Cockburn J, Pit S
University of Newcastle, Australia.
BMJ. 1997 Aug 30;315(7107):520-3. doi: 10.1136/bmj.315.7107.520.
To examine the effect of patients' expectations for medication and doctors' perceptions of patients' expectations on prescribing when patients present with new conditions.
Questionnaire study of practitioners and patients.
General practice in Newcastle, Australia.
22 non-randomly selected general practitioners and 336 of their patients with a newly diagnosed medical condition.
Prescription of medication and expectation of it.
Medication was prescribed for 169 (50%) patients. After controlling for the presenting condition, patients who expected medication were nearly three times more likely to receive medication (odds ratio = 2.9, 95% confidence interval 1.3 to 6.3). When the general practitioner thought the patient expected medication the patient was 10 times more likely to receive it (odds ratio = 10.1, 5.3 to 19.6). A significant association existed between patients' expectation and doctors' perception of patients' expectation (chi 2 = 52.0, df = 4, P = 0.001). For all categories of patient expectation, however, patients were more likely to receive medication when the practitioner judged the patient to want medication than when the practitioner ascribed no expectation to the patient.
Although patients brought expectations to the consultation regarding medication, the doctors' opinions about their expectations were the strongest determinants of prescribing.
探讨患者对药物治疗的期望以及医生对患者期望的认知对新发病患者处方开具的影响。
对从业者和患者进行问卷调查研究。
澳大利亚纽卡斯尔的全科医疗诊所。
22名非随机选取的全科医生及其336名新诊断疾病的患者。
药物处方及对药物的期望。
169名（50%）患者接受了药物处方。在控制了就诊病情后，期望接受药物治疗的患者接受药物治疗的可能性几乎是其他患者的三倍（优势比 = 2.9，95%置信区间1.3至6.3）。当全科医生认为患者期望接受药物治疗时，患者接受药物治疗的可能性高出10倍（优势比 = 10.1，5.3至19.6）。患者的期望与医生对患者期望的认知之间存在显著关联（卡方 = 52.0，自由度 = 4，P = 0.001）。然而，对于所有患者期望类别，当医生判断患者想要药物治疗时，患者比医生认为患者不期望药物治疗时更有可能接受药物治疗。
尽管患者在就诊时对药物治疗抱有期望，但医生对其期望的看法是处方开具的最主要决定因素。
