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[基层医疗中2型糖尿病症状的医疗决策]

[Medical decision making in symptoms of type 2 diabetes mellitus in general practice].

作者信息

de Cruppé W, von dem Knesebeck O, Gerstenberger E, Link C, Marceau L, Siegrist J, Geraedts M, McKinlay J

机构信息

Institut für Gesundheitssystemforschung, Universität Witten/Herdecke.

出版信息

Dtsch Med Wochenschr. 2011 Feb;136(8):359-64. doi: 10.1055/s-0031-1272536. Epub 2011 Feb 17.

Abstract

BACKGROUND

Patient and physician attributes influence medical decisions as non-medical factors. The current study examines the influence of patient age and gender and physicians' gender and years of clinical experience on medical decision making in patients with undiagnosed diabetes type 2.

METHOD

A factorial experiment was conducted to estimate the influence of patient and physician attributes. An identical physician patient encounter with a patient presenting with diabetes symptoms was videotaped with varying patient attributes. Professional actors played the “patients”. A sample of 64 randomly chosen and stratified (gender and years of experience) primary care physicians was interviewed about the presented videos.

RESULTS

Results show few significant differences in diagnostic decisions: Younger patients were asked more frequently about psychosocial problems while with older patients a cancer diagnosis was more often taken into consideration. Female physicians made an earlier second appointment date compared to male physicians. Physicians with more years of professional experience considered more often diabetes as the diagnosis than physicians with less experience.

CONCLUSION

Medical decision making in patients with diabetes type 2 is only marginally influenced by patients' and physicians' characteristics under study.

摘要

背景

患者和医生的属性作为非医学因素会影响医疗决策。本研究考察了患者年龄和性别以及医生性别和临床经验年限对未确诊的2型糖尿病患者医疗决策的影响。

方法

进行了一项析因实验以评估患者和医生属性的影响。对一名表现出糖尿病症状的患者与一名医生进行相同的诊疗过程进行录像,改变患者属性。专业演员扮演“患者”。对64名随机选取并按性别和经验年限分层的初级保健医生就所展示的视频进行访谈。

结果

结果显示诊断决策中几乎没有显著差异:年轻患者被更频繁地问及心理社会问题,而对于老年患者,癌症诊断更常被考虑。女医生比男医生确定的第二次预约日期更早。与经验较少的医生相比,有更多专业经验年限的医生更常将糖尿病作为诊断结果。

结论

2型糖尿病患者的医疗决策仅在一定程度上受到所研究的患者和医生特征的影响。

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