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首页> 外文期刊>JMIR medical education. >Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study
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Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study

机译：与虚拟人进行的模拟对话可改善患者与提供者之间的沟通并减少不必要的抗生素处方：一项重复测量的试验研究

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Background: Despite clear evidence that antibiotics do not cure viral infections, the problem of unnecessary prescribing of antibiotics in ambulatory care persists, and in some cases, prescribing patterns have increased. The overuse of antibiotics for treating viral infections has created numerous economic and clinical consequences including increased medical costs due to unnecessary hospitalizations, antibiotic resistance, disruption of gut bacteria, and obesity. Recent research has underscored the importance of collaborative patient-provider communication as a means to reduce the high rates of unnecessary prescriptions for antibiotics. However, most patients and providers do not feel prepared to engage in such challenging conversations. Objectives: The aim of this pilot study was to assess the ability of a brief 15-min simulated role-play conversation with virtual humans to serve as a preliminary step to help health care providers and patients practice, and learn how to engage in effective conversations about antibiotics overuse. Methods: A total of 69 participants (35 providers and 34 patients) completed the simulation once in one sitting. A pre-post repeated measures design was used to assess changes in patients’ and providers’ self-reported communication behaviors, activation, and preparedness, intention, and confidence to effectively communicate in the patient-provider encounter. Changes in patients’ knowledge and beliefs regarding antibiotic use were also evaluated. Results: Patients experienced a short-term positive improvement in beliefs about appropriate antibiotic use for infection ( F 1,30 =14.10, P =.001). Knowledge scores regarding the correct uses of antibiotics improved immediately postsimulation, but decreased at the 1-month follow-up ( F 1,30 =31.16, P .10) Patients with lower levels of activation exhibited positive, short-term benefits in increased intent and confidence to discuss their needs and ask questions in the clinic visit, positive attitudes regarding participation in SDM with their provider, and accurate beliefs about the use of antibiotics ( P .10). The results also suggest small immediate gains in providers’ attitudes about SDM (mean change 0.20; F 1,33 = 8.03, P =.01). Conclusions: This pilot study provided preliminary evidence on the efficacy of the use of simulated conversations with virtual humans as a tool to improve patient-provider communication (ie, through increasing patient confidence to actively participate in the visit and physician attitudes about SDM) for engaging in conversations about antibiotic use. Future research should explore if repeated opportunities to use the 15-min simulation as well as providing users with several different conversations to practice with would result in sustained improvements in antibiotics beliefs and knowledge and communication behaviors over time. The results of this pilot study offered several opportunities to improve on the simulation in order to bolster communication skills and knowledge retention.
机译：背景：尽管有明确的证据表明抗生素不能治愈病毒感染，但非卧床护理中不必要地开具抗生素的问题仍然存在，并且在某些情况下，开处方的方式有所增加。过度使用抗生素治疗病毒感染已造成许多经济和临床后果，包括由于不必要的住院，抗生素耐药性，肠道细菌破坏和肥胖而增加医疗费用。最近的研究强调了患者与供应商之间的协作交流作为减少大量不必要的抗生素处方的手段的重要性。但是，大多数患者和提供者并不准备参加这种具有挑战性的对话。目标：这项初步研究的目的是评估与虚拟人进行的简短15分钟模拟角色扮演对话的能力，以此作为帮助医疗保健提供者和患者进行练习的初步步骤，并学习如何进行有效的对话关于抗生素过度使用。方法：总共69名参与者（35名提供者和34名患者）一次坐了一次就完成了模拟。事前重复措施设计用于评估患者和提供者自我报告的沟通行为，激活以及准备，意图和信心的变化，以有效地与患者-提供者进行交流。还评估了患者关于抗生素使用的知识和信念的变化。结果：患者对使用适当的抗生素进行感染的信念得到了短期的积极改善（F 1,30 = 14.10，P = .001）。模拟后正确使用抗生素的知识得分在模拟后立即改善，但在随访1个月后下降（F 1,30 = 31.16，P .10）激活水平较低的患者表现出积极的，短期的意愿改善并有信心在诊所就诊时讨论他们的需求并提出问题，对与服务提供者一起参加SDM的积极态度，以及对使用抗生素的准确看法（P <.10）。结果还表明，提供者对SDM的态度会立即获得收益（平均变化0.20; F 1,33 = 8.03，P = .01）。结论：这项初步研究提供了关于与虚拟人进行模拟对话作为改善患者与提供者沟通的工具（即通过提高患者对参加SDM的积极性和医生态度的信心）的有效性的初步证据。在有关抗生素使用的对话中。未来的研究应探索使用15分钟模拟的重复机会，以及为用户提供一些不同的会话进行练习是否会随着时间的流逝而持续改善抗生素的信念，知识和交流行为。这项初步研究的结果为改进仿真提供了一些机会，以增强沟通技巧和知识保留能力。

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