Fuertes Jairo N, Boylan Laura S, Fontanella Jessie A
Division of Psychological & Educational Services, Counseling Psychology Program, Fordham University, Graduate School of Education, New York, NY 10023, USA.
J Gen Intern Med. 2009 Jan;24(1):80-5. doi: 10.1007/s11606-008-0841-4. Epub 2008 Oct 30.
The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome.
Cognitive and emotional dimensions of the physician-patient relationship were examined in relation to patients' ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients' adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment.
The study was based on an ex-post facto field correlation design.
One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study.
Surveys given to participants.
We used the following measurements: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire.
The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49).
Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes.
工作联盟已被证明是心理治疗中患者治疗结果和满意度的一致预测指标。本研究探讨工作联盟及相关行为指标在预测医疗结果中的作用。
研究医患关系的认知和情感维度与患者对医生同理心、医生多元文化能力、治疗感知效用以及患者依从性自我效能感的评分之间的关系。然后，将这些因素作为理论框架的一部分，通过路径分析来解释患者自我报告的治疗依从性和满意度。
本研究基于事后实地相关设计。
来自纽约市一家大型市级医院贝尔维尤医院神经科门诊的152名成年门诊患者参与了该研究。
向参与者发放调查问卷。
我们使用了以下测量工具：医患工作联盟量表、感知效用量表、治疗依从性自我效能量表、医疗结果研究依从性量表、医生同理心问卷、医生多元文化能力问卷、医疗患者满意度问卷。
依从性的效应大小在0.07至0.21之间，满意度的效应大小在0.10至>0.50之间。回归分析和路径分析表明，医生多元文化能力评分和患者依从性自我效能信念分别预测了患者的依从性（标准化回归系数=0.34）和（标准化回归系数=0.30）以及满意度（标准化回归系数=0.18）和（标准化回归系数=0.12）。工作联盟评分也预测了患者满意度（标准化回归系数=0.49）。
医疗护理的心理和人际维度与患者的依从性和满意度相关。医疗护理提供者或许能够利用这些维度来针对并改善医疗保健结果。
