Nivel, Netherlands institute for health services research, Utrecht, the Netherlands; Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands.
Nivel, Netherlands institute for health services research, Utrecht, the Netherlands.
Patient Educ Couns. 2020 Jun;103(6):1168-1175. doi: 10.1016/j.pec.2020.01.016. Epub 2020 Jan 23.
To gain insight into patient participation in general practice by examining if and how patients' question-asking behaviour has changed over the years (2007-2016).
A random set of real-life video-recorded consultations collected in 2015-2016 (n = 437) was observed and compared with that of a former study in 2007-2008 (n = 533). Patients' question-asking behaviour was coded using an adapted RIAS protocol containing six categories: medical condition/therapeutic regimen; psychosocial; social context; lifestyle; ask for opinion doctor; practical. GPs and patients completed questionnaires about their background characteristics. Data were analysed using multi-level analysis.
Patients asked fewer questions in 2016 than in 2007. The type of question-asking behaviour changed significantly: in particular medical questions decreased while practical questions increased. Less educated patients asked significantly more practical questions than higher educated patients.
Contrary to our expectations, patients' question-asking has decreased in 2016 compared to 2007, while the average consultation length has increased. The type of questions shifted from medical to practical, especially in less educated patients. It seems that GPs' professional role has expanded over time, since patients nowadays ask their GP more non-medical questions.
GPs probably could continue facilitating patient involvement by more frequently using partnership-building and supportive communication.
通过考察患者的提问行为是否以及如何随着时间的推移（2007-2016 年）而发生变化，深入了解患者在全科医疗中的参与度。
观察了 2015-2016 年（n=437）随机抽取的真实视频记录的咨询，并与 2007-2008 年（n=533）的前一项研究进行了比较。使用包含六个类别的改良 RIAS 方案对患者的提问行为进行编码：医疗状况/治疗方案；心理社会；社会背景；生活方式；向医生征求意见；实际情况。全科医生和患者完成了有关其背景特征的问卷。使用多水平分析对数据进行了分析。
与 2007 年相比，2016 年患者提出的问题较少。提问行为的类型发生了显著变化：特别是医疗问题减少，而实际问题增加。受教育程度较低的患者比受教育程度较高的患者提出的实际问题明显更多。
与我们的预期相反，与 2007 年相比，2016 年患者的提问量有所减少，而平均咨询时间却有所增加。问题的类型从医疗问题转移到了实际问题，尤其是在受教育程度较低的患者中。随着时间的推移，全科医生的专业角色似乎有所扩大，因为现在患者向他们的全科医生提出了更多的非医疗问题。
全科医生可能会通过更频繁地使用建立伙伴关系和支持性沟通来继续促进患者的参与度。
