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埃塞俄比亚奥罗米亚州吉马医疗中心成年住院患者对临床决策的感知参与度及相关因素:一项横断面研究

Patients' perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, Ethiopia: a cross-sectional study.

作者信息

Dibera Keneni Dina, Debancho Wadu Wolancho, Bedada Gadisa Bekele, Dugasa Yonas Gurmu

机构信息

Department of Nursing, Ambo University, Ambo, Oromo, Ethiopia

Department of Nursing, Jimma University Institute of Health, Jimma, Oromia, Ethiopia.

出版信息

BMJ Open. 2024 Dec 22;14(12):e085984. doi: 10.1136/bmjopen-2024-085984.

Abstract

OBJECTIVE

To assess patients' perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, Ethiopia, 2022.

DESIGN

An institution-based cross-sectional study was employed.

SETTING

A study was conducted at a governmental tertiary teaching and referral hospital located in Jimma Zone, Oromia region, southwestern part of Ethiopia. The study was conducted between 15 July and 7 September 2022.

PARTICIPANTS

A total of 422 randomly selected adult patients admitted at Jimma Medical Center were enrolled, after excluding those who were acutely ill during the study period.

METHODS

Data were collected via a structured, interviewer-administered tool, entered into EpiData V.4.6 and exported to SPSS V.26 for analysis. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the outcome variable. Significant factors were declared at p<0.05.

MAIN OUTCOME MEASURE

Patients' perceived involvement in clinical decision-making (adequate involvement/poor involvement).

RESULTS

A total of 51.4% (95% CI: 46.4 to 56.3) of respondents had adequate perceived involvement in clinical decision-making. Participants who were aged >60 years (adjusted OR (AOR): 2.01 (95% CI: 1.44 to 5.65)), college and above the level of education (AOR: 4.6 (95% CI: 1.6 to 13.26)), length of hospital stay >15 days (AOR: 2.8 (95% CI: 1.41 to 5.5)) and high health literacy level (AOR: 2.04 (95% CI: 1.34 to 4.21)) were more likely to be associated with adequate perceived involvement in clinical decision-making whereas non-prior hospitalisation (AOR: 0.493 (95% CI: 0.3 to 0.82)) and passive autonomy preference (AOR: 0.22 (95% CI: 0.13 to 0.37)) were less likely to be associated with adequate perceived involvement in clinical decision-making than each of their corresponding counterparts.

CONCLUSION

Only nearly half of the respondents had adequate perceived involvement in clinical decision-making. Collaborative autonomy preferences, high educational levels, long length of hospital stay, high health literacy level and patients in the older age group were among the factors significantly associated with respondents' adequate perceived involvement in clinical decision-making. Healthcare professionals have to consider empowering patients' perceived involvement in clinical decision-making, and hospital management has to reinforce healthcare professionals' efforts to promote patients' perceived involvement in clinical decision-making.

摘要

目的

评估2022年在埃塞俄比亚奥罗米亚州吉马医疗中心住院的成年患者对临床决策的感知参与度及相关因素。

设计

采用基于机构的横断面研究。

背景

研究在埃塞俄比亚西南部奥罗米亚州吉马地区的一家政府三级教学和转诊医院进行。研究于2022年7月15日至9月7日开展。

参与者

在排除研究期间病情严重的患者后,共纳入422名在吉马医疗中心随机选取的成年住院患者。

方法

通过结构化的、由访谈员实施的工具收集数据,录入EpiData V.4.6并导出至SPSS V.26进行分析。采用双变量和多变量逻辑回归分析来确定与结果变量相关的因素。p<0.05时声明为显著因素。

主要结局指标

患者对临床决策的感知参与度(充分参与/参与不足)。

结果

共有51.4%(95%置信区间:46.4%至56.3%)的受访者认为自己在临床决策中得到了充分参与。年龄>60岁的参与者(调整后比值比(AOR):2.01(95%置信区间:1.44至5.65))、大专及以上学历者(AOR:4.6(95%置信区间:1.6至13.26))、住院时间>15天者(AOR:2.8(95%置信区间:1.41至5.5))以及健康素养水平高者(AOR:2.04(95%置信区间:1.34至4.21))更有可能与对临床决策的充分感知参与相关,而非先前未住院者(AOR:0.493(95%置信区间:0.3至0.82))和被动自主偏好者(AOR:0.22(95%置信区间:0.13至0.37))与对临床决策的充分感知参与相关的可能性低于各自相应的对照者。

结论

只有近一半的受访者认为自己在临床决策中得到了充分参与。协作自主偏好、高学历水平、住院时间长、高健康素养水平以及老年患者群体是与受访者对临床决策的充分感知参与显著相关的因素。医疗保健专业人员必须考虑增强患者对临床决策的感知参与度,医院管理层必须加强医疗保健专业人员促进患者对临床决策的感知参与度的努力。

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