特立尼达的初级保健咨询是以患者为中心的吗？一项针对非传染性疾病患者的横断面研究。

Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases.

作者信息

Rahaman Reisa R, Motilal M Shastri, Khan Raveed, Maharaj Rohan G

机构信息

Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.

出版信息

BMC Prim Care. 2023 Oct 21;24(1):215. doi: 10.1186/s12875-023-02149-8.

DOI:10.1186/s12875-023-02149-8

PMID:37865738

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10589933/

Abstract

BACKGROUND

The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement.

METHOD

A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12.

RESULTS

There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025).

CONCLUSION

Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.

摘要

背景

本研究的目的是衡量患者在非传染性疾病（NCDs）会诊中对以患者为中心的感知。我们还测量了会诊时长和患者赋能情况。

方法

在特立尼达和多巴哥北中区卫生局（NCRHA）圣约瑟夫医疗组的四家基层医疗诊所进行了为期2个月的横断面研究。访谈人员记录会诊时间，并使用患者对以患者为中心的感知（PPPC）问卷和患者赋能指数（PEI）完成会诊后问卷调查。PPPC是一个包含14个项目（每项评分1 - 4）的李克特量表工具。总分取平均值，PPPC分数4分为最高分。PEI衡量患者应对生活和疾病的能力。PEI由6个问题组成，评分0 - 2，最高分12分。

结果

有180名受访者（回复率 = 82.5%）。参与者为女性（75.6%），年龄超过65岁（50.6%），已婚（51.1%），印度裔特立尼达人（52.2%），基督教徒（60.6%）。一半人接受过小学教育，37.2%接受过中学教育。会诊时长在1.32至31.22分钟之间。会诊时长的平均值、中位数和众数分别为8.5、7.74和10分钟。以患者为中心程度的测量指标的平均值、中位数和众数分别为PPPC（3.67、3.86和4）和PEI分数（5.93、6和6）。中风患者的PPPC平均值较低（p = 0.022），会诊被打断超过2次的患者以及与医生非常熟悉的患者的PPPC平均值较高（p = 0.015）。心脏病患者的PEI分数较低（p = 0.022）。受过高等教育的患者以及会诊被打断两次的患者的会诊时长较长（p = 0.044和p = 0.032）。PPPC平均值和PEI分数相关性良好（ρ = 0.408，p < 0.001）。会诊时长与PPPC平均值相关（ρ = 0.168，p = 0.025）。