Hamilton William, Russell David, Stabb Catherine, Seamark David, Campion-Smith Charles, Britten Nicky
CAPER research practices, Halford Wing Dean Clarke House, Southernhay, Exeter EX1 1PQ, UK.
Fam Pract. 2007 Feb;24(1):77-83. doi: 10.1093/fampra/cml057. Epub 2006 Nov 30.
What the patient wants from a general practice consultation and what the doctor believes they want are not always the same thing. This mismatch may lead to unwanted and unnecessary prescribing.
To study the effect of a one-page form completed by patients before their consultation and given to the doctor at the start of the consultation, in terms of a reduction in prescribing, satisfaction with the consultation and adherence with prescribed medication.
Randomized controlled trial.
Ten general practices in Devon and Dorset, UK.
Unselected patients attending general practice appointments were randomised to receive (or not) a self-completed agenda form (SCAF) asking five questions, including whether the patient considered they should receive a prescription.
Approximately 4125 patients were offered entry; 3124 (76%) agreed to randomisation. In 1783 (57%) of these prescribing or satisfaction outcomes were identified. 457 of 811 (56.4%) of SCAF patients received a prescription, at a median (IQR) cost of pound 5.60 (inter-quartile range pound 2.12- pound 16.10), compared with 418 of 799 (52.3%) of controls, at a median cost of pound 5.94 ( pound 2.46- pound 18.90); both results non-significant (P=0.10 for prescribing and 0.30 for cost). Satisfaction was also similar in both groups: mean satisfaction score in SCAFs 5.37 and in controls 5.40 (P=0.64), as was adherence: at 12 weeks, adherence of 75% or greater was reported by 92 of 136 SCAF patients (68%) and 105 of 145 controls (72%) (P=0.31).
The negative result could have two explanations. Either the intervention did not achieve the intention of communicating the patients' agendas, or if it did, patients may have been persuaded by doctors' explanations in the consultation.
患者对全科医疗咨询的期望与医生认为他们的期望并不总是一致。这种不匹配可能导致不必要的开药。
研究患者在咨询前填写并在咨询开始时交给医生的一页表格，在减少开药、咨询满意度和遵医嘱用药方面的效果。
随机对照试验。
英国德文郡和多塞特郡的十家全科诊所。
未经过挑选的前来进行全科医疗预约的患者被随机分组，分别接受（或不接受）一份自行填写的议程表（SCAF），该表包含五个问题，其中包括患者是否认为自己应该接受处方。
约4125名患者被邀请参与；3124名（76%）同意随机分组。其中1783名（57%）的开药或满意度结果被确定。811名SCAF组患者中有457名（56.4%）接受了处方，中位数（四分位间距）费用为5.60英镑（四分位间距为2.12英镑至16.10英镑），而799名对照组患者中有418名（52.3%）接受了处方，中位数费用为5.94英镑（2.46英镑至18.90英镑）；两组结果均无统计学意义（开药方面P = 0.10，费用方面P = 0.30）。两组的满意度也相似：SCAF组的平均满意度评分为5.37，对照组为5.40（P = 0.64），遵医嘱情况也是如此：在12周时，136名SCAF组患者中有92名（68%）报告遵医嘱率达到75%或更高，145名对照组患者中有105名（72%）（P = 0.31）。
阴性结果可能有两种解释。要么干预措施没有达到传达患者议程的目的，要么即使达到了，患者可能在咨询过程中被医生的解释所说服。
