对医疗保健的信任会影响慢性病患者对补充和替代医学的使用吗？
Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?
作者信息
van den Brink-Muinen A, Rijken P M
机构信息
NIVEL (Netherlands institute for health services research), Utrecht, The Netherlands.
出版信息
BMC Public Health. 2006 Jul 18;6:188. doi: 10.1186/1471-2458-6-188.
BACKGROUND
People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM), often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use.
METHODS
The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD). Patients (>or=25 years) were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis.
RESULTS
Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics.
CONCLUSION
Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care.
背景
人们对医疗保健及医疗保健专业人员的信任对于医疗保健的有效性至关重要，尤其是对于慢性病患者而言，因为慢性病从定义上来说（部分）是无法治愈的。因此，慢性病患者常常在接受常规治疗的同时还求助于补充和替代医学（CAM），这或许是可以理解的。慢性病患者使用CAM的频率是非慢性病患者的两到五倍。迄今为止，慢性病患者对医疗保健及医疗保健专业人员的信任以及这种信任与使用CAM之间的关系尚未见报道。在本研究中，我们考察了慢性病患者对医疗保健及医疗保健专业人员的信任对使用CAM的影响。
方法
本样本包括“慢性病患者小组”（PPCD）的受访者。患者（年龄≥25岁）由全科医生挑选。共纳入1625名慢性病患者。通过书面问卷测量信任度和CAM的使用情况。统计分析采用独立样本t检验、卡方检验和单因素方差分析以及逻辑回归分析。
结果
慢性病患者对未来医疗保健的信任度相对较低。他们对有资质的替代疗法从业者的信任低于对常规医疗保健专业人员的信任，对无资质的替代疗法从业者的信任更低。在控制了社会人口统计学和疾病特征后，患者对未来医疗保健的信任度越低，就越倾向于使用CAM。
结论
对未来医疗保健的信任是使用CAM的一个重要预测因素。慢性病患者使用CAM的情况在不久的将来可能会增加。因此，卫生政策制定者应警惕替代疗法从业者的执业质量，例如坚持要求专业认证。同样，高质量可能会增加人们对公共医疗保健的信任。
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