Williams Geoffrey C, McGregor Holly A, King Diane, Nelson Candace C, Glasgow Russell E
Department of Medicine, University of Rochester, Rochester, NY 14627, USA.
Patient Educ Couns. 2005 Apr;57(1):39-45. doi: 10.1016/j.pec.2004.04.001.
There is considerable variation in care provided to patients with diabetes related to metabolic control, preventive services, and degree of patient-centered support. This study evaluates the relation of self-determination theory (SDT) constructs of clinician autonomy support, and patient competence to glycemic control, depressive symptoms, and patient satisfaction from baseline surveys of 634 patients of 31 Colorado primary care physicians participating in a program to improve diabetes care. Spearman correlations of autonomy support from one's clinician with patient competence, HbA1c, depressive symptoms and satisfaction were significant (R = -0.11 to 0.55, P < 0.005). Structural equation modeling demonstrated that autonomy support was significantly related to perceived competence, depressive symptoms, patient satisfaction, and indirectly to glycemic control. Perceived competence was significantly related to depressive symptoms, patient satisfaction and glycemic control. Further, the motivation constructs from SDT accounted for 5% of the variance in glycemic control, 8% of the variance in depression, and 42% of the variance in patient satisfaction. Quality improvement efforts need to pay greater attention to patient competence, satisfaction, and depression, in addition to glycemic control. Clinician autonomy support was found to be reliably measured and moderately correlated with psychosocial and biologic outcomes related to diabetes self-management. These results suggest training clinicians to increase their support of patient autonomy may be one important avenue to improve diabetes outcomes.
在为糖尿病患者提供的护理方面，与代谢控制、预防服务以及以患者为中心的支持程度相关存在着相当大的差异。本研究通过对参与一项改善糖尿病护理项目的科罗拉多州31名初级保健医生的634名患者进行基线调查，评估了自我决定理论（SDT）中临床医生自主性支持和患者能力与血糖控制、抑郁症状及患者满意度之间的关系。临床医生给予的自主性支持与患者能力、糖化血红蛋白（HbA1c）、抑郁症状及满意度之间的斯皮尔曼相关性显著（R = -0.11至0.55，P < 0.005）。结构方程模型表明，自主性支持与感知能力、抑郁症状、患者满意度显著相关，并且间接与血糖控制相关。感知能力与抑郁症状、患者满意度及血糖控制显著相关。此外，自我决定理论中的动机构念分别解释了血糖控制变异的5%、抑郁变异的8%以及患者满意度变异的42%。除了血糖控制外，质量改进工作需要更加关注患者能力、满意度和抑郁情况。研究发现临床医生自主性支持能够得到可靠测量，并且与糖尿病自我管理相关的心理社会和生物学结果中度相关。这些结果表明，培训临床医生增加对患者自主性的支持可能是改善糖尿病治疗效果的一条重要途径。
