探究比利时家庭医学中的治疗联盟及其与医患特征的关联：一项横断面调查研究。
Exploring the therapeutic alliance in Belgian family medicine and its association with doctor-patient characteristics: a cross-sectional survey study.
机构信息
Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium.
Department of General Practice, Monash University, Melbourne, Victoria, Australia
出版信息
BMJ Open. 2020 Feb 5;10(2):e033710. doi: 10.1136/bmjopen-2019-033710.
OBJECTIVES
Patient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is enhancing the patient-doctor relationship. In this study, we aim to measure the therapeutic alliance in consultations between patients and family doctors in Belgium, and explore which patient, provider and practice characteristics are associated with the strength of the therapeutic alliance.
DESIGN
Cross-sectional cohort study using the Working Alliance Inventory for General Practice (WAI-GP). The patients and family doctors completed a survey after the consultation. The survey consisted of the WAI-GP, demographics, consultation characteristics and variables related to the patient-doctor relationship.
SETTING
Belgian primary care.
PARTICIPANTS
Every third patient (both practice and house call visits) was invited to participate. 170 patient-doctor dyads from four practices were included. Total of 10 doctors (30% men, age range 24-63 years) and 170 patients (35.9% men, age range 18-92 years).
PRIMARY AND SECONDARY OUTCOME MEASURES
Primary outcome was the WAI-GP score and its correlations with characteristics of the doctor (gender, age) and patients (gender, age, chronic disease, number of annual consultations).
RESULTS
The median WAI-GP score reported after these consultations was 4.5±0.62. Higher WAI-GP scores were reported for consultations with male doctors and by older patients. In the subsample of patients with a chronic illness, higher WAI-GP scores were reported by patients who had more than 10 follow-up consultations per year.
CONCLUSIONS
Consultation quality is an important aspect of healthcare, but attention is needed to understand how the WAI-GP performs in relation to variables that are beyond control, such as gender of the physician, age of the patient and variables related to building continuity of care. This has implications for the measurement of quality of healthcare.
目的
以患者为中心的护理与更好的健康结果、更高的患者满意度和降低医疗保健成本有关。以患者为中心的临床方法定义的以患者为中心护理的核心组成部分之一是增强医患关系。在这项研究中，我们旨在衡量比利时患者和家庭医生咨询中的治疗联盟，并探讨哪些患者、提供者和实践特征与治疗联盟的强度相关。
设计
使用一般实践工作联盟量表（WAI-GP）的横断面队列研究。患者和家庭医生在咨询后完成了一项调查。该调查包括 WAI-GP、人口统计学、咨询特征以及与医患关系相关的变量。
地点
比利时初级保健。
参与者
每个第三个患者（包括门诊和出诊）都被邀请参加。来自四个实践的 170 个医患二人组被纳入研究。共有 10 名医生（30%为男性，年龄在 24-63 岁之间）和 170 名患者（35.9%为男性，年龄在 18-92 岁之间）。
主要和次要结果
主要结果是 WAI-GP 评分及其与医生（性别、年龄）和患者（性别、年龄、慢性病、每年就诊次数）特征的相关性。
结果
这些咨询后报告的 WAI-GP 评分中位数为 4.5±0.62。与女性医生和老年患者相比，报告的 WAI-GP 评分更高。在患有慢性病的患者亚组中，每年就诊次数超过 10 次的患者报告的 WAI-GP 评分更高。
结论
咨询质量是医疗保健的一个重要方面，但需要注意的是，要了解 WAI-GP 在与医生性别、患者年龄和建立连续性护理相关的变量之外的变量方面的表现。这对医疗保健质量的衡量有影响。
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