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从“自称的权威专家”到“易受影响的怀疑论者”——构建一种患者类型学以区分患者与医疗保健的互动:德国的一项定性研究

From 'Sovereign Self-Proclaimed Experts' to 'Impressionable Sceptics'-Developing a Patient Typology to Distinguish Patients' Interactions With Healthcare: A Qualitative Study in Germany.

作者信息

Achstetter Katharina, Blümel Miriam, Röttger Julia, Köppen Julia, Polin Katherine, Busse Reinhard

机构信息

Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.

Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany.

出版信息

Int J Health Plann Manage. 2025 Jul;40(4):896-906. doi: 10.1002/hpm.3923. Epub 2025 Mar 21.

Abstract

BACKGROUND

Person-centredness in health systems puts patients and their preferences at the centre of healthcare. However, there is not an 'one size fits all' approach as patients are heterogenous and have varying interactions with and perceptions of healthcare, and assessments of the health system performance. This study aims to explore these patient differences by (1) identifying core attributes of patients that shape their general approach to and interactions with healthcare and (2) deriving specific patient types based on these core attributes.

METHODS

The qualitative study included content analysis of semi-structured, problem-oriented interviews with 27 participants selected with the aim of maximum variation and heterogeneity (e.g., regarding age, gender, health status, place of living) from the Berlin-Brandenburg region of Germany.

RESULTS

Based on the interviews with the participants, three core patient attributes were found that shape interactions with healthcare: (1) taking care of health and illness, (2) the self-assigned patient role, and (3) the patient-assigned healthcare provider role. Seven patient types were identified across (opposing) manifestations of these core attributes, ranging from 'sovereign self-proclaimed experts' (focussing-autonomous-fulfiller) to 'impressionable sceptics' (ignoring-heteronomous-seller).

CONCLUSION

Consideration of the identified patient types and their different ways of engaging with healthcare providers and their varying perceptions of the health system can help to develop strategies to promote person-centredness in health systems. Furthermore, this typology can inform providers about the diverse ways in which patients may perceive healthcare interactions, and it can be useful for the training of future physicians and other healthcare professionals.

摘要

背景

卫生系统中的以人为本将患者及其偏好置于医疗保健的核心位置。然而,并不存在“一刀切”的方法,因为患者是异质的,他们与医疗保健的互动以及对医疗保健的认知和对卫生系统绩效的评估各不相同。本研究旨在通过以下方式探索这些患者差异:(1)确定塑造患者对医疗保健的总体态度和互动方式的核心属性;(2)基于这些核心属性推导特定的患者类型。

方法

这项定性研究包括对来自德国柏林-勃兰登堡地区的27名参与者进行的半结构化、以问题为导向的访谈的内容分析,这些参与者的选择旨在实现最大程度的差异和异质性(例如,在年龄、性别、健康状况、居住地点方面)。

结果

基于对参与者的访谈,发现了塑造与医疗保健互动的三个核心患者属性:(1)照顾健康和疾病;(2)自我认定的患者角色;(3)患者认定的医疗保健提供者角色。在这些核心属性的(相反)表现形式中识别出了七种患者类型,从“自主宣称的专家”(专注-自主-履行者)到“易受影响的怀疑者”(忽视-他主-推销者)。

结论

考虑已识别的患者类型及其与医疗保健提供者互动的不同方式以及他们对卫生系统的不同认知,有助于制定促进卫生系统以人为本的策略。此外,这种类型学可以让提供者了解患者可能感知医疗保健互动的多种方式,并且对未来医生和其他医疗保健专业人员的培训可能有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9ade/12215595/76ec4c3a9ddc/HPM-40-896-g002.jpg

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