2人の患者の物語:不平等を減らすためのゲートウェイとしての患者中心のアプローチ

Nancy R Kressin¹, Sheila E Chapman², Jared W Magnani²

¹From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.). Nkressin@bu.edu.

Circulation

|June 15, 2016

まとめ

健康の社会的決定要因を理解することで心血管のケアが改善されます患者の障壁と臨床医のバイアスを取り除くと治療への従順性が向上し健康的な結果が改善されます

科学分野:

心臓病科
公衆衛生
健康に関する公平性

背景:

健康の社会的決定因子 (SDOH) は,心臓血管の健康と医療へのアクセスを大きく影響します.
限られた研究で,SDOHに対処することで,臨床的相互作用と患者の治療への従順性が改善される方法を調査しています.
臨床医の無意識の偏見は患者のケアと治療結果に否定的な影響を及ぼします

研究の目的:

心血管の臨床医がSDOHの障壁を特定し,対処する方法を示します.
無意識の臨床医のバイアスの影響を軽減するための患者中心のアプローチを実証する.
SDOHの検討を臨床実践に統合するための枠組みを提案する.

主な方法:

SDOHに対処する際の課題を例示する臨床事例を紹介しています.
患者中心のアプローチを提案しています "RESPECT"の記憶法を使って
患者の説明モデルと社会的な文脈を理解することの重要性を強調します.

主要な成果:

臨床医は病気や治療に関する患者の異なる信念体系を認識する必要があります
患者の理解に基づいた臨床アプローチの調整は極めて重要です.
RESPECT 記憶術は患者への関わりを組織的に提供します

結論:

SDOHの意識を臨床実践に統合することで,患者の遵守を改善することができます.
患者中心のコミュニケーション戦略は効果的な心血管治療に不可欠です
臨床医のバイアスと患者特有の障壁に対処することで治療関係と成果が向上します

キーワード:

粘着性格差, 医療人種患者中心のケア健康の社会的決定因子社会経済的地位トリートメント

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