Kaplan S H, Gandek B, Greenfield S, Rogers W, Ware J E
New England Medical Center, Primary Care Outcomes Research Institute, Boston, MA 02111, USA.
Med Care. 1995 Dec;33(12):1176-87. doi: 10.1097/00005650-199512000-00002.
This article identifies the characteristics of patients and office visits associated with decreased mutual decision-making between physicians and patients. In the baseline cross-sectional survey of the Medical Outcomes Study we measured specific patient characteristics hypothesized to influence participatory decision-making (PDM) styles of physicians. We related these characteristics to the PDM style scores for their physicians. The study was conducted in solo practices, multi-specialty groups, and health maintenance organizations in Boston, Chicago, and Los Angeles. Over a 9-day period in 1986, 8,316 patients were sampled from the practices of 344 participating Medical Outcome Study physicians, representing general internal medicine, family practice, cardiology and endocrinology. Physicians' PDM style was measured using a 3-item scale included on the baseline questionnaire completed by patients after office visits to their Medical Outcome Study physicians. We found that the elderly (age 75 and older) and young adult (younger than age 30) patients, patients with high school education or less, minority patients, and male patients had the least participatory visits with their physicians. We also found that male patients seeing male physicians had the least participatory visits compared with male patients seeing female physicians, and compared with female patients seeing physicians of either gender. Our data indicated that PDM style increased as duration or tenure of the physician-patient relationship increased. Participatory decision-making style also increased with increasing length of office visits. The role of effective interpersonal care in optimizing patients' health outcomes may be underappreciated. We have identified seven patient and visit characteristics that maximize or compromise the effectiveness of interpersonal care. Recognizing those at risk for suboptimal interpersonal care may be a first step in improving the management of chronic disease. Key words: participatory decision-making style; interpersonal care; doctor-patient communication.
本文确定了与医患之间共同决策减少相关的患者特征和门诊情况。在医疗结果研究的基线横断面调查中，我们测量了假设会影响医生参与式决策（PDM）风格的特定患者特征。我们将这些特征与他们医生的PDM风格得分相关联。该研究在波士顿、芝加哥和洛杉矶的单人诊所、多专科团体以及健康维护组织中进行。1986年的9天时间里，从344名参与医疗结果研究的医生的诊所中抽取了8316名患者，这些医生代表普通内科、家庭医学、心脏病学和内分泌学。医生的PDM风格是通过患者在就诊后填写的基线问卷中的一个3项量表来测量的，该问卷是针对他们的医疗结果研究医生的。我们发现，75岁及以上的老年患者、30岁以下的年轻成年患者、高中及以下学历的患者、少数族裔患者和男性患者与医生的参与度最低。我们还发现，男性患者看男医生的参与度最低，与男性患者看女医生相比，也与女性患者看任何性别的医生相比。我们的数据表明，随着医患关系持续时间或任期的增加，PDM风格会增加。参与式决策风格也随着门诊时间的延长而增加。有效的人际关怀在优化患者健康结果中的作用可能未得到充分重视。我们已经确定了七个患者和门诊特征，这些特征会最大化或损害人际关怀的有效性。识别那些人际关怀次优风险较高的人可能是改善慢性病管理的第一步。关键词：参与式决策风格；人际关怀；医患沟通。
