Turner Judith A, Ciol Marcia A, Von Korff Michael, Berger Richard
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98195, USA.
Arch Intern Med. 2005 May 9;165(9):1054-9. doi: 10.1001/archinte.165.9.1054.
Heightened awareness of patients' reasons for physician visits for male pelvic pain (nonbacterial prostatitis) and symptom concerns may increase patient satisfaction with care and help guide better management of this syndrome, for which evidence-based treatment is lacking.
We interviewed men with recent health maintenance organization visits for new episodes of nonbacterial prostatitis (N = 286; mean age, 46.7 years) and again 3, 6, and 12 months later. We inquired about their reasons for the visit and, at each interview, symptom concerns. We used Poisson regression to examine the association between baseline symptom worry and health care utilization during the 14 months after the index visit.
Most patients reported concern at the index visit that they might have an infection (73%) or cancer (68%). One year later, 43% reported prostatitis symptoms in the past month. Among these, many were still concerned that their symptoms would worsen if untreated (71%), that they had cancer (46%) or an infection (45%), and that they might need surgery (44%). Controlling for patient age and baseline symptom severity, we found that baseline symptom worry predicted prostatitis-related health care visits over the 14 months after the index visit (P = .005).
Despite symptom improvement following a health care visit for a new episode of pelvic pain/nonbacterial prostatitis, continued patient concerns about cancer, infection, and symptom worsening without treatment were common, even 1 year later. Patient worry may be associated with increased health care utilization.
提高对男性盆腔疼痛(非细菌性前列腺炎)患者就诊原因及症状担忧的认识,可能会提高患者对治疗的满意度,并有助于更好地管理这种缺乏循证治疗的综合征。
我们对近期因新发非细菌性前列腺炎就诊于健康维护组织的男性进行了访谈(N = 286;平均年龄46.7岁),并在3、6和12个月后再次访谈。我们询问了他们的就诊原因以及每次访谈时的症状担忧情况。我们使用泊松回归分析来研究基线症状担忧与首次就诊后14个月内医疗服务利用之间的关联。
大多数患者在首次就诊时表示担心自己可能患有感染(73%)或癌症(68%)。一年后,43%的患者报告在过去一个月有前列腺炎症状。在这些患者中,许多人仍然担心如果不治疗症状会恶化(71%),担心自己患有癌症(46%)或感染(45%),以及担心可能需要手术(44%)。在控制患者年龄和基线症状严重程度后,我们发现基线症状担忧可预测首次就诊后14个月内与前列腺炎相关的医疗就诊情况(P = 0.005)。
尽管因新发盆腔疼痛/非细菌性前列腺炎就诊后症状有所改善,但患者对癌症、感染以及未经治疗症状会恶化的持续担忧仍然普遍,即使在一年后也是如此。患者的担忧可能与医疗服务利用增加有关。