老年人医疗决策中的患者参与和疼痛：由医生还是患者主导？
Patient involvement in medical decision-making and pain among elders: physician or patient-driven?
作者信息
Borders Tyrone F, Xu Ke Tom, Heavner James, Kruse Gina
机构信息
Department of Health Management and Policy, University of North Texas School of Public Health, 3500 Camp Bowie Blvd,, Fort Worth, TX 76107, USA.
出版信息
BMC Health Serv Res. 2005 Jan 14;5(1):4. doi: 10.1186/1472-6963-5-4.
BACKGROUND
Pain is highly prevalent among older adults, but little is known about how patient involvement in medical decision-making may play a role in limiting its occurrence or severity. The purpose of this study was to evaluate whether physician-driven and patient-driven participation in decision-making were associated with the odds of frequent and severe pain.
METHODS
A cross-sectional population-based survey of 3,135 persons age 65 and older was conducted in the 108-county region comprising West Texas. The survey included self-reports of frequent pain and, among those with frequent pain, the severity of pain.
RESULTS
Findings from multivariate logistic regression analyses showed that higher patient-driven participation in decision-making was associated with lower odds (OR, 0.82; 95% CI, 0.75-0.89) of frequent pain, but was not significantly associated with severe pain. Physician-driven participation was not significantly associated with frequent or severe pain.
CONCLUSIONS
The findings suggest that patients may need to initiate involvement in medical decision-making to reduce their chances of experiencing frequent pain. Changes to other modifiable health care characteristics, including access to a personal doctor and health insurance coverage, may be more conducive to limiting the risk of severe pain.
背景
疼痛在老年人中极为普遍，但对于患者参与医疗决策如何在限制疼痛的发生或严重程度方面发挥作用，人们了解甚少。本研究的目的是评估医生主导和患者主导的决策参与是否与频繁且严重疼痛的几率相关。
方法
在包括西德克萨斯州的108个县地区，对3135名65岁及以上的人群进行了基于人群的横断面调查。该调查包括频繁疼痛的自我报告，以及在频繁疼痛者中疼痛的严重程度。
结果
多变量逻辑回归分析的结果表明，患者主导的决策参与度较高与频繁疼痛的几率较低相关（比值比，0.82；95%置信区间，0.75 - 0.89），但与严重疼痛无显著关联。医生主导的参与与频繁或严重疼痛无显著关联。
结论
研究结果表明，患者可能需要主动参与医疗决策，以降低经历频繁疼痛的几率。改变其他可改变的医疗保健特征，包括获得私人医生服务和医疗保险覆盖范围，可能更有助于限制严重疼痛的风险。
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