Zebiene E, Svab I, Sapoka V, Kairys J, Dotsenko M, Radić S, Miholic M
Department of Internal Medicine, General Practice and Oncology, Vilnius University, Lithuania.
Patient Educ Couns. 2008 Nov;73(2):246-50. doi: 10.1016/j.pec.2008.07.034.
Efficient patient-physician collaboration is proven to have a direct benefit on health care outcomes through improved compliance, appointment keeping and use of preventive services. The aim of this study was to evaluate the patient-physician agreement on communication during primary care consultations and consider possible discrepancies.
A cross-sectional survey using self-administered questionnaires was performed in primary care in four European countries (Lithuania, Slovenia, Serbia and Russia). Post-consultation evaluations of doctor-patient communication were made by patients and physicians and were compared with pre-consultation expectations of the patient. Discrepancies in these evaluations were determined for the entire database, and within groups of expectations, using factor analysis.
One thousand three hundred and thirty-two sets of questionnaires were collected by the study team. In this sample, in more than 90% of consultations physicians and patients agreed about meeting patient expectations. Discrepancies were more likely to be identified when the patients were consulting the physician for the first time or had not seen that physician for more than 12 months (up to 26.1%). There is a significantly lower correlation between the physician recognising patient's unmet expectations for all factors if the physician had been working in Primary Care for between 6 and 10 years (8.6%). The results demonstrate that physicians working more than 16 years in practice are less likely to recognise that they have failed to meet the expectations of patients who are seeking reassurance (9%).
Personal continuity of care is associated with a lower discrepancy between the opinions of patients and physicians regarding meeting patient expectations during consultations in primary care. The highest agreement is within first 6 years in practice, which may reflect long-term effects of training.
Primary care physicians should put more emphasis on identifying and addressing patient expectations in primary care consultation, including agreement with patient. Existing discrepancies may be considered to be indicators of potential opportunities to improve physician's performance and overall quality of care.
事实证明，有效的医患合作通过提高依从性、按时就诊率以及预防性服务的利用率，对医疗保健结果有直接益处。本研究的目的是评估初级保健会诊期间医患之间在沟通方面的一致性，并考虑可能存在的差异。
在四个欧洲国家（立陶宛、斯洛文尼亚、塞尔维亚和俄罗斯）的初级保健机构中开展了一项使用自填式问卷的横断面调查。患者和医生对会诊后的医患沟通进行评价，并与患者会诊前的期望进行比较。使用因子分析确定整个数据库以及不同期望组内这些评价的差异。
研究团队共收集到1332份问卷。在这个样本中，超过90%的会诊中医师和患者对满足患者期望达成一致。当患者首次咨询医生或超过12个月未看过该医生时，差异更有可能被发现（高达26.1%）。如果医生在初级保健领域工作6至10年，对于所有因素，医生识别患者未满足期望的相关性显著较低（8.6%）。结果表明，从业超过16年的医生不太可能意识到他们未能满足寻求安心的患者的期望（9%）。
在初级保健会诊期间，连续性的个人医疗护理与患者和医生在满足患者期望方面的意见差异较小有关。实践的前6年一致性最高，这可能反映了培训的长期效果。
初级保健医生应更加重视在初级保健会诊中识别和处理患者期望，包括与患者达成一致。现有的差异可被视为改善医生表现和整体护理质量的潜在机会指标。
