Zigman Suchsland Monica L, Hardy Victoria, Zhang Ying, Vigil Patrick D, Collins Kimberly L, Woodhouse William M, Chou Roger, Findlay Steven D, Lavallee Danielle C, Thompson Matthew J
From the Department of Family Medicine (MLZS, VH, YZ, KLC, MJT), Surgical Outcomes Research Center, Department of Surgery, (DCL) of the University of Washington, Seattle, WA; Community Health Care, Tacoma, WA (PDV); Family Medicine Residency, Idaho State University, Pocatello, Idaho (WMW); Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (RC); Independent health policy researcher and consumer advocate (SDF).
J Am Board Fam Med. 2019 May-Jun;32(3):392-397. doi: 10.3122/jabfm.2019.03.180288.
Imaging tests are a widely used tool in primary care with many known benefits. Without an understanding of which outcomes matter the most to patients, clinicians are challenged to balance the benefits and harms of imaging tests. This study aimed to explore the perceived impacts imaging tests have on patients from the perspective of the primary care providers (PCPs) and determine PCPs' understanding of patient-centered outcomes (PCOs) from imaging tests.
Recruitment of PCPs occurred at 4 family medicine clinics in Washington and Idaho. Primary care physicians, nurse practitioners, or physician assistants who order imaging tests were eligible to participate. Semistructured interviews explored providers' perceptions of patient experiences during the process of ordering, performing and following up on imaging tests. Classic content analysis generated themes and subthemes.
Sixteen PCPs, including 11 physicians, 3 physician assistants, and 2 nurse practitioners, completed interviews. Two themes were identified: 1) perceived PCOs, and 2) factors influencing the incorporation of PCOs into clinical management. Perceived outcomes included emotions related to the answer a test provides and costs to the patient such as monetary, physical, and added risk. Patient expectations, provider-patient communication, and inadequate knowledge all contributed as barriers to incorporating PCOs into clinical management.
PCPs recognize different outcomes of imaging tests that they consider important for patients. While providers are perceptive to patient outcomes there remains a challenge to how patient outcomes are used to improve care. Communication with patients and improving provider knowledge are needed to incorporate identified PCOs.
影像学检查是基层医疗中广泛使用的工具，有诸多已知益处。如果不了解哪些结果对患者最为重要，临床医生在平衡影像学检查的利弊时就会面临挑战。本研究旨在从基层医疗提供者（PCP）的角度探讨影像学检查对患者的感知影响，并确定PCP对影像学检查以患者为中心的结果（PCO）的理解。
在华盛顿州和爱达荷州的4家家庭医学诊所招募PCP。订购影像学检查的初级保健医生、执业护士或医师助理有资格参与。半结构化访谈探讨了提供者在订购、进行和跟进影像学检查过程中对患者体验的看法。经典内容分析产生了主题和子主题。
16名PCP完成了访谈，其中包括11名医生、3名医师助理和2名执业护士。确定了两个主题：1）感知到的PCO，以及2）影响将PCO纳入临床管理的因素。感知到的结果包括与检查结果相关的情绪以及患者的成本，如金钱、身体和额外风险。患者期望、医患沟通和知识不足都是将PCO纳入临床管理的障碍。
PCP认识到影像学检查的不同结果，他们认为这些结果对患者很重要。虽然提供者能够感知患者的结果，但在如何利用患者结果改善护理方面仍然存在挑战。需要与患者沟通并提高提供者的知识水平，以纳入已确定的PCO。
