Henselmans Inge, Heijmans Monique, Rademakers Jany, van Dulmen Sandra
Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Health Expect. 2015 Dec;18(6):2375-88. doi: 10.1111/hex.12206. Epub 2014 May 12.
Chronic patients are increasingly expected to participate actively in medical consultations. This study examined (i) patients' perceived efficacy and barriers to participation in consultations, (ii) patients' interest in communication support and (iii) correlates of perceived efficacy and barriers, with an emphasis on differences across providers' disciplines.
A representative panel of chronic patients (n = 1314) filled out the short Perceived Efficacy in Patient-Provider Interaction scale and were questioned about barriers to participation and interest in communication support. Potential correlates included socio-demographic (age, sex, education, living situation), clinical (discipline care provider, type of illness, comorbidity, illness duration, functional disabilities, health consultations in last year) and personal characteristics (information preference, health literacy, level of general patient activation).
Most patients felt efficacious in consultations, although 46% reported barriers to participation and 39% had an interest in support. Barriers most frequently recognized were 'not wanting to be bothersome', 'perception there is too little time' and 'remembering subjects only afterwards'. Patients most frequently endorsed relatively simple support. Patients perceived the least barriers and were least likely to endorse support when seeing a nurse. In multivariate models, consistent risk factors for low efficacy and perceived barriers were low health literacy and a low general patient activation.
Many chronically ill patients feel confident in medical interactions. Still, a significant number might benefit from support. Often this concerned more generally vulnerable patients, that is, the low literate and generally less activated. Relatively simple supportive interventions are likely to be endorsed and might overcome frequent barriers.
越来越期望慢性病患者积极参与医疗咨询。本研究调查了：（i）患者对参与咨询的感知效能和障碍；（ii）患者对沟通支持的兴趣；（iii）感知效能和障碍的相关因素，重点关注不同医疗服务提供者学科之间的差异。
一个具有代表性的慢性病患者小组（n = 1314）填写了简短的患者-医疗服务提供者互动感知效能量表，并被询问参与障碍和对沟通支持的兴趣。潜在的相关因素包括社会人口统计学因素（年龄、性别、教育程度、生活状况）、临床因素（医疗服务提供者学科、疾病类型、合并症、病程、功能残疾、去年的健康咨询情况）和个人特征（信息偏好、健康素养、一般患者激活水平）。
大多数患者在咨询中感到有效能，尽管46%的患者报告存在参与障碍，39%的患者对支持有兴趣。最常被认可的障碍是“不想添麻烦”、“感觉时间太少”和“事后才想起主题”。患者最常认可相对简单的支持。患者在看护士时感知到的障碍最少，且最不可能认可支持。在多变量模型中，效能低下和感知障碍的一致风险因素是健康素养低和一般患者激活水平低。
许多慢性病患者在医疗互动中感到自信。然而，相当一部分患者可能会从支持中受益。通常这涉及更普遍的弱势群体，即低文化水平和一般活跃度较低的患者。相对简单的支持性干预措施可能会得到认可，并可能克服常见障碍。
