Santiago Luiz Miguel, Simões José Augusto, Vale Martinha, Faria Elleni, Ferreira Pedro Lopes, Rosendo Inês
Clínica Universitária de Medicina Geral e Familiar. Faculdade de Medicina. Universidade de Coimbra. Coimbra; Centro de Estudos e Investigação em Saúde. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.
Centro de Estudos e Investigação em Saúde. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.
Acta Med Port. 2020 Jun 1;33(6):407-414. doi: 10.20344/amp.11742. Epub 2020 May 31.
Patient Centred Medicine is a method and a model of practicing allowing gains for both the doctor and the patient. Its practice must be evaluated for purposes of continuous professional development and continuous medical education. The aim of this study was to create an instrument focused in measuring the practice based on person centered medicine in general and family medicine, as well as in determining its reliability and validity.
A first version of a questionnaire according to the four dimensions of the patient- centred clinical method was revised in a focus group providing the content validity. The final questionnaire includes 22 items, using a Likert scale with four response options. Factorial analysis made it possible to confirm the dimensions defined by Moira Stewart, and internal consistency, test-retest reproducibility and item-total correlations were determined. The online implementation of the questionnaire to a sample of 905 family doctors guaranteed the construct and criterion validities.
The measurement instrument includes four dimensions: (i) exploring health, disease and the illness experience; (ii) investing in the doctor-patient relationship; (iii) seeking understanding; and (iv) understanding the whole person. The internal consistency was demonstrated with a global Cronbach's alpha of 0.892, varying between 0.783 and 0.844 for all dimensions. The test-retest reproducibility obtained an intraclass correlation value between 0.678 and 1.000. The item-total correlations varied between 0.457 and 0.870. Women doctors are more aware than their colleagues about seeking understanding with the person, and young doctors are more susceptible to approach the disease through history and to seek understanding with the patient. Specialist physicians have shown to be more careful with the history and with viewing the patient as a whole and the professionals who work in a Family Health Unit are those who seek a better understanding with the person. Finally, specific training about person centered medicine and about consultation in person centered medicine demonstrated a positive impact in all dimensions of the person-centred medicine and this is acknowledged by professionals.
The assessment of self-perception of person-centred medicine is now possible.
The questionnaire presents good reliability and validity, thus allowing doctors to assess their main weaknesses, as well as enabling the development of specific training.
以患者为中心的医学是一种实践方法和模式，对医生和患者都有益处。必须对其实践进行评估，以促进持续的专业发展和继续医学教育。本研究的目的是创建一种工具，用于衡量一般医学和家庭医学中以患者为中心的医学实践，并确定其信度和效度。
根据以患者为中心的临床方法的四个维度，对问卷的初稿在一个焦点小组中进行了修订，以确保内容效度。最终问卷包括22个项目，采用具有四个回答选项的李克特量表。因子分析证实了莫伊拉·斯图尔特定义的维度，并确定了内部一致性、重测信度和项目与总分的相关性。通过对905名家庭医生样本进行问卷的在线发放，确保了结构效度和效标效度。
该测量工具包括四个维度：（i）探索健康、疾病和患病经历；（ii）投入医患关系；（iii）寻求理解；（iv）了解整个人。整体Cronbach's alpha系数为0.892，表明内部一致性良好，所有维度的系数在0.783至0.844之间。重测信度的组内相关值在0.678至1.000之间。项目与总分的相关性在0.457至0.870之间。女医生比同事更注重寻求对患者的理解，年轻医生更倾向于通过病史来了解疾病并寻求与患者的理解。专科医生在病史询问和将患者视为一个整体方面表现得更为谨慎，而在家庭健康单位工作的专业人员更注重寻求对患者的更好理解。最后，关于以患者为中心的医学和以患者为中心的医学咨询的特定培训在以患者为中心的医学的所有维度上都显示出积极影响，并且得到了专业人员的认可。
现在可以对以患者为中心的医学的自我认知进行评估。
该问卷具有良好的信度和效度，从而使医生能够评估自己的主要弱点，并有助于开展特定培训。
