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首页> 外文期刊>BMC Family Practice >Symptoms as the main problem: a cross- sectional study of patient experience in primary care
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Symptoms as the main problem: a cross- sectional study of patient experience in primary care

机译：症状是主要问题：对初级保健中患者经验的横断面研究

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Background Symptoms are common in primary care. Besides providing thorough assessment of possible severe disease, the general practitioner (GP) must ensure good health care to all patients, irrespective of diagnoses. We aimed to explore patient satisfaction with the provided care and how well expectations in patients were met when no diagnosis was made during the consultation. Method Cross-sectional study based on a questionnaire survey conducted in 2008–2009 among 377 GPs and their patients in the Central Denmark Region. A total of 2286 patients completed a questionnaire after the consultation (response rate: 54 %). The questionnaire included four satisfaction items from the EUROPEP instrument and a question about unmet expectations. For each patient, the GP answered a one-page registration form including information about the main problem in the consultation, chronic disorders and assessment of prognosis. Statistical analyses were adjusted for patient characteristics and GP clustering. Results A higher proportion of patients reported illness worry (20 vs. 17 %, p -value: 0.005), unmet expectations (17 vs. 13 %, p -value: 0.019) and dissatisfaction with their GP after the consultation when no diagnosis was made. Dissatisfaction was primarily related to the medical examination (adjusted OR 1.30; 95 % CI: 1.06–1.60) and GP explanations (adjusted OR 1.40; 95 % CI: 1.14–1.71). Exploratory analyses revealed an association between dissatisfaction with examination and the GP assessment that symptoms were unrelated to biomedical disease. This association was found both in patients with ‘symptoms only’ and patients given a specific diagnosis. Conclusion GPs are challenged by patients presenting symptoms that do not fit the patterns of biomedical diagnoses. The current study demonstrates more illness worry, unmet expectations and dissatisfaction with the consultation in these patients compared to patients receiving a diagnosis. This trend is true for all patients assessed as having ‘symptoms only’ at the end of a consultation and not only for the minority group with ‘medically unexplained symptoms’. As primary care is the frontline of the health-care system, symptoms are managed as the main problem in almost one in three consultations. It is about time that we take the same professional approach to symptoms as we have done for years to biomedical disease.
机译：背景症状在初级保健中很常见。除了对可能的严重疾病进行彻底评估之外，全科医生（GP）还必须确保所有患者的健康状况，无论诊断结果如何。我们旨在探讨患者对所提供护理的满意度，以及在咨询过程中未进行诊断时患者对患者的期望得到了满足。方法横断面研究基于2008-2009年在丹麦中部地区的377名GP及其患者进行的问卷调查。总共2286例患者在咨询后完成了问卷（回复率：54％）。问卷包括来自EUROPEP仪器的四个满意度项目以及一个关于未满足期望的问题。对于每位患者，GP都会回答一张一页的注册表格，其中包含有关咨询中的主要问题，慢性疾病和预后评估的信息。根据患者特征和GP聚类对统计分析进行了调整。结果较高比例的患者在没有诊断出诊断时会诊，担心疾病（20％vs. 17％，p值：0.005），未达到期望水平（17％vs. 13％，p值：0.019）以及对GP的不满意制作。不满意主要与体格检查（调整后的OR 1.30; 95％CI：1.06-1.60）和GP解释（调整后的OR 1.40; 95％CI：1.14-1.71）有关。探索性分析显示，对检查的不满与GP评估（症状与生物医学疾病无关）之间存在关联。这种关联在“仅症状”患者和接受特定诊断的患者中均被发现。结论GP受到患者提出不符合生物医学诊断方式的症状的挑战。当前的研究表明，与接受诊断的患者相比，这些患者有更多的疾病担忧，未满足的期望和对咨询的不满。这种趋势不仅适用于在咨询结束时被评估为“仅症状”的所有患者，而且不仅适用于患有“医学上无法解释的症状”的少数患者。由于初级保健是卫生保健系统的前线，因此几乎三分之二的诊治中，症状都是主要问题。现在是时候采取与生物医学疾病多年相同的专业方法来治疗症状了。

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