在初级保健中，全科医生和经常就诊的患者对 BATHE 技术的可接受性：一项嵌套定性研究。
Acceptability of the BATHE technique amongst GPs and frequently attending patients in primary care: a nested qualitative study.
机构信息
Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
出版信息
BMC Fam Pract. 2019 Sep 3;20(1):121. doi: 10.1186/s12875-019-1011-y.
BACKGROUND
BATHE is a brief psychosocial intervention designed for physician use in patient consultations. The technique has gained some international recognition, but there is currently limited research evidence to demonstrate its acceptability and benefits to patient care. We conducted a pilot cluster randomised controlled trial and feasibility study to explore the use of BATHE as a key component of a person-focused intervention to improve the care of frequent attending patients in UK primary care.
METHODS
A nested qualitative interview study conducted within a pilot trial. The trial took place in six general practices in the South West of England. Eligible patients had been identified as being in the top 3% of attenders in the previous 12 months. General practitioners (GPs) were trained to use BATHE during a one-hour initial training session, and two top-up trainings which included feedback on implementation fidelity. GPs were asked to use BATHE with their study patients for a period of 12 months. 34 GPs were trained and documented using BATHE in a total of 577 consultations with eligible patients during the intervention period. At the end of the intervention period, GPs and study patients from the intervention practices were invited to take part in an interview. Interviews were semi-structured, audio-recorded and transcribed. Thematic analysis was used.
RESULTS
Eleven GPs and 16 patients took part in post-intervention interviews. Benefits of using BATHE included making consultations more person-centred, challenging assumptions that the GP knew what was going on for the patient and their main concerns, and supporting self-management. Difficulties reported included changing existing consultation habits, identifying appropriate consultations in which to use BATHE, and organisational constraints.
CONCLUSIONS
The study suggests that using BATHE is both acceptable and beneficial but also highlighted some of the difficulties GPs had incorporating BATHE into routine practice. Strategies to reduce these difficulties are needed before the extent of the potential benefits of BATHE can be fully assessed.
TRIAL REGISTRATION
ISRCTN62939408 Prospectively registered on 24/06/2015.
背景
BATHE 是一种简短的心理社会干预措施，专为医生在患者咨询中使用而设计。该技术已获得一定的国际认可，但目前仍缺乏研究证据证明其对患者护理的可接受性和益处。我们进行了一项试点群组随机对照试验和可行性研究，以探索将 BATHE 作为以患者为中心的干预措施的关键组成部分，以改善英国初级保健中频繁就诊患者的护理。
方法
在一项试点试验中进行嵌套定性访谈研究。该试验在英格兰西南部的六家全科诊所进行。合格的患者被确定为在前 12 个月中就诊率最高的 3%。全科医生（GP）在一个小时的初始培训课程中接受了使用 BATHE 的培训，并进行了两次补充培训，包括对实施保真度的反馈。要求 GP 在 12 个月的时间内使用 BATHE 为其研究患者提供服务。在干预期间，有 34 名 GP 接受了培训并记录了与合格患者进行的总共 577 次咨询中使用 BATHE 的情况。在干预结束时，邀请干预实践中的 GP 和研究患者参加访谈。访谈采用半结构化、录音和转录。使用主题分析。
结果
11 名 GP 和 16 名患者参加了干预后的访谈。使用 BATHE 的好处包括使咨询更加以患者为中心，挑战 GP 了解患者及其主要关注点的假设，并支持自我管理。报告的困难包括改变现有的咨询习惯，确定适合使用 BATHE 的咨询，以及组织限制。
结论
该研究表明，使用 BATHE 既可以接受又有益，但也强调了 GP 将 BATHE 纳入常规实践的一些困难。在充分评估 BATHE 的潜在益处之前，需要采取策略来减少这些困难。
试验注册
ISRCTN62939408 于 2015 年 6 月 24 日前瞻性注册。
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