Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 692, Baltimore, MD 21205, USA.
J Gen Intern Med. 2012 Jun;27(6):661-8. doi: 10.1007/s11606-011-1957-5. Epub 2011 Dec 17.
Late-life mental health disorders are prevalent, costly, and commonly under-diagnosed and under-treated.
To investigate whether family companion presence in routine primary care visits helps or hinders patient-centered processes among older adults with poor mental health function.
Observational study of accompanied (n = 80) and unaccompanied (n = 310) primary care patients ages 65 and older.
Audio-taped medical visit communication, coded with the Roter Interactional Analysis System, and three process measures: visit duration (in minutes), patient/companion verbal activity, and a ratio of patient-centered communication, adjusted for patient age, gender, race, and physical function. Participants were stratified by SF-36 mental health subscale (MCS) using two approaches (1) standardized population midpoint to delineate "good" (50+) and "poor" health (< 50) and (2) clinically derived cut-points (<35; 35-49; 50+).
When patients with poor mental health were accompanied by a family companion, patient/companions provided less psychosocial information, physicians engaged in less question-asking and partnership-building, and both patient/companions and physicians contributed more task-oriented, biomedical discussion. Accompanied patients with poor mental health were less likely to experience patient-centered communication relative to unaccompanied patients (aOR = 0.21; 95% CI: 0.06, 0.68); no difference was observed for patients with good mental health (aOR = 1.02; 95% CI: 0.46, 2.27). Verbal activity was comparable for accompanied patients/companions and unaccompanied patients in both mental health strata. Medical visits were 2.3 minutes longer when patients with good mental health were accompanied (b = 2.31; p = 0.006), but was comparable for patients with poor mental health (b = -0.37; p = 0.827). Study findings were amplified in the lowest functioning mental health subgroup (MCS < 35): medical visits were shorter, and communication was least patient-centered (p = 0.019) when these patients were accompanied.
Older adults with poor mental health function may experience more communication challenges in the form of shorter visits and less patient-centered communication when a family companion is present.
晚年心理健康障碍普遍存在，代价高昂，且通常诊断不足和治疗不足。
调查在常规初级保健就诊中，有家人陪伴是否有助于或阻碍心理健康状况不佳的老年人的以患者为中心的过程。
对 80 名有陪伴的和 310 名无陪伴的年龄在 65 岁及以上的初级保健患者进行了观察性研究。
使用 Roter 互动分析系统对录音医疗访问的沟通进行编码，并采用三种过程测量：就诊时长（以分钟计）、患者/陪伴者的口头活动以及以患者为中心的沟通比例，该比例根据患者年龄、性别、种族和身体功能进行了调整。参与者根据 SF-36 心理健康子量表（MCS）进行分层，使用两种方法：（1）标准化人群中点来划定“良好”（≥50）和“不良”（<50）健康状况，以及（2）临床得出的切点（<35；35-49；50+）。
当心理健康状况不佳的患者有家人陪伴时，患者/陪伴者提供的心理社会信息较少，医生提出的问题和建立伙伴关系的次数较少，患者/陪伴者和医生的讨论更多地集中在任务导向和生物医学上。与无陪伴的患者相比，有陪伴的心理健康状况不佳的患者不太可能经历以患者为中心的沟通（优势比=0.21；95%置信区间：0.06，0.68）；对于心理健康状况良好的患者，没有观察到差异（优势比=1.02；95%置信区间：0.46，2.27）。在两个心理健康分层中，有陪伴的患者/陪伴者的口头活动与无陪伴的患者相当。当心理健康状况良好的患者有陪伴时，就诊时间延长了 2.3 分钟（b=2.31；p=0.006），而心理健康状况不佳的患者则没有差异（b=-0.37；p=0.827）。在心理健康状况最低的亚组（MCS<35）中，研究结果更为明显：当这些患者有陪伴时，就诊时间更短，沟通以患者为中心的程度最低（p=0.019）。
当有家人陪伴时，心理健康状况不佳的老年人可能会遇到更多沟通方面的挑战，表现为就诊时间更短，以患者为中心的沟通更少。
