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通过向医生反馈功能状态来提高患者生活质量。

Improving patient quality of life with feedback to physicians about functional status.

作者信息

Rubenstein L V, McCoy J M, Cope D W, Barrett P A, Hirsch S H, Messer K S, Young R T

机构信息

Sepulveda VA Medical Center, CA 91343, USA.

出版信息

J Gen Intern Med. 1995 Nov;10(11):607-14. doi: 10.1007/BF02602744.

Abstract

OBJECTIVE

To improve functional status among primary care patients.

INTERVENTION

  1. Computer-generated feedback to physicians about the patient's functional status, the patient's self-reported "chief complaint," and problem-specific resource and management suggestions; and 2) two brief interactive educational sessions for physicians.

DESIGN

Randomized controlled trial.

SETTING

University primary care clinic.

PARTICIPANTS

All 73 internal medicine house officers and 557 of their new primary care patients.

MEASURES

  1. Change in patient functional status from enrollment until six months later, using the Functional Status Questionnaire (FSQ); 2) management plans and additional information about functional status abstracted from the medical record; and 3) physician attitude about whether internists should address functional status problems.

RESULTS

Emotional well-being scores improved significantly for the patients of the experimental group physicians compared with those of the control group physicians (p < 0.03). Limitations in social activities indicated as "due to health" decreased among the elderly (> or = 70 years of age) individuals in the experimental group compared with the control group (p < 0.03). The experimental group physicians diagnosed more symptoms of stress or anxiety than did the control group physicians (p < 0.001) and took more actions recommended by the feedback form (p < 0.02).

CONCLUSIONS

Computer-generated feedback of functional status screening results accompanied by resource and management suggestions can increase physician diagnoses of impaired emotional well-being, can influence physician management of functional status problems, and can assist physicians in improving emotional well-being and social functioning among their patients.

摘要

目的

改善初级保健患者的功能状态。

干预措施

1)计算机生成的关于患者功能状态、患者自我报告的“主要诉求”以及针对特定问题的资源和管理建议的反馈信息给医生;2)为医生提供两次简短的互动式教育课程。

设计

随机对照试验。

地点

大学初级保健诊所。

参与者

所有73名内科住院医师及其557名新的初级保健患者。

测量指标

1)使用功能状态问卷(FSQ)评估患者从入组到六个月后的功能状态变化;2)从病历中提取的关于功能状态的管理计划和其他信息;3)医生对内科医生是否应解决功能状态问题的态度。

结果

与对照组医生的患者相比,实验组医生的患者的情绪幸福感得分显著提高(p < 0.03)。与对照组相比,实验组中老年人(≥70岁)因“健康原因”导致的社会活动受限情况有所减少(p < 0.03)。实验组医生诊断出的压力或焦虑症状比对照组医生更多(p < 0.001),并且采取反馈表中建议行动的比例更高(p < 0.02)。

结论

计算机生成的功能状态筛查结果反馈信息并附带资源和管理建议,可增加医生对情绪幸福感受损的诊断,可影响医生对功能状态问题的管理,并可帮助医生改善患者的情绪幸福感和社会功能。

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