北京市全科医生门诊医患沟通技能水平现状调查
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摘要
背景全科医生是社区卫生服务的主要提供者,是居民健康的"守门人",较强的医患沟通能力尤为重要。目的探讨北京社区卫生服务中心全科医生医患沟通技能水平的现状。方法采用便利抽样法,在北京社区卫生服务网推荐的77家国家级及北京市市级社区卫生服务示范中心中选取60家,再采用偶遇抽样法从每家社区卫生服务中心选择5名门诊医生,共300名为调查对象。调查于2017年1月—2018年3月进行,测评人员随患者及其家属进入诊室,采用《医患沟通技能评价表》(SEGUE量表)通过现场观察打分的方式,对其进行医患沟通能力测评。结果300名全科医生SEGUE量表总得分为6～22分,平均得分(16.0±6.3)分;准备阶段得分(3.9±1.9)分;信息收集阶段得分(6.4±2.1)分;信息给予阶段得分(3.0±1.7)分;理解患者得分(2.7±1.5)分;结束问诊阶段得分(1.8±0.4)分。全科医生与同期三级甲等医院门诊医生SEGUE量表得分比较,全科医生在准备阶段得分高于三级甲等医院门诊医生,差异有统计学意义(P<0.05);全科医生在准备阶段得分高于三级甲等医院专家组门诊医生,差异有统计学意义(P<0.05);全科医生在准备阶段、信息收集阶段、结束问诊阶段得分及SEGUE量表总分高于三级甲等医院普通组门诊医生,差异有统计学意义(P<0.05)。全科医生、三级甲等医院医生SEGUE量表总分均低于美国通科医生,差异有统计学意义(P<0.05)。结论目前北京市全科医生的临床沟通技能水平有待于进一步提高,仅准备阶段评分高于同期三级甲等医院门诊医生,但与国际同行比较存在一定差距。
Background General practitioners(GPs) are the main providers of community health services and gatekeepers of residents' health.For them,mastery of doctor-patient communication skills is particularly important.Objective To evaluate the communication skills of GPs when they interact with patients in community health centers(CHCs) of Beijing.Methods Using convenience sampling,60 out of 77 national and municipal community health demonstration centers recommended by Beijing Community Health Service Network were selected,from which 300 doctors in outpatient clinic settings were selected by accidental sampling(5 from each center).The survey was conducted from January 2017 to March 2018.The assessors entered the clinic with the patients and their families.The doctor-patient communication skills were observed on-site and assessed by the SEGUE Framework.Results The total SEGUE score of the GPs ranged 6-22,with an average score of(16.0±6.3);the mean scores of 5 stages of set the stage,elicit information,give information,understand the patient's perspective and end the encounter were was(3.9±1.9)(6.4±2.1)(3.0±1.7)(2.7±1.5)(1.8±0.4),respectively.Compared with the physicians and specialists in outpatient clinic settings of tertiary grade A hospitals in Beijing who received the same assessment during this period,GPs in outpatient clinic settings of CHCs had much higher mean scores of set the stage(P<0.05).Compared with the general physicians in outpatient clinic settings of tertiary grade A hospitals,GPs in outpatient clinic settings of CHCs obtained significantly higher mean scores in 3 stages of set the stage,elicit information,and end the encounter and higher mean total SEGUE score(P<0.05).However,both these GPs from CHCs and the physicians from tertiary grade A hospitals achieved lower total SEGUE scores than the American general physicians(P<0.05).Conclusion In Beijing,only the score of set the stage of GPs in CHCs is higher than those of physicians in outpatient clinic settings of tertiary grade A hospitals,but are lower than those of international counterparts.GPs are suggested to improve their clinical communication skills further.
Background General practitioners(GPs) are the main providers of community health services and gatekeepers of residents' health.For them,mastery of doctor-patient communication skills is particularly important.Objective To evaluate the communication skills of GPs when they interact with patients in community health centers(CHCs) of Beijing.Methods Using convenience sampling,60 out of 77 national and municipal community health demonstration centers recommended by Beijing Community Health Service Network were selected,from which 300 doctors in outpatient clinic settings were selected by accidental sampling(5 from each center).The survey was conducted from January 2017 to March 2018.The assessors entered the clinic with the patients and their families.The doctor-patient communication skills were observed on-site and assessed by the SEGUE Framework.Results The total SEGUE score of the GPs ranged 6-22,with an average score of(16.0±6.3);the mean scores of 5 stages of set the stage,elicit information,give information,understand the patient's perspective and end the encounter were was(3.9±1.9)(6.4±2.1)(3.0±1.7)(2.7±1.5)(1.8±0.4),respectively.Compared with the physicians and specialists in outpatient clinic settings of tertiary grade A hospitals in Beijing who received the same assessment during this period,GPs in outpatient clinic settings of CHCs had much higher mean scores of set the stage(P<0.05).Compared with the general physicians in outpatient clinic settings of tertiary grade A hospitals,GPs in outpatient clinic settings of CHCs obtained significantly higher mean scores in 3 stages of set the stage,elicit information,and end the encounter and higher mean total SEGUE score(P<0.05).However,both these GPs from CHCs and the physicians from tertiary grade A hospitals achieved lower total SEGUE scores than the American general physicians(P<0.05).Conclusion In Beijing,only the score of set the stage of GPs in CHCs is higher than those of physicians in outpatient clinic settings of tertiary grade A hospitals,but are lower than those of international counterparts.GPs are suggested to improve their clinical communication skills further.
引文
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[9]赵铁夫,许学敏,王铁军,等.医生术前沟通现状研究[J].中国卫生质量管理,2015,22(6):68-70.ZHAO T F,XU X M,WANG T J,et al.Research on the status quo before the doctor's surgery communication skills[J].Chinese Health Quality Management,2015,22(6):68-70.
[10]赵铁夫,马涵英,许学敏,等.在校医学生医患沟通技能评价现状的研究[J].卫生职业教育,2016,34(6):88-89.ZHAOTF,MAHY,XUXM,etal.Researchonthe evaluation of doctor-patient communication skills in medical school students[J].Health Vocational Education,2016,34(6):88-89.
[11]赵铁夫,王盛宇,邹晓昭,等.全科医师在非体外循环冠状动脉旁路移植术后患者焦虑抑郁倾向干预中的作用[J].中国医药,2018,13(3):372-375.DOI:10.3760/cma.j.issn.1673-4777.2018.03.012.ZHAO T F,WANG S Y,ZOU X Z,et al.Effect of medical intervention by general practitioners on anxiety and depression in patients after off-pump coronary artery bypass graft[J].China Medicine,2018,13(3):372-375.DOI:10.3760/cma.j.issn.1673-4777.2018.03.012.
[2]温世浩,江晓滨.美国医学生学习的沟通技能[J].医学教育探索,2006,5(7):604-606.WEN S H,JIANG X B.Communication skill taught to medical students in USA[J].Chinese Journal of Medical Education Research,2006,5(7):604-606.
[3]REESC,SHEPHERDM.Theacceptabilityof360-degree judgments as a method of assessing undergraduate medical students'personal and professional behaviors[J].Medical Education,2005,39(1):49-57.DOI:10.1111/j.1365-2929.2004.02032.x.
[4]JOSHIR,LINGFW,JAEGERJ,etal.Assessmentofa360-degree instrument to evaluate resident's competency in interpersonal and communication skills[J].Academic Medicine,2004,79(5):458-463.
[5]孙宝志.21世纪新的医学目标与高等医学教育改革[J].医学与哲学,2005,26(2):24-26.SUN B Z.New medical goals in 21th century and medical education reform[J].Medicine and Philosophy,2005,26(2):24-26.
[6]李娟.用SEGUE量表对医学生医患沟通技能评价的研究[D].沈阳:中国医科大学,2008.
[7]王玲,马俊,甘代军.叙事医学对提高患者依从性的影响[J].医学与哲学,2016,37(3b):71-73.WANG L,MA J,GAN D J.The Influence of narrative medicine on improvement of patients'compliance[J].Medicine and Philosophy,2016,37(3b):71-73.
[8]申丽君,孙刚.基于SEGUE量表的医生医患沟通技能评价研究[J].中国全科医学,2017,20(16):1998-2002. DOI:10.3969/j.issn.1007-9572.2017.16.019.SHEN L J,SUN G.Assessment of physician-patient communication skills in practicing physicians by SEGUE framework[J].Chinese General Practice,2017,20(16):1998-2002. DOI:10.3969/j.issn.1007-9572.2017.16.019.
[9]赵铁夫,许学敏,王铁军,等.医生术前沟通现状研究[J].中国卫生质量管理,2015,22(6):68-70.ZHAO T F,XU X M,WANG T J,et al.Research on the status quo before the doctor's surgery communication skills[J].Chinese Health Quality Management,2015,22(6):68-70.
[10]赵铁夫,马涵英,许学敏,等.在校医学生医患沟通技能评价现状的研究[J].卫生职业教育,2016,34(6):88-89.ZHAOTF,MAHY,XUXM,etal.Researchonthe evaluation of doctor-patient communication skills in medical school students[J].Health Vocational Education,2016,34(6):88-89.
[11]赵铁夫,王盛宇,邹晓昭,等.全科医师在非体外循环冠状动脉旁路移植术后患者焦虑抑郁倾向干预中的作用[J].中国医药,2018,13(3):372-375.DOI:10.3760/cma.j.issn.1673-4777.2018.03.012.ZHAO T F,WANG S Y,ZOU X Z,et al.Effect of medical intervention by general practitioners on anxiety and depression in patients after off-pump coronary artery bypass graft[J].China Medicine,2018,13(3):372-375.DOI:10.3760/cma.j.issn.1673-4777.2018.03.012.