针对医学无法解释症状的重新归因训练实践的整群随机对照试验
Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms.
作者信息
Morriss Richard, Dowrick Christopher, Salmon Peter, Peters Sarah, Dunn Graham, Rogers Anne, Lewis Barry, Charles-Jones Huw, Hogg Judith, Clifford Rebecca, Rigby Christine, Gask Linda
机构信息
Division of Psychiatry, School of Community Health Sciences, University of Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7 2UH, UK.
出版信息
Br J Psychiatry. 2007 Dec;191:536-42. doi: 10.1192/bjp.bp.107.040683.
BACKGROUND
Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.
AIMS
To determine if practice-based training of GPs in reattribution changes doctor-patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.
METHOD
Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.
RESULTS
With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference -0.9, 95% CI -1.6 to -0.1; P=0.027) with no other effects on patient outcome or health contacts.
CONCLUSIONS
Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.
背景
重新归因常作为一种结构化咨询向全科医生（GP）传授，它能为医学无法解释的症状提供心理学解释。
目的
确定以实践为基础对全科医生进行重新归因培训是否会改变医患沟通，从而改善持续3个月医学无法解释症状患者的治疗效果。
方法
在16家诊所进行整群随机对照试验，74名全科医生和141名有医学无法解释症状的患者，6小时重新归因培训组与常规治疗组对比。
结果
经过培训，大部分符合重新归因的会诊比例增加（31%对2%，P = 0.002）。培训与生活质量下降相关（健康温度计差异-0.9，95%可信区间-1.6至-0.1；P = 0.027），对患者治疗效果或医疗接触无其他影响。
结论
以实践为基础的重新归因培训改变了医患沟通，但未改善医学无法解释症状患者的治疗效果。
Zotero 插件