改善骨关节炎患者初级护理的问题与需求：患者、全科医生及执业护士的观点
Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses.
作者信息
Rosemann Thomas, Wensing Michel, Joest Katharina, Backenstrass Matthias, Mahler Cornelia, Szecsenyi Joachim
机构信息
Department of General Practice and Health Services Research, University of Heidelberg, Vossstr, 2, 69115 Heidelberg, Germany.
出版信息
BMC Musculoskelet Disord. 2006 Jun 2;7:48. doi: 10.1186/1471-2474-7-48.
BACKGROUND
Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients.
METHODS
We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses.
RESULTS
Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement.
CONCLUSION
GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed.
背景
骨关节炎（OA）极为常见，对生活质量以及医疗成本有着重大影响。全科医生（GP）通常是这类慢性病患者的首诊医疗服务提供者。本研究的目的是确定OA患者的医疗需求，并揭示OA患者初级保健管理改善过程中可能存在的障碍。
方法
我们对20名患者、20名全科医生和20名执业护士组成的分层样本进行了半结构化访谈。
结果
诊断OA没有重大问题，但在OA病程中，全科医生发现难以区分关节病变引起的症状与并发抑郁症相关的症状。患者感觉自己对疾病的退行性本质和药物可能的副作用有充分了解，但他们缺乏关于该疾病个体后果的信息。因此，许多患者最主要的担忧是疼痛和对残疾的恐惧，他们觉得全科医生对这些问题关注甚少。在疼痛治疗方面，医生和患者对非甾体抗炎药和阿片类药物持矛盾态度。因此，疼痛治疗未按照现行指南进行。全科医生对关于生活方式改变的咨询效果感到沮丧，但另一方面也承认对此没有系统的方法。患者表示意识到生活方式对OA有影响，但缺乏详细信息，例如如何锻炼。针对改善提出了一些建议。
结论
全科医生应更多地关注残疾和疼痛，并提供有关治疗的信息，因为这些问题未得到充分解决。需要采用先进的方法来增强全科医生对患者生活方式的影响。鉴于意识到给患者贴上慢性病标签的问题，需要更积极主动、以患者为中心的护理。
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