Hultberg Josabeth, Rudebeck Carl Edvard
Åby Health Care Centre, County Council of Östergötland, Department of Medical and Health Sciences, General Practice, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden.
Int J Family Med. 2012;2012:612572. doi: 10.1155/2012/612572. Epub 2012 Nov 18.
Aims. To explore general practitioners' (GPs') descriptions of their thoughts and action when prescribing cardiovascular preventive drugs. Methods. Qualitative content analysis of transcribed group interviews with 14 participants from two primary health care centres in the southeast of Sweden. Results. GPs' prescribing of cardiovascular preventive drugs, from their own descriptions, involved "the patient as calculated" and "the inclination to prescribe," which were negotiated in the interaction with "the patient in front of me." In situations with high cardiovascular risk, the GPs reported a tendency to adopt a directive consultation style. In situations with low cardiovascular risk and great uncertainty about the net benefit of preventive drugs, the GPs described a preference for an informed patient choice. Conclusions. Our findings suggest that GPs mainly involve patients at low and uncertain risk of cardiovascular disease in treatment decisions, whereas patient involvement tends to decrease when GPs judge the cardiovascular risk as high. Our findings may serve as a memento for clinicians, and we suggest them to be considered in training in communication skills.
目的。探讨全科医生（GPs）在开具心血管预防药物时对其想法和行为的描述。方法。对瑞典东南部两个初级卫生保健中心的14名参与者进行的小组访谈转录本进行定性内容分析。结果。从全科医生自身的描述来看，他们开具心血管预防药物涉及“作为计算对象的患者”和“开药倾向”，这两者在与“我面前的患者”的互动中进行协商。在心血管风险高的情况下，全科医生报告倾向于采用指导性咨询方式。在心血管风险低且预防药物净效益存在很大不确定性的情况下，全科医生表示倾向于让患者做出明智的选择。结论。我们的研究结果表明，全科医生在治疗决策中主要让心血管疾病风险低且不确定的患者参与，而当全科医生判断心血管风险高时，患者参与度往往会降低。我们的研究结果可为临床医生提供警示，我们建议在沟通技巧培训中考虑这些结果。
