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“医生对我的病情更了解”:患者对即时检验在管理呼吸道感染方面价值的看法。一项欧洲初级保健的定性研究

'The doctors were more knowledgeable about what I had': patient views on the value of point-of-care tests for managing respiratory infections. A qualitative study in European primary care.

作者信息

Wanat Marta, Hoste Melanie Eugenie, Anastasaki Marilena, Böhmer Femke, Colliers Annelies, Gkamaletsou Maria, Löffler Christin, Lionis Christos, Malania Lile, Shah Mala, Wollny Anja, Vellinga Akke, Butler Christopher C, van der Velden Alike W, Anthierens Sibyl, Tonkin-Crine Sarah

机构信息

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.

出版信息

BJGP Open. 2025 Jul 23;9(2). doi: 10.3399/BJGPO.2024.0139. Print 2025.

Abstract

BACKGROUND

Point-of-care tests (POCT) can support diagnosis of patients with community-acquired acute respiratory tract infections (CA-RTI) in primary care and thereby reduce uncertainty whether antibiotics may benefit patients. However, successful roll out of POCTs need to be built on a deep understanding of patients' perspectives on the place of POCTs in patient-centred care.

AIM

To explore patients' perceptions of the value of POCTs during consultations for CA-RTI.

DESIGN & SETTING: A qualitative study using semi-structured interviews in Belgium, Republic of Ireland, Georgia, Germany, Greece, and the UK with patients who consulted for CA-RTI in primary care.

METHOD

Interviews were audio recorded, transcribed, and analysed using reflexive thematic analysis.

RESULTS

Interviews with 56 participants revealed that in the process of a GP making a diagnosis and treatment decision, patients valued several components, such as a physical examination, their GP enquiring about and listening to concerns, and a POCT. Yet, the visibility and relative importance of each of these components varied in the four main ways in which patients perceived the value of POCTs, including 1) test as objective evidence compared to 'subjective' clinical judgment; 2) test as providing more precision; 3) test as inferior to clinical judgment; 4) test as one of the tools in the GP's toolbox.

CONCLUSION

The wide variation in patient perceptions about POCT for CA-RTI underscores the importance of recognising patient preferences regarding the diagnostic process. This understanding is important to ensure that POCT results optimally influence treatment decision-making, patient satisfaction, and acceptance of their care plan.

摘要

背景

即时检验(POCT)有助于基层医疗中社区获得性急性呼吸道感染(CA-RTI)患者的诊断,从而减少抗生素对患者是否有益的不确定性。然而,成功推广POCT需要深入了解患者对POCT在以患者为中心的医疗中所起作用的看法。

目的

探讨患者在CA-RTI会诊期间对POCT价值的认知。

设计与设置

一项定性研究,在比利时、爱尔兰共和国、格鲁吉亚、德国、希腊和英国对基层医疗中因CA-RTI前来会诊的患者进行半结构化访谈。

方法

访谈进行录音、转录,并采用反思性主题分析法进行分析。

结果

对56名参与者的访谈显示,在全科医生(GP)做出诊断和治疗决策的过程中,患者重视几个方面,如体格检查、GP询问并倾听他们的担忧以及POCT。然而,这些方面在患者认知POCT价值的四种主要方式中,其可见性和相对重要性各不相同,包括1)检验作为与“主观”临床判断相对的客观证据;2)检验提供更高的准确性;3)检验不如临床判断;4)检验是GP工具箱中的工具之一。

结论

患者对CA-RTI的POCT认知差异很大,这凸显了认识患者对诊断过程偏好的重要性。这种理解对于确保POCT结果能最佳地影响治疗决策、患者满意度以及对其护理计划的接受度很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a959/12421285/bf04d09c168f/bjgpopen-9-0139-f1.jpg

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