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医生共情与糖尿病的实验室结果无关:一项横断面研究。

Physician Empathy Is Not Associated with Laboratory Outcomes in Diabetes: a Cross-sectional Study.

机构信息

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.

Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.

出版信息

J Gen Intern Med. 2019 Jan;34(1):75-81. doi: 10.1007/s11606-018-4731-0. Epub 2018 Nov 7.

Abstract

BACKGROUND

One widely cited study suggested a link between physician empathy and laboratory outcomes in patients with diabetes, but its findings have not been replicated. While empathy has a positive impact on patient experience, its impact on other outcomes remains unclear.

OBJECTIVE

To assess associations between physician empathy and glycosylated hemoglobin (HgbA1c) as well as low-density lipoprotein (LDL) levels in patients with diabetes.

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS

Patients with diabetes who received care at a large integrated health system in the USA between January 1, 2011, and May 31, 2014, and their primary care physicians.

MAIN MEASURES

The main independent measure was physician empathy, as measured by the Jefferson Scale of Empathy (JSE). The JSE is scored on a scale of 20-140, with higher scores indicating greater empathy. Dependent measures included patient HgbA1c and LDL. Mixed-effects linear regression models adjusting for patient sociodemographic characteristics, comorbidity index, and physician characteristics were used to assess the association between physician JSE scores and their patients' HgbA1c and LDL.

KEY RESULTS

The sample included 4176 primary care patients who received care with one of 51 primary care physicians. Mean physician JSE score was 118.4 (standard deviation (SD) = 12). Median patient HgbA1c was 6.7% (interquartile range (IQR) = 6.2-7.5) and median LDL concentration was 83 (IQR = 66-104). In adjusted analyses, there was no association between JSE scores and HgbA1c (β = - 0.01, 95%CI = - 0.04, 0.02, p = 0.47) or LDL (β = 0.41, 95%CI = - 0.47, 1.29, p = 0.35).

CONCLUSION

Physician empathy was not associated with HgbA1c or LDL. While interventions to increase physician empathy may result in more patient-centered care, they may not improve clinical outcomes in patients with diabetes.

摘要

背景

一项广泛引用的研究表明,医生同理心与糖尿病患者的实验室结果之间存在关联,但该研究结果尚未得到复制。虽然同理心对患者体验有积极影响,但它对其他结果的影响尚不清楚。

目的

评估医生同理心与糖尿病患者糖化血红蛋白(HgbA1c)和低密度脂蛋白(LDL)水平之间的关联。

设计

回顾性横断面研究。

参与者

2011 年 1 月 1 日至 2014 年 5 月 31 日期间在美国一家大型综合医疗系统接受治疗的糖尿病患者及其初级保健医生。

主要措施

主要的独立测量指标是医生同理心,采用杰斐逊同理心量表(JSE)进行测量。JSE 的得分为 20-140 分,得分越高表示同理心越强。依赖措施包括患者的 HgbA1c 和 LDL。使用混合效应线性回归模型调整患者的社会人口统计学特征、合并症指数和医生特征,以评估医生 JSE 评分与其患者的 HgbA1c 和 LDL 之间的关联。

主要结果

样本包括 4176 名接受 51 名初级保健医生治疗的初级保健患者。医生 JSE 平均得分为 118.4(标准差(SD)=12)。患者的 HgbA1c 中位数为 6.7%(四分位距(IQR)=6.2-7.5),LDL 浓度中位数为 83(IQR=66-104)。在调整后的分析中,JSE 评分与 HgbA1c(β=-0.01,95%置信区间(CI)=-0.04,0.02,p=0.47)或 LDL(β=0.41,95%CI=-0.47,1.29,p=0.35)之间无关联。

结论

医生同理心与 HgbA1c 或 LDL 无关。虽然增加医生同理心的干预措施可能会导致更以患者为中心的护理,但它们可能不会改善糖尿病患者的临床结局。

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