Astin John A, Soeken Karen, Sierpina Victor S, Clarridge Brian R
California Pacific Medical Center, 2300 California Street, Room 207, San Francisco, CA 94115, USA.
J Am Board Fam Med. 2006 Nov-Dec;19(6):557-65. doi: 10.3122/jabfm.19.6.557.
Examine physicians' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and identify barriers to the integration of evidence-based mind-body methods.
Random sample of primary care physicians and physicians from selected non-primary specialties was drawn. A total of 1058 physicians completed a 12-page survey.
The response rate was 27%. Although a majority of physicians seem to recognize the importance of addressing psychosocial issues, approximately one third believe that addressing such factors would lead to minimal or no improvements in outcomes. A minority reports their training regarding the role of psychosocial factors was effective, and relatively few indicate interest in receiving further training in these areas. Males were less likely to believe in the importance of addressing psychosocial factors. Additional factors included perceptions that training was poor in these areas; feelings of low self-efficacy to address psychosocial issues and the perception that such factors are difficult to control; lack of knowledge of the evidence-base supporting the role of psychosocial factors; and lack of time and inadequate reimbursement to address the psychosocial domain.
These results suggest the need for more comprehensive training in the role of psychosocial factors in health. In addition, the finding that physicians identify lack of time and inadequate reimbursement as significant barriers suggests that the current health care delivery system may, in many respects, be antithetical to the biopsychosocial model.
研究医生对在诊断和治疗中纳入社会心理因素的态度，并确定循证身心方法整合的障碍。
抽取初级保健医生和选定非初级专科医生的随机样本。共有1058名医生完成了一份12页的调查问卷。
回复率为27%。虽然大多数医生似乎认识到解决社会心理问题的重要性，但约三分之一的医生认为解决这些因素对治疗结果的改善微乎其微或没有改善。少数医生报告称他们关于社会心理因素作用的培训有效，相对较少的医生表示有兴趣接受这些领域的进一步培训。男性不太可能相信解决社会心理因素的重要性。其他因素包括认为这些领域的培训较差；应对社会心理问题时自我效能感低，以及认为这些因素难以控制；缺乏支持社会心理因素作用的循证知识；以及缺乏时间和报销不足，无法处理社会心理领域的问题。
这些结果表明需要对社会心理因素在健康中的作用进行更全面的培训。此外，医生将缺乏时间和报销不足视为重大障碍这一发现表明，当前的医疗保健提供系统在许多方面可能与生物心理社会模型背道而驰。
