Department of Clinical Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, New York 10461, USA.
Ophthalmology. 2010 Jul;117(7):1339-47.e6. doi: 10.1016/j.ophtha.2009.11.026. Epub 2010 Mar 7.
To assess communication about adherence and to determine the impact of communication skills training on physicians' approach to nonadherence.
Sociolinguistic analysis of videotaped community ophthalmologists' encounters with patients with glaucoma before and after training. Patients in both phases and physicians in phase I knew communication was being studied but not what the focus of the study was. In phase II, physicians knew the targeted communication behaviors.
Twenty-three ophthalmologists and 100 regularly scheduled patients with glaucoma (50 per phase).
An educational program with videotaped vignettes of simulated patient encounters using audience response and role play to teach patient-centered communication skills, including a 4-step adherence assessment and the use of open-ended questions in ask-tell-ask sequences.
Physician eliciting an acknowledgment of nonadherence during a clinical encounter compared with acknowledgment of nonadherence during a postvisit research interview (primary outcome), and performance of targeted communication and substantive discussion of adherence.
After intervention, physicians increased the proportion of open-ended questions (15% vs 6%; P = 0.001) and specifically about medication taking (82% compared with 18% of encounters; P<0.001). Compared with the absence of ask-tell-ask communication, 32% of phase II encounters included a complete ask-tell-ask sequence, 78% included an ask-tell sequence, and 32% a tell-ask sequence (P<0.001). Three of 4 steps for assessment of adherence were more common in phase II, and substantial discussions of adherence occurred in 86% versus 30% of encounters (P<0.001). In phase II, physicians elicited acknowledgment of nonadherence in 78% (7/9) of those who acknowledged nonadherence in the postvisit interview compared with 25% in phase I (3/12; P = 0.03).
This study demonstrates that experienced community physicians significantly improved their communication strategies and ability to detect and address nonadherence after a 3-hour educational program.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
评估关于遵医行为的沟通情况，并确定沟通技巧培训对医生处理不遵医行为的方法的影响。
在培训前后，对社区眼科医生与青光眼患者的录像会面进行社会语言学分析。两阶段的患者和第一阶段的医生都知道沟通正在被研究，但不知道研究的重点是什么。在第二阶段，医生知道了目标沟通行为。
23 名眼科医生和 100 名定期预约的青光眼患者（每阶段 50 名）。
使用观众反应和角色扮演的录像短剧来教授以患者为中心的沟通技巧的教育计划，包括 4 步遵医评估和在询问-告知-询问序列中使用开放式问题。
与在随访研究访谈中相比，医生在临床接触中引出不遵医行为的承认（主要结果），以及执行目标沟通和对遵医行为进行实质性讨论。
干预后，医生增加了开放式问题的比例（15%比 6%；P=0.001），特别是关于药物使用的问题（82%比接触中 18%；P<0.001）。与缺乏询问-告知-询问沟通相比，第二阶段的接触中有 32%包括完整的询问-告知-询问序列，78%包括询问-告知序列，32%包括告知-询问序列（P<0.001）。在第二阶段，评估遵医行为的 4 个步骤中的 3 个更常见，86%的接触中有实质性的遵医行为讨论，而第一阶段只有 30%（P<0.001）。在第二阶段，在那些在随访访谈中承认不遵医行为的人中，有 78%（7/9）的人被医生引出了不遵医行为的承认，而第一阶段只有 25%（3/12；P=0.03）。
这项研究表明，在经过 3 小时的教育计划后，经验丰富的社区医生显著改善了他们的沟通策略和发现并处理不遵医行为的能力。
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