在诊室中讨论患者的生活方式选择：1975 年至 2008 年间全科医生-患者咨询的分析。
Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008.
机构信息
Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN Utrecht, The Netherlands.
出版信息
BMC Fam Pract. 2010 Nov 9;11:87. doi: 10.1186/1471-2296-11-87.
BACKGROUND
The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room.This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background.
METHOD
We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression.
RESULTS
This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach). GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition). GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity).
CONCLUSION
In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle issues with patients who do not (yet) have risk symptoms.
背景
慢性病的发病率不断上升，人们越来越认识到生活方式对改善整体健康起着至关重要的作用，这表明需要在诊疗室更多地关注生活方式选择。本研究旨在调查与前几十年相比，患者的健康和不健康生活方式选择目前是否在初级保健咨询中讨论得更多。此外，我们还对全科医生在咨询中处理生活方式行为的方法感兴趣。最后，我们还调查了生活方式行为是否会因性别、年龄和教育背景等因素在咨询中与某些患者讨论得更多。
方法
我们分析了 1975 年至 2008 年间在荷兰全科医生诊所收集的医疗咨询的视频记录。使用逻辑回归分析数据。
结果
本研究表明，随着时间的推移，关于吸烟行为和体育活动的讨论有所增加。然而，关于营养和酒精的讨论变化则不那么明显。总体而言，在咨询中，饮酒的讨论最少，体育活动的讨论最多。全科医生主要在与患者的投诉（症状方法）相关时才会提到生活方式。全科医生对生活方式行为的处理方法并未随时间而改变。一般来说，生活方式行为在与老年、男性患者（营养除外）的咨询中讨论得更多。全科医生与来自不同教育背景的患者平等地讨论生活方式行为（体育活动除外）。
结论
近年来，人们对健康生活方式的认识有所提高，这在一定程度上反映在本研究中。尽管如此，生活方式行为仅在少数咨询中讨论。全科医生并没有将生活方式行为作为常规程序来处理，即不将其纳入初级预防。这凸显了引入预防咨询的重要性，在预防咨询中，全科医生可以与没有（尚未）出现风险症状的患者讨论生活方式问题。
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