在线获取临床记录的患者对心理健康临床医生的信任。
Trust in Mental Health Clinicians Among Patients Who Access Clinical Notes Online.
作者信息
Cromer Risa, Denneson Lauren M, Pisciotta Maura, Williams Holly, Woods Susan, Dobscha Steven K
机构信息
Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
出版信息
Psychiatr Serv. 2017 May 1;68(5):520-523. doi: 10.1176/appi.ps.201600168. Epub 2017 Feb 1.
OBJECTIVE
This study explored patient perspectives of how online access to clinical notes (OpenNotes) within the Veterans Affairs (VA) health care system may affect patients' relationships with their mental health clinicians.
METHODS
Semistructured qualitative interviews were conducted with 28 patients receiving VA mental health care who had accessed OpenNotes. Transcripts were coded and analyzed with a constant comparative approach.
RESULTS
Respondents consistently reported that patient-clinician relationships-feelings of trust in particular-are critical to the therapeutic process and that reading clinical notes strengthens or strains patients' trust in mental health clinicians. Perceptions of transparency and respect as conveyed in notes were central to maintaining trust.
CONCLUSIONS
Findings suggest that ensuring consistency between what occurs during appointments and what appears in clinical notes, as well as highlighting patient individuality and strengths in notes, may help engender patient trust and avoid negative consequences of OpenNotes in mental health care.
目的
本研究探讨了退伍军人事务部（VA）医疗保健系统中患者对在线获取临床记录（开放笔记）如何影响其与心理健康临床医生关系的看法。
方法
对28名接受VA心理健康护理且已访问开放笔记的患者进行了半结构化定性访谈。对访谈记录进行编码，并采用持续比较法进行分析。
结果
受访者一致表示，患者与临床医生的关系，尤其是信任感受，对治疗过程至关重要，阅读临床记录会增强或削弱患者对心理健康临床医生的信任。记录中传达的透明度和尊重感是维持信任的核心。
结论
研究结果表明，确保预约期间发生的事情与临床记录中出现的内容之间的一致性，以及在记录中突出患者的个性和优势，可能有助于建立患者信任，并避免开放笔记在心理健康护理中产生负面影响。
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