Mead Nicola, Bower Peter, Roland Martin
National Primary Care Research and Development Centre, University of Manchester, Manchester.
Br J Gen Pract. 2008 May;58(550):346-52. doi: 10.3399/bjgp08X280218.
Quality-improvement activities are most often focused on clinical quality indicators. However, patient evaluations are important additional indicators of the quality of general practice consultations, including measures of satisfaction or enablement (that is, the extent to which the consultation enhances the patient's feelings of confidence and ability to cope). There is limited evidence concerning factors associated with enablement in UK general practice.
To identify patient and practice characteristics associated with enablement scores following general practice consultations.
Cross-sectional survey using a large routinely-collected dataset of patient evaluations of general practice (190,038 individual patient responses).
A total of 1031 UK general practices.
Relationships between health, demographic factors, evaluations of general practice care, and patient self-reported enablement were estimated using multiple regression.
The primary predictor of enablement was positive patient evaluation of the GPs' communication. Reported continuity of care accounted for a lower proportion of the variance. Of the included patient demographic variables, ethnicity was a key predictor, with patients from minority ethnic groups reporting greater enablement once other factors were controlled.
The current results provide support for the construct validity of the enablement measure. However, if enablement is to become a valid and useful measure of quality, it is necessary to understand the mechanisms by which enablement is increased in certain patients and practices. Detailed qualitative research may also be required to explain the relatively high scores of ethnic minority responders, despite lower overall satisfaction scores, and to understand why some items included in the enablement measure are regarded as 'not applicable' by a substantial minority of patients.
质量改进活动大多聚焦于临床质量指标。然而，患者评估是全科医疗咨询质量的重要附加指标，包括满意度或赋能度（即咨询在多大程度上增强患者的信心和应对能力）的衡量。关于英国全科医疗中与赋能度相关因素的证据有限。
确定全科医疗咨询后与赋能度得分相关的患者和诊所特征。
采用大型常规收集的全科医疗患者评估数据集（190,038份个体患者回复）进行横断面调查。
英国共1031家全科诊所。
使用多元回归估计健康状况、人口统计学因素、全科医疗护理评估与患者自我报告的赋能度之间的关系。
赋能度的主要预测因素是患者对全科医生沟通的积极评价。所报告的连续护理在方差中所占比例较低。在纳入的患者人口统计学变量中，种族是一个关键预测因素，在控制其他因素后，少数族裔患者报告的赋能度更高。
当前结果为赋能度测量的结构效度提供了支持。然而，如果赋能度要成为质量的有效且有用的衡量标准，有必要了解某些患者和诊所中赋能度提高的机制。可能还需要进行详细的定性研究，以解释少数族裔受访者尽管总体满意度得分较低但赋能度得分相对较高的原因，并理解为什么赋能度测量中包含的一些项目被相当一部分患者视为“不适用”。
