优先考虑身体和心理症状：在初级保健咨询中讨论焦虑的障碍和促进因素是什么？
Prioritising physical and psychological symptoms: what are the barriers and facilitators to the discussion of anxiety in the primary care consultation?
机构信息
Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
出版信息
BMC Fam Pract. 2019 Jul 27;20(1):106. doi: 10.1186/s12875-019-0996-6.
BACKGROUND
Anxiety is under-recorded and under-treated in the UK and is under-represented in research compared with depression. Detecting anxiety can be difficult because of co-existing conditions. GPs can be reluctant to medicalise anxiety symptoms and patients can be reluctant to disclose them, for a variety of reasons. This research addresses the gap in evidence of real-life consultations of patients with anxiety and explores how physical and psychological symptoms are discussed and prioritised by patients and GPs in primary care consultations.
METHODS
A mixed methods study using a baseline questionnaire, video-recorded primary care consultations and interview data with patients and GPs.
RESULTS
Seventeen patients with anxiety symptoms (GAD-7 score ≥ 10) completed a questionnaire, had their consultation video-recorded and took part in a semi-structured interview. Four GPs were interviewed. The main themes that emerged from GP and patients accounts as barriers and facilitators to discussing anxiety mostly mirrored each other. The GP/patient relationship and continuity of care was the main facilitator for the discussion of anxiety in the consultation. The main barriers were: attribution of or unacknowledged symptoms; co-morbidities; and time constraints. GPs overcame these barriers by making repeat appointments and employing prioritising techniques; patients by choosing an empathetic GP.
CONCLUSIONS
The findings add to the evidence base concerning the management of anxiety in primary care. The findings suggest that the discussion around anxiety is a process negotiated between the patient and the GP influenced by a range of barriers and facilitators. Co-existing depression and health anxieties can mask anxiety symptoms in patients. Good practice techniques such as bringing back patients for appointments to foster continuity of care and understanding can help disclosure and detection of anxiety symptoms. Future research could investigate this longitudinally and should include a wider range of GPs practices and GPs.
背景
在英国，焦虑症的记录和治疗不足，与抑郁症相比，在研究中也代表性不足。由于存在共病情况，焦虑症的检测可能较为困难。由于各种原因，全科医生可能不愿意将焦虑症状视为医学问题，患者也可能不愿意透露这些症状。这项研究旨在填补关于焦虑症患者实际就诊情况的证据空白，并探讨在初级保健就诊中，患者和全科医生如何讨论和优先考虑身体和心理症状。
方法
采用基线问卷调查、记录初级保健就诊的视频和对患者及全科医生进行访谈的混合方法研究。
结果
17 名有焦虑症状（GAD-7 评分≥10）的患者完成了一份问卷，他们的就诊过程被视频记录，并接受了半结构化访谈。对 4 名全科医生进行了访谈。全科医生和患者对讨论焦虑症的障碍和促进因素的描述主要相互呼应，这些主题从他们的描述中浮现出来。医患关系和连续护理是在就诊中讨论焦虑症的主要促进因素。主要障碍包括：症状归因或未被承认；共病；以及时间限制。全科医生通过安排重复预约和使用优先排序技术来克服这些障碍；患者则通过选择有同理心的全科医生来克服这些障碍。
结论
这些发现为初级保健中焦虑症的管理提供了更多的证据基础。研究结果表明，围绕焦虑症的讨论是一个由患者和全科医生协商的过程，受到一系列障碍和促进因素的影响。共患的抑郁症和健康焦虑症可能会掩盖患者的焦虑症状。良好的实践技巧，如为促进连续性护理和理解而让患者回诊，有助于披露和检测焦虑症状。未来的研究可以对此进行纵向调查，并应包括更广泛的全科医生实践和全科医生。
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