中老年人群高额自付医疗支出导致的生活中断。
Life disruptions for midlife and older adults with high out-of-pocket health expenditures.
机构信息
Department of Medicine, University of Pennsylvania, Philadelphia, 19104, USA.
出版信息
Ann Fam Med. 2013 Jan-Feb;11(1):37-42. doi: 10.1370/afm.1444.
PURPOSE
Physicians prescribing new medications often do not convey important medication-related information. This study tests an intervention to improve physician-patient communication about newly prescribed medications.
METHODS
We conducted a controlled clinical trial of patients in 3 primary care practices, combining data from patient surveys with audio-recorded physician-patient interactions. The intervention consisted of a 1-hour physician-targeted interactive educational session encouraging communication about 5 basic elements regarding a new prescription and a patient information handout listing the 5 basic elements. Main outcome measures were the Medication Communication Index (MCI), a 5-point index assessed by qualitative analysis of audio-recorded interactions (giving points for discussion of medication name, purpose, directions for use, duration of use, and side effects), and patient ratings of physician communication about new prescriptions.
RESULTS
Twenty-seven physicians prescribed 113 new medications to 82 of 256 patients. The mean MCI for medications prescribed by physicians in the intervention group was 3.95 (SD = 1.02), significantly higher than that for medications prescribed by control group physicians (2.86, SD = 1.23, P <.001). This effect held regardless of medication type (chronic vs nonchronic medication). Counseling about 3 of the 5 MCI components was significantly higher for medications prescribed by physicians in the intervention group, as were patients' ratings of new medication information transfer (P = .02). Independent of intervention or control groups, higher MCI scores were associated with better patient ratings about information about new prescriptions (P = .003).
CONCLUSIONS
A physician-targeted educational session improved the content of and enhanced patient ratings of physician communication about new medication prescriptions. Further work is required to assess whether improved communication stimulated by the intervention translates into better clinical outcomes.
目的
医生在开新药处方时，常常无法传达重要的药物相关信息。本研究旨在检验一种干预措施，以改善医生与患者之间关于新处方药物的沟通。
方法
我们在 3 家初级保健诊所开展了一项对照临床试验，将患者的调查数据与记录的医患互动音频相结合。该干预措施包括针对医生的 1 小时互动教育课程，鼓励医生就新处方的 5 个基本要素进行沟通，并提供一份列出这 5 个基本要素的患者信息传单。主要观察指标为药物沟通指数（MCI），这是一个 5 分制指数，通过对录音互动的定性分析进行评估（根据讨论药物名称、用途、使用说明、使用期限和副作用等情况给予分数），以及患者对医生新处方沟通的评价。
结果
27 名医生为 256 名患者中的 82 名开具了 113 种新药。干预组医生开具的药物的平均 MCI 为 3.95（标准差=1.02），显著高于对照组医生开具的药物的 MCI（2.86，标准差=1.23，P<.001）。无论药物类型（慢性与非慢性药物）如何，这一效果均成立。干预组医生在 MCI 的 5 个组成部分中的 3 个部分提供的咨询明显更高，患者对新药物信息传递的评价也更高（P=.02）。无论干预组还是对照组，较高的 MCI 评分与患者对新处方信息的评价更高相关（P=.003）。
结论
针对医生的教育课程提高了医生沟通新药物处方的内容，并增强了患者的评价。需要进一步研究，以评估干预措施所激发的更好的沟通是否能转化为更好的临床效果。
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