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[初级保健咨询中陪伴者对沟通技巧和问诊时间的影响]

[Influence of the companion in Primary Care consultations on communication skills and interview time].

作者信息

Pérez-Milena Alejandro, Zafra-Ramírez Natalia, Ramos-Ruiz Juan Andrés, Rodríguez-Bayón Antonina, Zafra-Ramírez Javier

机构信息

Centro de Salud El Valle, Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España.

Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España.

出版信息

Aten Primaria. 2022 Sep;54(9):102388. doi: 10.1016/j.aprim.2022.102388. Epub 2022 Jun 29.

Abstract

OBJETIVES

To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview.

DESIGN

Cross-sectional descriptive study.

LOCATION

10 Primary Care Centers.

PARTICIPANTS

Resident doctors of Family and Community Medicine.

INTERVENTIONS

Peer review of video recordings of clinical demand consultations.

MAIN MEASUREMENTS

CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings.

RESULTS

73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]).

CONCLUSIONS

Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.

摘要

目的

了解三人临床问诊中陪伴者对医患沟通质量及问诊时长的影响。

设计

横断面描述性研究。

地点

10个初级保健中心。

参与者

家庭与社区医学住院医生。

干预措施

对临床需求咨询的视频记录进行同行评审。

主要测量指标

使用CICAA - 2问卷评估沟通技巧(可改进、可接受或充分);年龄、性别、咨询原因及问诊时长。进行双变量和多变量分析。伦理授权、口头知情同意及视频记录保管。

结果

73名住院医生(53.8%为女性,年龄32.9±7.7岁)参与了260次问诊(60.3%为女性,临床需求2.1±1.0个)。27.7%的问诊有陪伴者(女性占65.3%)。问诊的平均时长为8.5±4.0分钟。有陪伴者在场时临床问诊持续时间更长(多2.7±0.5分钟;p<.001,学生t检验),且临床需求数量更多时也是如此(40%有≥3个原因,p = 0.048,卡方检验)。有陪伴者在场时,CICAA - 2量表总分的平均值(46.9±16.5;差值4.6±2.3)和任务2的平均值(39.3±15.8,差值4.4±2.2)更高(p<.05,学生t检验)。逻辑回归模型显示,有陪伴者时问诊持续时间更长(比值比1.2;可信区间[1.1 - 1.3]),任务2沟通技巧得分可能更高(比值比1.02;可信区间[0.99 - 1.1])。

结论

三人沟通对临床医生的沟通技巧构成挑战,虽以投入更多时间为代价,但能提高其识别和理解患者问题的能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65b3/9253964/fcfe5c3e676c/fx1.jpg

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