Laerum E, Steine S, Finset A, Lundevall S
Department of General Practice and Community Medicine, University of Oslo, Blindern, Norway.
Fam Pract. 1998 Apr;15(2):172-81. doi: 10.1093/fampra/15.2.172.
Many patients in general practice present with complex health problems. It is argued that the GP who is in a prime position to counsel patients with such problems, will, however, often perceive a lack of tools to manage them. The aim of the present study was to develop a novel instrument in terms of a patient-administered questionnaire, the Patient Perspective Survey (PPS), designed to enhance the quality of clinical communication in the consultation. It is based on a biopsychosocial patient perspective, patient centredness, patient resources, involvement and coping, and quality of life orientation.
Development of the PPS has included comprehensive literature research, discussions and advice, during several phases, from groups of GPs, patients, broad panels of experts and testing in pilot studies. After many revisions, a 102-item version, consisting of a main somatic, mental and social domain axis, was evaluated by GPs and patients in 213 consultations.
The basic idea, theoretical elements and purpose of the PPS appeared in general to be well accepted. Seventy-five to eighty-five per cent of the patients found the questions relevant and easy to understand and there were high positive scorings regarding influence on the doctor-patient relationship, communication, resource and coping aspects, occurrence of new information and general satisfaction with the consultation. Similar scorings were obtained from the GPs' evaluation. Both parties agreed that there is a need for a shorter and more specific PPS version, and that the resource and coping dimension should be even more extended.
We consider it well documented that there is a need for this new instrument to deal with complex health problems in general practice, and that it has promising potentials for consultation improvement.
许多普通科患者存在复杂的健康问题。有人认为，处于为这类患者提供咨询最佳位置的全科医生，往往会觉得缺乏管理这些问题的工具。本研究的目的是开发一种新型工具，即患者自填式问卷——患者视角调查（PPS），旨在提高会诊中临床沟通的质量。它基于生物心理社会患者视角、以患者为中心、患者资源、参与和应对以及生活质量导向。
PPS的开发包括在几个阶段进行全面的文献研究、讨论和咨询，参与的有全科医生小组、患者、广泛的专家小组，并在试点研究中进行测试。经过多次修订，一个由102个项目组成的版本，包括一个主要的躯体、心理和社会领域轴，在213次会诊中由全科医生和患者进行了评估。
PPS的基本理念、理论要素和目的总体上似乎得到了很好的接受。75%至85%的患者认为这些问题相关且易于理解，在对医患关系、沟通、资源和应对方面、新信息的出现以及对会诊的总体满意度方面有很高的积极评分。全科医生的评估也得到了类似的评分。双方都认为需要一个更简短、更具体的PPS版本，并且资源和应对维度应该进一步扩展。
我们认为有充分的证据表明，在普通科处理复杂健康问题需要这种新工具，并且它在改善会诊方面有很大的潜力。
