Beach Mary Catherine, Duggan Patrick S, Moore Richard D
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA.
J Gen Intern Med. 2007 Aug;22(8):1119-24. doi: 10.1007/s11606-007-0241-1. Epub 2007 May 19.
Previous studies suggest that patients who are more involved in their medical care have better outcomes.
We sought to compare health care processes and outcomes for patients with HIV based on their preferred level of involvement in health decisions.
Cross-sectional analysis of audio computer-assisted interviews with patients at an urban HIV clinic.
One thousand and twenty-seven patients awaiting an appointment with their primary care provider.
Patients were asked how they preferred to be involved in decisions (doctor makes most or all decisions, doctor and patient share decisions, patient makes all decisions). We also asked patients to rate the quality of communication with their HIV provider, and their self-reported receipt of and adherence to HAART.
Overall, 23% patients preferred that their doctor make all or most decisions, 63% preferred to share decisions with their doctor, and 13% preferred to make all final decisions alone. Compared to patients who prefer to share decisions with their HIV provider, patients who prefer that their provider make all/most decisions were significantly less likely to adhere to HAART (OR [odds ratio] 0.57, 95% CI 0.38-0.86) and patients who preferred to make decisions alone were significantly less likely to receive HAART or to have undetectable HIV RNA in unadjusted analyses (OR 0.52, 95% CI 0.31-0.87 for receipt of HAART; OR 0.64, 95% CI 0.44-0.95 for undetectable HIV RNA). After controlling for potentially confounding patient characteristics and differences in patient ratings of communication quality, patients who preferred that their provider make all/most decisions remained significantly less likely to adhere to HAART (OR 0.58, 95% CI 0.38-0.89); however, the associations with receipt of HAART and undetectable HIV RNA were no longer significant (OR 0.60, 95% CI 0.34-1.05 for receipt of HAART; OR 0.80, 95% C.I 0.53-1.20 for undetectable HIV RNA).
Although previous research suggests that more patient involvement in health care decisions is better, this benefit may be reduced when the patient wants to make decisions alone. Future research should explore the extent to which this preference is modifiable so as to improve outcomes.
先前的研究表明，更多参与医疗护理的患者会有更好的治疗结果。
我们试图根据患者在健康决策中偏好的参与程度，比较艾滋病病毒（HIV）患者的医疗保健过程和结果。
对一家城市HIV诊所的患者进行音频计算机辅助访谈的横断面分析。
1027名等待预约初级保健提供者的患者。
询问患者他们希望如何参与决策（医生做出大多数或所有决策、医生和患者共同做出决策、患者做出所有决策）。我们还询问患者对与HIV提供者沟通质量的评分，以及他们自我报告的高效抗逆转录病毒治疗（HAART）的接受情况和依从性。
总体而言，23%的患者希望医生做出所有或大多数决策，63%的患者希望与医生共同做出决策，13%的患者希望独自做出所有最终决策。与倾向于与HIV提供者共同做出决策的患者相比，倾向于让提供者做出所有/大多数决策的患者坚持HAART的可能性显著降低（比值比[OR]0.57，95%置信区间[CI]0.38 - 0.86），在未经调整的分析中，倾向于独自做出决策的患者接受HAART或HIV RNA检测不到的可能性显著降低（接受HAART的OR为0.52，95%CI为0.31 - 0.87；HIV RNA检测不到的OR为0.64，95%CI为0.44 - 0.95）。在控制了潜在的混杂患者特征和患者沟通质量评分的差异后，倾向于让提供者做出所有/大多数决策的患者坚持HAART的可能性仍然显著降低（OR 0.58，95%CI 0.38 - 0.89）；然而，与接受HAART和HIV RNA检测不到的关联不再显著（接受HAART的OR为0.60，95%CI为0.34 - 1.05；HIV RNA检测不到的OR为0.80，95%CI为0.53 - 1.20）。
尽管先前的研究表明患者更多地参与医疗保健决策更好，但当患者希望独自做出决策时，这种益处可能会降低。未来的研究应该探索这种偏好可改变的程度，以改善治疗结果。
