评估老年多病患者在全科实践中的精神病史——HoPES3 项目中的混合方法研究。
Evaluation of a Spiritual History with Elderly Multi-Morbid Patients in General Practice-A Mixed-Methods Study within the Project HoPES3.
机构信息
Department of Psychosomatic Medicine and Psychotherapy, Professorship for Spiritual Care and Psychosomatic Health, Technical University of Munich, Langerstr. 3, 81675 Munich, Germany.
Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
出版信息
Int J Environ Res Public Health. 2022 Jan 4;19(1):538. doi: 10.3390/ijerph19010538.
BACKGROUND
The "Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity and Self-Care into Disease Management in Primary Care" (HoPES3) examines the implementation of a spiritual history (SH) as part of a multifaceted intervention in German general practices. While the effectiveness of the interventions was evaluated in a cluster-randomized trial, this article investigates the patients' views concerning the acceptability of the SH and its effects.
METHODS
A mixed-methods study was conducted in which 133 patients of the intervention group filled in a standardized questionnaire after the intervention. Later, 29 of these patients took part in qualitative semi-standardized interviews.
RESULTS
According to the survey, 63% ( = 77) of patients found the SH helpful. In the interviews, however, many indicated that they either kept the conversation brief or declined the offer to talk about spirituality. Contents of longer conversations referred to difficult life events, personal sources of strength, and experiences with religious institutions. Many patients who had a longer conversation about spirituality reported that their relationship with their general practitioner (GP) had improved. Almost all patients recommended integrating a personal conversation of this kind into primary care.
CONCLUSIONS
The SH seems to be a possible 'door opener' for a trusting doctor-patient relationship, which can then be built upon.
背景
“老年人综合关怀计划，将精神需求、社会活动和自我护理整合到初级保健中的疾病管理”（HoPES3）研究了在德国普通诊所实施精神病史（SH）作为多方面干预措施的一部分。虽然干预措施的效果在一项集群随机试验中进行了评估，但本文调查了患者对 SH 的可接受性及其效果的看法。
方法
本研究采用混合方法，干预组的 133 名患者在干预后填写了一份标准化问卷。之后，其中 29 名患者参加了定性半标准化访谈。
结果
根据调查，63%（=77）的患者认为 SH 有帮助。然而，在访谈中，许多人表示他们要么简短地进行了对话，要么拒绝了谈论精神信仰的邀请。较长对话的内容涉及困难的生活事件、个人力量的来源以及与宗教机构的经历。许多与全科医生进行了较长时间精神信仰对话的患者报告说，他们与全科医生的关系得到了改善。几乎所有患者都建议将这种个人对话纳入初级保健。
结论
SH 似乎是建立信任医患关系的一个可能的“敲门砖”，之后可以在此基础上进一步发展。
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