Braido Fulvio, Baiardini Ilaria, Menoni Stefania, Brusasco Vito, Centanni Stefano, Girbino Giuseppe, Dal Negro Roberto, Canonica Giorgio Walter
Department of Internal Medicine, Allergy and Respiratory Disease Clinic, University of Genoa, Genoa, Italy.
J Asthma. 2011 Apr;48(3):266-74. doi: 10.3109/02770903.2011.555040. Epub 2011 Mar 7.
Patient-physician communication and patients' knowledge about asthma are relevant factors that influence health outcomes. The aim of this study was to explore general practitioners' (GPs) behaviors, asthma patients' knowledge requirements, and the relationship between physicians' communicative issues, and failures in patients' knowledge.
GPs participating in a continuing medical education program on asthma completed an ad hoc survey on communicative style and recruited at least three adult asthma patients to indicate, among 10 options, three aspects of asthma about which they felt less informed.
The survey was completed by 2332 GPs (mean age 54.39 ± 5.93 years) and 7884 patients (mean age 49.59 ± 18.03 years). Several ineffective strategies emerged in the physicians' behaviors: 28.5% of GPs did not encourage patients to express doubts, expectations, or concerns; 39.4% tried to frighten patients concerning disease-related risks; only 25.7% used a written action plan. In addition, 18.6% of GPs were not averse to informing the patient about potential side effects; 16.3% did not try to simplify asthma treatment; approximately 30% considered ease of use when selecting drugs; 18% were not disposed to carry out a partnership with the patient; 36.9% were unlikely to involve the patient in asthma management; and 73% tried to retain control over their patients. Finally, 90.3% of GPs declared they want to be consulted before any treatment change. The three topics on which patients felt less informed were the meaning of asthma control (14% of patients); integration of asthma into daily life (13.3%); and periodic checkups (12.7%). There were significant associations between patients' choices and physicians' answers.
These results demonstrate that in general medicine the recommendations of international guidelines on education, communication, and development of a doctor-patient partnership are still ignored and that patients' educational priorities may differ from those identified by medical specialists and by patients belonging to patients' associations.
医患沟通以及患者对哮喘的了解是影响健康结局的相关因素。本研究的目的是探讨全科医生（GP）的行为、哮喘患者的知识需求，以及医生沟通问题与患者知识欠缺之间的关系。
参加哮喘继续医学教育项目的全科医生完成了一项关于沟通方式的专项调查，并招募至少三名成年哮喘患者，让他们从10个选项中指出自己了解较少的三个哮喘方面。
2332名全科医生（平均年龄54.39±5.93岁）和7884名患者（平均年龄49.59±18.03岁）完成了调查。医生的行为中出现了几种无效策略：28.5%的全科医生不鼓励患者表达疑问、期望或担忧；39.4%的医生试图就疾病相关风险吓唬患者；只有25.7%的医生使用了书面行动计划。此外，18.6%的全科医生不反对告知患者潜在副作用；16.3%的医生不试图简化哮喘治疗；约30%的医生在选择药物时考虑使用便利性；18%的医生不愿意与患者建立合作关系；36.9%的医生不太可能让患者参与哮喘管理；73%的医生试图对患者保持控制。最后，90.3%的全科医生表示在任何治疗变更前都希望得到咨询。患者了解较少的三个主题是哮喘控制的含义（14%的患者）；哮喘融入日常生活（13.3%）；以及定期检查（12.7%）。患者的选择与医生的回答之间存在显著关联。
这些结果表明，在普通医学中，国际指南关于教育、沟通和建立医患合作关系的建议仍被忽视，而且患者的教育重点可能与医学专家以及患者协会的患者所确定的重点不同。
