困难的住院患者也是困难的初级保健患者吗?
Jeffrey L Jackson1, Akira Kuriyama2
1Department of General Internal Medicine, Clement J Zablocki VAMD, Milwaukee, WI, USA. jjackson@mcw.edu.
Journal of general internal medicine
|December 2, 2025
概括
大多数被住院提供者认为困难的患者也被他们的初级保健提供者视为困难. 这种重叠凸显了解决患者困难的重要性,特别是在人格障碍和抑郁症的情况下.
科学领域:
- 医学社会学 医学社会学
- 医疗保健提供者-患者动态
- 临床心理学 临床心理学
背景情况:
- 医疗保健提供者经常在住院和门诊环境中遇到被认为是困难的患者.
- 与住院困难相关的患者特征包括人格障碍,长时间住院和慢性疼痛.
- 在医疗上表现出无法解释的症状,心理健康状况 (抑郁,焦虑),人格障碍或慢性疼痛的门诊患者通常被认为是困难的.
研究的目的:
- 确定住院医疗服务提供者认为困难的患者是否也被他们的初级保健提供者 (PCP) 认为困难.
- 调查与困难相关的患者特征是否在住院和初级保健机构之间一致.
主要方法:
- 进行了一项前性队列研究,涉及退伍军人事务 (VA) 患者.
- 住院和初级保健提供者通过调查使用二分法和连续尺度对患者的困难进行了评分.
- 患者数据,包括特征,从电子健康记录中抽象出来.
主要成果:
- 在192名住院患者中,161人患有PCP,132人 (82%) 被纳入PCP调查.
- 67%的住院患者被他们的住院提供者认为是困难的,他们的PCP也认为是困难的.
- 住院困难,人格障碍和抑郁症是临床环境中感知到困难的独立预测因素.
结论:
- 在住院患者和初级保健提供者如何感知患者困难方面存在显著的重叠.
- 人格障碍和抑郁症是导致患者被PCP视为困难的关键因素.
- 研究结果强调,需要采用一致的方法来管理不同医疗保健机构的困难患者遭遇.
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