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患者对生活方式改变的责任困境:基层医疗医生和护士的看法

The dilemma of patient responsibility for lifestyle change: perceptions among primary care physicians and nurses.

作者信息

Jallinoja Piia, Absetz Pilvikki, Kuronen Risto, Nissinen Aulikki, Talja Martti, Uutela Antti, Patja Kristiina

机构信息

National Public Health Institute, Finland.

出版信息

Scand J Prim Health Care. 2007 Dec;25(4):244-9. doi: 10.1080/02813430701691778.

Abstract

OBJECTIVE

To explore physicians' and nurses' views on patient and professional roles in the management of lifestyle-related diseases and their risk factors.

DESIGN

A questionnaire study with a focus on adult obesity, dyslipidemia, high blood pressure, type 2 diabetes, and smoking.

SETTING

Healthcare centres in Päijät-Häme hospital district, Finland.

SUBJECTS

Physicians and nurses working in primary healthcare (n =220).

MAIN OUTCOME MEASURES

Perceptions of barriers to treatment of lifestyle-related conditions, perceptions of patients' responsibilities in self-care, experiences of awkwardness in intervening in obesity and smoking, perceptions of rushed schedules, and perceptions of health professionals' roles and own competence in lifestyle counselling.

RESULTS

A majority agreed that a major barrier to the treatment of lifestyle-related conditions is patients' unwillingness to change their habits. Patients' insufficient knowledge was considered as such a barrier less often. Self-care was actively encouraged. Although a majority of both physicians and nurses agreed that providing information, and motivating and supporting patients in lifestyle change are part of their tasks, only slightly more than one half estimated that they have sufficient skills in lifestyle counselling. Among nurses, those with less professional experience more often reported having sufficient skills than those with more experience. Two-thirds of the respondents reported that they had been able to help many patients to change their lifestyles into healthier ones.

CONCLUSIONS

The primary care professionals experienced a dilemma in patients' role in the treatment of lifestyle-related diseases: the patient was recognized as central in disease management but also, if reluctant to change, a major potential barrier to treatment.

摘要

目的

探讨医生和护士对于生活方式相关疾病及其危险因素管理中患者和专业人员角色的看法。

设计

一项以成人肥胖、血脂异常、高血压、2型糖尿病和吸烟为重点的问卷调查研究。

地点

芬兰派亚特-海梅医院区的医疗中心。

研究对象

在基层医疗工作的医生和护士(n = 220)。

主要观察指标

对生活方式相关疾病治疗障碍的认知、对患者自我护理责任的认知、干预肥胖和吸烟时的尴尬经历、对忙碌日程的认知、对卫生专业人员角色的认知以及自身在生活方式咨询方面的能力。

结果

大多数人认为生活方式相关疾病治疗的一个主要障碍是患者不愿改变习惯。患者知识不足较少被视为这样一个障碍。积极鼓励自我护理。虽然大多数医生和护士都认为提供信息以及激励和支持患者改变生活方式是他们任务的一部分,但只有略多于一半的人估计自己在生活方式咨询方面有足够的技能。在护士中,专业经验较少的人比经验较多的人更常报告自己有足够的技能。三分之二的受访者报告说他们能够帮助许多患者将生活方式转变为更健康的方式。

结论

基层医疗专业人员在生活方式相关疾病治疗中患者角色方面面临两难境地:患者被认为是疾病管理的核心,但如果不愿意改变,也是治疗的一个主要潜在障碍。

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