Innes Michael, Skelton John, Greenfield Sheila
Department of Primary Care and General Practice, Medical School, University of Birmingham, Edgbaston, Birmingham.
Br J Gen Pract. 2006 May;56(526):363-8.
Telephone consultations are a part of everyday practice, there is surprisingly little research on the subject.
To describe the variation of consulting skills within a body of telephone consultations in primary care, highlighting the performance of one method of assessing the process of the consultation-- the Roter Interaction Analysis System-- with telephone consultations.
Cross sectional study of 43 recordings of telephone consultations with GPs.
One rural county in the Midlands.
Recordings were made of 8 GPs, purposively selected for maximum variance in one region of the UK. Forty-three consultations were coded using the Roter Interaction Analysis System. From the descriptive categories, six composite categories were compiled reflecting a number of domains of interaction in a consultation: rapport, data gathering, patient education and counselling, partnership building, doctor dominance and patient-centredness. Analysis of variance was undertaken to explain variations between consultations for the different domains. Comparison was made to findings from similar work for face-to-face consultations.
These telephone consultations feature more biomedical information exchange than psychosocial or affective communication. Length of interaction accounts for much of the variation seen between consultations in the domains of rapport, data gathering, patient education and counselling and partnership. Male doctors are more patient centred in this study. There is the suggestion of more doctor dominance and a less patient-centred approach when comparisons are made with previous work on face-to-face consultations.
Although the telephone is increasingly being used to provide care, this study highlights the fact that telephone consultations cannot be taken as equivalent to those conducted face to face. More work needs to be done to delineate the features of telephone consultations.
电话咨询是日常医疗实践的一部分，但令人惊讶的是，关于这一主题的研究很少。
描述基层医疗中电话咨询群体内咨询技巧的差异，突出一种评估咨询过程的方法——罗特互动分析系统在电话咨询中的表现。
对43份全科医生电话咨询录音进行横断面研究。
英格兰中部的一个乡村县。
录制了8位全科医生的咨询录音，这些医生是在英国一个地区特意挑选出来以实现最大差异的。使用罗特互动分析系统对43次咨询进行编码。从描述性类别中，编制了六个综合类别，反映咨询中互动的多个领域：融洽关系、数据收集、患者教育与咨询、建立伙伴关系、医生主导和以患者为中心。进行方差分析以解释不同领域咨询之间的差异。与面对面咨询的类似研究结果进行比较。
这些电话咨询的特点是生物医学信息交流多于心理社会或情感交流。互动时长在融洽关系、数据收集、患者教育与咨询以及建立伙伴关系等领域的咨询差异中占很大比例。在本研究中，男医生更以患者为中心。与之前关于面对面咨询的研究相比，有迹象表明医生主导性更强，以患者为中心的程度更低。
尽管电话越来越多地用于提供医疗服务，但本研究强调了电话咨询不能等同于面对面咨询这一事实。需要做更多工作来描绘电话咨询的特征。
