Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Postgrad Med. 2022 Jan;134(1):20-25. doi: 10.1080/00325481.2021.2009237. Epub 2021 Dec 6.
The concept of 'patient-centered care' was touted as a pillar of good clinical practice and endorsed by the US Institute of Medicine in a seminal 2001 publication. We explore the extent to which differing medical specialties have engaged with the concept over the last 20 years and how and why this attention has varied among a sample of medical specialties since 2001.
Reference to patient-centered care in the medical literature for selected specialties was used as a proxy for clinical application of patient-centered care in those disciplines. We undertook a statistical analysis and historical review of the medical literature that references the concept of patient-centered care in pediatrics, obstetrics and gynecology (OB-GYN), orthopedics, radiology, dermatology, and neurosurgery. We analyzed the extent to which the literature referencing patient-centered care has changed for the six disciplines since first mentioned in the Institute of Medicine 2001 publication. We measured changes over time in reference to patient-centered care in the medical literature for the six diverse medical specialties.
The six disciplines differed significantly in reference to patient-centered care when comparing publications between the disciplines (p < 0.001). Pediatrics showed the most extensive reference to the concept followed by OB-GYN. In contrast, patient-centered care was hardly mentioned in dermatology and neurosurgery, nor orthopedics or radiology. When correcting for the number of papers published in the different fields, reference to patient-centered care is ~18X more common in pediatrics than in neurosurgery.
Uptake, attention, and applicability of the principles of patient-centered care have varied over the last 20 years. Differences among specialties appear to reflect true differences in patient centricities in the disciplines, with higher uptake in specialties that are person-oriented rather than technique-oriented. Greater engagement with patient-centered care correlates strongly with the number of female physicians in each field.
“以患者为中心的护理”理念被吹捧为良好临床实践的支柱，并得到了美国医学研究所（US Institute of Medicine）在 2001 年一份开创性出版物中的认可。我们探讨了过去 20 年来不同医学专业对该理念的参与程度，以及自 2001 年以来，该理念在医学专业中的关注程度和原因。
我们使用选定专业领域的医学文献中对“以患者为中心的护理”的提及作为这些学科中临床应用“以患者为中心的护理”的代理指标。我们对参考“以患者为中心的护理”概念的儿科、妇产科、骨科、放射科、皮肤科和神经外科的医学文献进行了统计分析和历史回顾。我们分析了自医学研究所 2001 年的出版物首次提到以来，六大学科的文献中参考“以患者为中心的护理”的程度发生了怎样的变化。我们测量了过去 20 年中，六种不同医学专业的医学文献中参考“以患者为中心的护理”的变化情况。
六个学科在比较学科间的文献时，对“以患者为中心的护理”的参考存在显著差异（p<0.001）。儿科的参考文献最多，其次是妇产科。相比之下，皮肤科和神经外科几乎没有提到“以患者为中心的护理”，骨科和放射科也是如此。当根据不同领域发表的论文数量进行校正时，儿科参考“以患者为中心的护理”的文献数量是神经外科的约 18 倍。
过去 20 年来，“以患者为中心的护理”原则的接受程度、关注度和适用性存在差异。专业之间的差异似乎反映了这些学科中患者为中心的真实差异，以患者为中心的专业接受度更高，而以技术为中心的专业接受度较低。与“以患者为中心的护理”的更大参与度密切相关的是每个领域的女性医生人数。
