与医患关系质量相关的因素：一项针对有风湿性疾病的流动墨西哥门诊患者的横断面研究。

Factors Associated With the Quality of the Patient-Doctor Relationship: A Cross-Sectional Study of Ambulatory Mexican Patients With Rheumatic Diseases.

机构信息

From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Department of Ethics, Law, and Medical Humanities, Amsterdam UMC, Amsterdam, the Netherlands.

出版信息

J Clin Rheumatol. 2022 Jun 1;28(4):183-189. doi: 10.1097/RHU.0000000000001816. Epub 2021 Dec 17.

DOI:10.1097/RHU.0000000000001816

PMID:35616508

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9169750/

Abstract

BACKGROUND

The patient-doctor relationship (PDR) is a complex phenomenon with strong cultural determinants, which impacts health-related outcomes and, accordingly, does have ethical implications. The study objective was to describe the PDR from medical encounters between 600 Mexican outpatients with rheumatic diseases and their attending rheumatologists, and to identify factors associated with a good PDR.

METHODS

A cross-sectional study was performed. Patients completed the PDRQ-9 (Patient-Doctor Relationship Questionnaire, 9 items), the HAQ-DI (Health Assessment Questionnaire Disability Index), the Short-Form 36 items (SF-36), a pain-visual analog scale, and the Ideal Patient Autonomy Scale. Relevant sociodemographic, disease-related, and treatment-related variables were obtained. Patients assigned a PDRQ-9 score to each patient-doctor encounter. Regression analysis was used to identify factors associated with a good PDR, which was defined based on a cutoff point established using the borderline performance method.

RESULTS

Patients were primarily middle-aged female subjects (86%), with substantial disease duration (median, 11.1 years), without disability (HAQ-DI within reference range, 55.3%), and with deteriorated quality of life (SF-36 out of reference range, 73.7%-78.6%). Among them, 36.5% had systemic lupus erythematosus and 31.8% had rheumatoid arthritis. There were 422 patients (70.3%) with a good PDR and 523 medical encounters (87.2%) involved certified rheumatologists.Patient paternalistic ideal of autonomy (odds ratio [OR], 3.029; 95% confidence interval [CI], 1.793-5.113), SF-36 score (OR, 1.014; 95% CI, 1.003-1.025), female sex (OR, 0.460; 95% CI, 0.233-0.010), and being certified rheumatologist (OR, 1.526; 95% CI, 1.059-2.200) were associated with a good PDR.

CONCLUSIONS

Patient-related factors and the degree of experience of the attending physician impact the quality of the PDR, in Mexican outpatients with rheumatic diseases.

摘要

背景

医患关系（PDR）是一种受文化因素影响较大的复杂现象，它会影响与健康相关的结果，因此具有伦理意义。本研究的目的是描述 600 名患有风湿性疾病的墨西哥门诊患者与他们的主治风湿病医生之间的医患关系，并确定与良好医患关系相关的因素。

方法

本研究采用了横断面研究方法。患者完成了 PDRQ-9（医患关系问卷，9 项）、HAQ-DI（健康评估问卷残疾指数）、SF-36 短表（36 项）、疼痛视觉模拟量表和理想患者自主量表。收集了相关的社会人口统计学、疾病相关和治疗相关变量。患者对每次医患接触的 PDRQ-9 评分进行赋值。采用回归分析确定与良好医患关系相关的因素，良好医患关系的定义是基于使用边界性能方法确定的临界值。

结果

患者主要为中年女性（86%），疾病持续时间较长（中位数为 11.1 年），无残疾（HAQ-DI 在参考范围内，55.3%），生活质量恶化（SF-36 不在参考范围内，73.7%-78.6%）。其中，36.5%的患者患有系统性红斑狼疮，31.8%的患者患有类风湿关节炎。有 422 名患者（70.3%）有良好的医患关系，523 次医疗接触（87.2%）由认证的风湿病医生进行。患者家长式的自主理想（比值比 [OR]，3.029；95%置信区间 [CI]，1.793-5.113）、SF-36 评分（OR，1.014；95%CI，1.003-1.025）、女性（OR，0.460；95%CI，0.233-0.010）和认证的风湿病医生（OR，1.526；95%CI，1.059-2.200）与良好的医患关系相关。