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Effect of discordant physician-patient perceptions on patient adherence in inflammatory bowel disease.

机译：医患观念不一致对炎症性肠病患者依从性的影响。

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摘要

Background. Discordant physician-patient perceptions on health-related information have been related to less favourable health outcomes and increased use of health services.;Objectives. To develop a psychometrically-sound measure of physician-patient discordance that could be used by clinicians and researchers working with patients with various chronic diseases. To investigate the relationship between physician-patient discordance and patient adherence to self-care in inflammatory bowel disease.;Study design and population. A prospective cohort study with follow-ups at 2-weeks and 4-months was conducted between February and November 1999 at three gastroenterology clinics affiliated with the McGill University Health Centre. Ten physicians and 200 patients with inflammatory bowel disease participated in the study.;Methods. A 10-item visual analog scale questionnaire was developed which assessed perceptions of the patient's health status and of the clinical visit. Questionnaires were completed independently by physicians and patients following the index clinical visit. Discordance was calculated within physician-patient pairs. Demographic, clinical and psychosocial data were obtained prior to the visit. Patient adherence data were obtained at 2-weeks using a telephone interview and mail-back survey. General adherence was assessed with a visual analog scale; medication adherence was determined with a validated questionnaire. Medication data were obtained by chart review at 4-months. Multivariable generalized estimating equations models and mixed models for unbalanced repeated measures analysis of variance were used to determine associations between discordance and patient adherence.;Results. Satisfactory psychometric properties were obtained for discordance scores. Higher psychological distress was the most important determinant of higher discordance. Higher distress was correlated with active disease, less time since diagnosis, greater number and impact of negative life events. Higher satisfaction with social support reduced psychological distress by buffering the negative impact of perceived stress. Higher discordance on symptoms and treatment increased the risk of general nonadherence in patients with higher social support satisfaction. Medication adherence was associated with active disease, greater disease duration and scheduling another appointment. Higher discordance on well-being decreased the probability of medication adherence in non-distressed patients.;Conclusion. Preliminary evidence has been provided to support the validity of the new measure of physician-patient discordance. Higher discordance was associated with an increased risk of nonadherence in patients with healthy psychosocial characteristics.
机译：背景。医患对健康相关信息的看法不一致与健康状况欠佳和卫生服务使用增加有关。开发一种从心理上听起来不错的对医患矛盾的方法，以供与各种慢性疾病患者一起工作的临床医生和研究人员使用。调查医患之间的矛盾与患者对炎症性肠病自我护理的依从性之间的关系。研究设计和人群。在1999年2月至11月之间，在麦吉尔大学健康中心下属的三个胃肠病诊所进行了一项为期2个月和4个月的随访研究。方法：10名医师和200名炎症性肠病患者参加了研究。制定了一项10项视觉模拟量表，以评估患者对健康状况和临床就诊的看法。索引临床访问后，由医生和患者独立完成问卷调查。在医师-患者对之间计算不一致。在访问之前获得了人口统计学，临床和社会心理数据。使用电话访问和回邮调查在2周时获得患者依从性数据。用视觉模拟量表评估一般依从性；用经过验证的问卷确定药物依从性。在4个月时通过图表审查获得药物数据。使用多变量广义估计方程模型和混合模型进行不平衡重复测量方差分析，以确定不一致和患者依从性之间的关联。对于不一致分数，获得了令人满意的心理测量特性。较高的心理困扰是造成较高不和谐的最重要因素。更高的痛苦与活动性疾病，诊断以来的时间短，负面生活事件的数量和影响有关。对社会支持的更高满意度通过减轻感知压力的负面影响，减轻了心理困扰。社会支持满意度较高的患者在症状和治疗上的较高不一致会增加普遍不依从的风险。依从性与活动性疾病，更长的疾病持续时间和安排另一次约会有关。对幸福感的更高不一致性降低了非困扰患者的药物依从性的可能性。提供了初步证据来支持新的医患矛盾测量方法的有效性。心理健康状况良好的患者，较高的不一致性会增加不依从的风险。

著录项

  • 作者

    Sewitch, Maida J.;

  • 作者单位

    McGill University (Canada).;

  • 授予单位 McGill University (Canada).;
  • 学科 Health Sciences Medicine and Surgery.
  • 学位 Ph.D.
  • 年度 2001
  • 页码 253 p.
  • 总页数 253
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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