Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine, Seattle, WA 98195, USA.
J Gen Intern Med. 2011 Nov;26(11):1317-23. doi: 10.1007/s11606-011-1773-y. Epub 2011 Jul 7.
Patients want all their concerns heard, but physicians fear losing control of time and interrupt patients before all concerns are raised.
We hypothesized that when physicians were trained to use collaborative upfront agenda setting, visits would be no longer, more concerns would be identified, fewer concerns would surface late in the visit, and patients would report greater satisfaction and improved functional status.
Post-only randomized controlled trial using qualitative and quantitative methods. Six months after training (March 2004-March 2005) physician-patient encounters in two large primary care organizations were audio taped and patients (1460) and physicians (48) were surveyed.
Experimental physicians received training in upfront agenda setting through the Establishing Focus Protocol, including two hours of training and two hours of coaching per week for four consecutive weeks.
Outcomes included agenda setting behaviors demonstrated during the early, middle, and late encounter phases, visit length, number of raised concerns, patient and physician satisfaction, trust and functional status.
Experimental physicians were more likely to make additional elicitations (p < 0.01) and their patients were more likely to indicate agenda completion in the early phase of the encounter (p < 0.01). Experimental group patients and physicians raised fewer concerns in the late encounter phase (p < 0.01). There were no significant differences in visit length, total concerns addressed, patient or provider satisfaction, or patient trust and functional status
Collaborative upfront agenda setting did not increase visit length or the number of problems addressed per visit but may reduce the likelihood of "oh by the way" concerns surfacing late in the encounter. However, upfront agenda setting is not sufficient to enhance patient satisfaction, trust or functional status. Training focused on physicians instead of teams and without regular reinforcement may have limited impact in changing visit content and time use.
患者希望他们所有的担忧都能被听到，但医生担心在所有问题都提出之前会失去对时间的控制并打断患者。
我们假设当医生接受使用协作式预先设定议程的培训时，就诊时间不会延长，会发现更多的问题，就诊后期出现的问题会减少，患者会报告更高的满意度和改善的功能状态。
仅在后期进行的随机对照试验，采用定性和定量方法。在培训后 6 个月（2004 年 3 月至 2005 年 3 月），对两个大型初级保健机构的医患双方进行音频录制，并对患者（1460 名）和医生（48 名）进行调查。
实验组医生通过“建立焦点协议”接受预先设定议程的培训，包括每周 2 小时的培训和 2 小时的辅导，连续进行 4 周。
包括在早期、中期和晚期就诊阶段展示的议程设定行为、就诊时间、提出的问题数量、患者和医生的满意度、信任度和功能状态。
实验组医生更有可能进行额外的引出（p < 0.01），他们的患者更有可能在就诊早期阶段表示完成了议程（p < 0.01）。实验组患者和医生在就诊后期阶段提出的问题较少（p < 0.01）。就诊时间、处理的总问题数量、患者或提供者满意度、患者信任度和功能状态没有显著差异。
协作式预先设定议程不会增加就诊时间或每次就诊解决的问题数量，但可能会减少在就诊后期出现“顺便一提”问题的可能性。然而，预先设定议程不足以提高患者满意度、信任度或功能状态。培训重点是医生而不是团队，且没有定期强化，可能会对改变就诊内容和时间使用产生有限的影响。
