患者と医師の関係における意見の相違を解決する: マネージドケアにおけるコミュニケーションを改善するためのツール

W Levinson¹, R Gorawara-Bhat, R Dueck

¹Section of General Internal Medicine and Program for Physician Patient Communication Research, University of Chicago, Ill 60627, USA. wendy@medicine.bsd.uchicago.edu

JAMA

|October 27, 1999

まとめ

マネージドケア (Managed Care) とは,管理された介護のことです.

科学分野:

ヘルスケア・マネジメント・ヘルスケア・マネジメント
医療倫理医療倫理について
患者と医師のコミュニケーション

背景:

マネージドケアには,金銭的インセンティブと利用制限があり,医師の意思決定と医療費に影響を及ぼします.
医者の客観性に対する懸念と,患者ケアにおける財政的影響に対する懸念が原因で,国民の信頼が損なわれています.
これらの要因は,患者と医師の関係における紛争の可能性を生む.

研究の目的:

マネージドケアから生じる患者と医師の関係における新興の意見の相違を特定し,明確に述べる.
資源の配分,患者のアクセス,および財政的インセンティブに関連する紛争を示す特定のシナリオを探求する.
これらの意見の相違を緩和するためのコミュニケーションと政策戦略を提案する.

主な方法:

1998年10月,患者代表,医療指導者,医師,コミュニケーション専門家,倫理学者を含む多学科グループを招集した.
3つの異なるシナリオを分析した:リソースの割り当て (紹介の変更),患者のアクセス (提供者の選択),および財政的インセンティブ (注文テスト).
医者のためのコミュニケーション戦略を策定し,健康プラン/グループのための政策勧告を策定しました.

主要な成果:

マネージドケア実践から生じる患者と医師の対立の重要な分野を特定しました.
具体的で関連性のあるシナリオを通して,潜在的な意見の相違を図解した.
マネージドケア下での患者と医師の相互作用を改善するために,実行可能なコミュニケーション戦略を生成しました.

結論:

効果的なコミュニケーション戦略は,医師が管理されたケアに関連する紛争をナビゲートするのに役立ちます.
医療プランや医師団は,患者と医師の意見の相違を減らすための政策を実施することができます.
これらの問題に対処することは,マネージドケアシステムにおける信頼と最適な患者ケアを維持するために極めて重要です.

キーワード:

保健医療と公衆衛生についてプロフェッショナル患者との関係患者との関係

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