2004.10.651.
To evaluate and describe an integrative medicine clinic including its patients; their presenting problems, medical objectives, treatment recommendations; whether recommendations were recalled and adhered to; and patients' self-reported health outcomes.
A prospective cohort study of 160 new clinic patients were treated using a wide range of integrative medicine therapies. Patients were interviewed at intervals of 1, 3, and 6 months after their initial visit.
The study was conducted at the Institute for Health and Healing clinic, at California Pacific Medical Center located in San Francisco, CA.
The subjects were new clinic patients seeking care for a variety of symptoms and diagnoses.
Patients presented with an average of 4.0 symptoms and 2.9 diagnoses; physicians recommended 9.5 "treatments" per patient.
At 6-month follow-up, symptom intensity decreased from 6.5 to 4.2 (on a 10-point scale; p < 0.005); and 57% of the patients had made "substantial" progress or had completely achieved their health objectives (p < 0.005). The Short Form 12 (SF-12) measure of mental and physical functioning improved significantly from baseline to one month (p = 0.05; p = 0.001, respectively) and maintained this improvement at 3 (p = 0.01; p = 0.01) and 6 months (p = 0.001; p = .001). At 1-month follow-up, patients recalled 57% of the actionable statements from the physician without a prompt and they followed 55% of all recommendations well (90% or above). Over the follow-up period, patients increasingly attributed the reductions in symptoms (p = 0.01) and achieving their health objectives (p = 0.01) to the treatment plan. Self-reported measures of days ill and days missed at work/school did not differ significantly from the year before coming to the clinic.
The results indicate that patients can recall and follow a complex treatment regimen. Subjective and objective measures of patients' health status improved after one month and this effect was sustained or improved further at 6 months follow-up. Further study is needed to determine whether patients' improvement was the result of the treatment regimen.
评估并描述一家综合医学诊所，包括其患者、患者所呈现的问题、医疗目标、治疗建议、患者是否能记住并遵守这些建议，以及患者自我报告的健康状况。
一项前瞻性队列研究，对160名新诊所患者采用多种综合医学疗法进行治疗。在患者初次就诊后的1个月、3个月和6个月时进行随访访谈。
该研究在位于加利福尼亚州旧金山的加利福尼亚太平洋医疗中心的健康与康复研究所诊所进行。
研究对象为因各种症状和诊断前来寻求治疗的新诊所患者。
患者平均呈现4.0种症状和2.9种诊断；医生为每位患者推荐9.5种“治疗方法”。
在6个月的随访中，症状强度从6.5降至4.2（采用10分制；p<0.005）；57%的患者取得了“显著”进展或完全实现了健康目标（p<0.005）。简明健康调查量表（SF - 12）中关于心理和生理功能的测量从基线到1个月时显著改善（分别为p = 0.05；p = 0.001），并在3个月（p = 0.01；p = 0.01）和6个月（p = 0.001；p = 0.001）时保持这种改善。在1个月的随访中，患者在没有提示的情况下能记住医生57%的可行建议，并且能很好地遵循所有建议的55%（90%及以上）。在随访期间，患者越来越多地将症状减轻（p = 0.01）和实现健康目标（p = 0.01）归因于治疗方案。自我报告的生病天数以及工作/学校缺勤天数与来诊所前一年相比没有显著差异。
结果表明患者能够记住并遵循复杂的治疗方案。患者健康状况的主观和客观测量在1个月后有所改善，并且在6个月随访时这种效果得以维持或进一步改善。需要进一步研究以确定患者的改善是否是治疗方案的结果。
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