Kinmonth A L, Woodcock A, Griffin S, Spiegal N, Campbell M J
Primary Medical Care Group (Aldermoor Health Centre), Faculty of Health, Medicine and Biological Sciences, University of Southampton, Southampton SO16 5ST.
BMJ. 1998 Oct 31;317(7167):1202-8. doi: 10.1136/bmj.317.7167.1202.
To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes.
Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle.
41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England.
250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group).
1.5 days' group training for the doctors and nurses-introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions.
Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2).
Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6; 1.1 to 2.5) and wellbeing (difference in means (d) 2.8; 0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower (d=-2.74; -0.23 to -5.25). Differences in lifestyle and glycaemic control were not significant.
The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.
评估为实习护士和全科医生提供以患者为中心的护理额外培训，对新诊断的2型糖尿病患者生活方式、心理和生理状况的影响。
实用平行组设计，在医疗团队之间随机分配至常规护理（对照组）或常规护理加额外培训（干预组）；一年后进行分析，考虑医疗团队效应和分层因素；患者自行报告与医护人员的沟通情况、对治疗的满意度、护理方式和生活方式。
英格兰南部一个健康区域的41个医疗团队（干预组21个，对照组20个）。
250/360名被诊断为2型糖尿病且完成一年随访的患者（干预组142名，对照组108名），年龄在30至70岁之间。
为医生和护士提供1.5天的小组培训——介绍以患者为中心的护理的证据和技能，并发放一本鼓励患者提问的手册。
生活质量、幸福感、糖化血红蛋白和血脂浓度、血压、体重指数（kg/m²）。
与对照组患者相比，干预组患者报告称与医生的沟通更好（优势比2.8；95%置信区间1.8至4.3）、对治疗的满意度更高（1.6；1.1至2.5）以及幸福感更强（均值差异（d）2.8；0.4至5.2）。然而，他们的体重指数显著更高（d = 2.0；0.3至3.8），甘油三酯浓度也是如此（d = 0.4 mmol/l；0.07至0.73 mmol/l），而知识得分更低（d = -2.74；-0.23至-5.25）。生活方式和血糖控制方面的差异不显著。
研究结果表明，接受培训的医护人员对咨询过程的关注高于预防护理；致力于实现以患者为中心咨询益处的人员不应忽视对疾病管理的关注。
