以患者为中心的汉堡难民初级保健门诊
Patient-centredness in primary care walk-in clinics for refugees in Hamburg.
机构信息
Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
BMC Prim Care. 2023 May 6;24(1):112. doi: 10.1186/s12875-023-02060-2.
BACKGROUND
The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg.
METHODS
Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients' reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations.
RESULTS
Patient-centredness of all consultations on average was 64% (95% CI 60-67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65-94), the lowest in respiratory ones with 55% (49-61). Longer consultations resulted in higher MPCC scores.
CONCLUSIONS
The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness.
PRACTICE IMPLICATIONS
We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.
背景
大量难民涌入德国，对医疗系统造成了巨大挑战。我们旨在通过汉堡基层医疗门诊（PCWC）中的视频口译员，检查初级保健门诊中为难民患者提供的以患者为中心的医疗咨询水平。
方法
分析了 2017 年至 2018 年 83 名患者的 92 次视频咨询。两名评估者使用医患沟通测量表（MPCC）和初级保健国际分类（ICPC-2）进行评分。根据年龄、性别和咨询时长，对患者就诊原因和采取的措施进行方差分析，探讨 MPCC 评分。进一步用 Pearson 相关系数分析咨询时长。
结果
根据 MPCC，所有咨询的以患者为中心程度平均为 64%（95%CI 60-67），健康相关问题影响了结果。心理健康问题的以患者为中心程度最高，达到 79%（65-94），呼吸问题最低，为 55%（49-61）。咨询时间越长，MPCC 评分越高。
结论
在讨论的健康问题以及咨询时长方面，以患者为中心的程度存在差异。尽管存在差异，但咨询中的视频口译支持了坚实的以患者为中心的沟通。
实践意义
我们建议在门诊医疗中使用远程视频口译服务，以支持以患者为中心的沟通，并弥补现场合格口译员代表性不足的问题，因为这里有多种语言。
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