关于共同决策的实施建议:对住院和门诊患者进行比较研究的结果,体验调查
Cindy Yue Tian1,2, Eliza Lai-Yi Wong3,4, Hong Qiu1,2
1JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China.
分享决策 (SDM) 的整合因护理环境而异. 住院护理质量提高SDM,通过信任调节,而门诊护理质量降低它,信任调解这种效应. 弱势群体需要更多的SDM支持.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 以患者为中心的护理
- 临床决策 - 临床决策
背景情况:
- 共享决策 (SDM) 对于以患者为中心的护理至关重要,但在常规实践中未得到充分利用.
- 在不同的医疗保健环境中了解患者对SDM的体验对于改善其实施至关重要.
- 影响SDM的因素,例如对护理质量和患者信任的感知,需要进行调查.
研究的目的:
- 调查患者在香港门诊和住院环境中与共享决策 (SDM) 的经验.
- 在不同的医疗保健环境中,探索医生的护理质量和患者信任对SDM的影响.
- 确定与患者参与SDM相关的人口因素.
主要方法:
- 利用了来自香港2019年住院体验和2021年专家门诊体验调查的横截面调查数据.
- 采用多变量逻辑回归和路径分析来检查变量之间的关系.
- 包括一个大样本20675名参与者 (8275名住院患者,12400名门诊患者).
主要成果:
- 报告医生护理质量更高的住院患者更有可能参与SDM (OR=1.29),信任调节了这一联系.
- 报告医生护理质量更高的门诊患者显示SDM参与度下降 (OR=0.91),信任调解了这一效应.
- 妇女,老年人,更健康的人,受教育程度较低的人,以及独自生活的人在两个环境中都不太可能参与SDM.
结论:
- SDM实施策略必须是特定于环境的,应对住院患者和门诊患者的独特挑战.
- 培养患者对医生的信任对于增强SDM参与至关重要.
- 针对弱势群体提供有针对性的支持是必要的,以确保公平参与医疗保健决策.
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