Chen Tsung-Tai, Chueh Ke-Hsin, Chen Kao-Chen, Chou Chi-Ling, Yang Jing-Jung
PhD, Associate Professor, Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
PhD, RN, Associate Professor, Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
J Nurs Res. 2023 Apr 1;31(2):e268. doi: 10.1097/jnr.0000000000000549.
Pharmacological interventions combined with nonpharmacological treatments such as patient-centered care (PCC)-related activities are widely used to enhance outcomes in patients with schizophrenia. However, few studies have examined and identified the PCC factors essential to achieving better outcomes in patients with schizophrenia.
This study was designed to identify the Picker-Institute-identified PCC domains associated with satisfaction and to determine which of these domains are most important in the context of schizophrenia care.
Data were collected using patient surveys in outpatient settings and record reviews at two hospitals in northern Taiwan between November and December 2016. PCC data were collected in five domains: (a) support of patient autonomy; (b) goal setting; (c) collaboration and integration of healthcare services; (d) information, education, and communication; and (e) emotional support. The outcome measure was patient satisfaction. The study controlled for demographic factors, including age, gender, education, occupation, marriage, and urbanization level in the respondent's area of residence. Clinical characteristics included the Clinical Global Impressions severity and improvement index scores, previous admission, previous emergency department visit, and readmission within 1 year. Methods were adopted to prevent common method variance bias. Multivariable linear regression with stepwise selection and the generalized estimating equation were used to analyze the data.
After controlling for confounding factors, the generalized estimating equation model found only three PCC factors significantly associated with patient satisfaction, which differed slightly from the results of the multivariable linear regression. These three factors are as follows, in order of importance: information, education, and communication (parameter = 0.65 [0.37, 0.92], p < .001); emotional support (parameter = 0.52 [0.22, 0.81], p < .001); and goal setting (parameter = 0.31 [0.10, 0.51], p = .004).
The three critical PCC-related factors were evaluated in terms of enhancing patient satisfaction in patients with schizophrenia. Practicable strategies related to these three factors should also be developed for implementation in clinical settings.
药物干预与以患者为中心的护理（PCC）相关活动等非药物治疗相结合，被广泛用于改善精神分裂症患者的治疗效果。然而，很少有研究探讨并确定对精神分裂症患者取得更好治疗效果至关重要的PCC因素。
本研究旨在确定与满意度相关的皮克研究所确定的PCC领域，并确定在精神分裂症护理背景下这些领域中哪些最为重要。
2016年11月至12月期间，在台湾北部的两家医院，通过门诊患者调查和病历审查收集数据。PCC数据在五个领域收集：（a）支持患者自主性；（b）设定目标；（c）医疗服务的协作与整合；（d）信息、教育与沟通；（e）情感支持。结果指标为患者满意度。该研究控制了人口统计学因素，包括年龄、性别、教育程度、职业、婚姻状况以及受访者居住地区的城市化水平。临床特征包括临床总体印象严重程度和改善指数评分、既往住院史、既往急诊就诊史以及1年内再次入院情况。采用方法防止共同方法方差偏差。使用逐步选择的多变量线性回归和广义估计方程对数据进行分析。
在控制混杂因素后，广义估计方程模型发现只有三个PCC因素与患者满意度显著相关，这与多变量线性回归的结果略有不同。这三个因素按重要性排序如下：信息、教育与沟通（参数 = 0.65 [0.37, 0.92]，p <.001）；情感支持（参数 = 0.52 [0.22, 0.81]，p <.001）；设定目标（参数 = 0.31 [0.10, 0.51]，p =.004）。
从提高精神分裂症患者满意度的角度评估了三个关键的PCC相关因素。还应制定与这三个因素相关的可行策略，以便在临床环境中实施。
