Johns Hopkins University, Department of Health Policy and Management, 624 North Broadway, Baltimore, MD 21205, USA.
Soc Sci Med. 2011 Mar;72(6):823-31. doi: 10.1016/j.socscimed.2011.01.015. Epub 2011 Feb 24.
Older adults are commonly accompanied to routine physician visits, primarily by adult children and spouses. This is the first review of studies investigating the dynamics and consequences of patient accompaniment. Two types of evidence were examined: (1) observational studies of audio and/or videotaped medical visits, and (2) surveys of patients, families, or health care providers that ascertained experiences, expectations, and preferences for family companion presence and behaviors in routine medical visits. Meta-analytic techniques were used to summarize the evidence describing attributes of unaccompanied and accompanied patients and their companions, medical visit processes, and patient outcomes. The weighted mean rate of patient accompaniment to routine adult medical visits was 37.6% in 13 contributing studies. Accompanied patients were significantly older and more likely to be female, less educated, and in worse physical and mental health than unaccompanied patients. Companions were on average 63 years of age, predominantly female (79.4%), and spouses (54.7%) or adult children (32.2%) of patients. Accompanied patient visits were significantly longer, but verbal contribution to medical dialog was comparable when accompanied patients and their family companion were compared with unaccompanied patients. When a companion was present, health care providers engaged in more biomedical information giving. Given the diversity of outcomes, pooled estimates could not be calculated: of 5 contributing studies 0 were unfavorable, 3 inconclusive, and 2 favorable for accompanied relative to unaccompanied patients. Study findings suggest potential practical benefits from more systematic recognition and integration of companions in health care delivery processes. We propose a conceptual framework to relate family companion presence and behaviors during physician visits to the quality of interpersonal health care processes, patient self management and health care.
老年人通常在常规医生就诊时会有成年人陪同，主要是子女和配偶。这是首次对研究患者陪同的动态和后果的综述。两种证据都进行了检查：（1）对音频和/或视频录制的医疗就诊的观察性研究，以及（2）对患者、家庭或医疗保健提供者进行的调查，以确定在常规医疗就诊中对家庭陪伴的存在和行为的经验、期望和偏好。使用荟萃分析技术总结了描述无陪伴和有陪伴患者及其陪伴者、医疗就诊过程和患者结果的属性的证据。在 13 项参与研究中，有 37.6%的常规成年医疗就诊有患者陪同。有陪伴的患者明显年龄更大，更可能是女性、受教育程度更低，身体和心理健康状况更差。陪伴者的平均年龄为 63 岁，主要是女性（79.4%），是患者的配偶（54.7%）或成年子女（32.2%）。陪同患者的就诊时间明显更长，但当陪同患者及其家庭陪伴者与无陪伴患者进行比较时，他们对医疗对话的口头贡献相当。当有陪伴者在场时，医疗保健提供者会提供更多的生物医学信息。鉴于结果的多样性，无法计算汇总估计值：在 5 项参与研究中，0 项对陪同患者不利，3 项结果不确定，2 项对陪同患者有利。研究结果表明，从更系统地认识和整合陪伴者在医疗保健提供过程中的作用，可能具有潜在的实际益处。我们提出了一个概念框架，将家庭陪伴者在医生就诊时的存在和行为与人际医疗保健过程、患者自我管理和医疗保健的质量联系起来。
