Leopold N, Cooper J, Clancy C
Agency for Health Care Policy and Research, Rockville, Maryland 20852, USA.
J Fam Pract. 1996 Feb;42(2):129-37.
In 1994, the Institute of Medicine (IOM) convened the Committee on the Future of Primary Care to provide a clearer understanding of the essential and desirable attributes of primary care. Perhaps the committee's most striking addition to the IOM's 1978 definition was the concept that primary care includes a sustained partnership with patients. Development of the partnership is considered an explicit responsibility of the primary care clinician. Although there is an extensive and growing body of literature on the effects of clinician-patient communication on outcomes such as patient satisfaction, adherence, symptom abatement, and physiological measures of health status, the impact of a sustained partnership in a clinician-patient relationship remains largely unstudied. There is also no consensus regarding either the definition or achievement of a sustained partnership. This paper reviews selected relevant literature and proposes a theoretical basis for assessing the existence, antecedents, and outcomes of sustained partnerships between clinicians and patients. At a time when there is increased discussion and clarification of optimal clinician and patient roles in a rapidly evolving health care delivery system, we believe this mode can provide guidance to clinicians and provider organizations seeking to improve the quality of primary care.
1994年，美国医学研究所（IOM）召集了初级保健未来委员会，以更清晰地了解初级保健的基本属性和理想属性。或许该委员会对IOM 1978年定义最显著的补充是，初级保健包括与患者建立持续的伙伴关系这一概念。建立这种伙伴关系被视为初级保健临床医生的一项明确职责。尽管关于医患沟通对诸如患者满意度、依从性、症状缓解以及健康状况生理指标等结果的影响，已有大量且不断增加的文献，但医患关系中持续伙伴关系的影响在很大程度上仍未得到研究。对于持续伙伴关系的定义或实现也没有达成共识。本文回顾了部分相关文献，并提出了一个理论基础，用于评估临床医生与患者之间持续伙伴关系的存在、前提条件和结果。在一个快速发展的医疗服务体系中，关于最佳临床医生和患者角色的讨论和阐释日益增多之际，我们认为这种模式可为寻求提高初级保健质量的临床医生和医疗机构提供指导。
