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Helping Patients Improve Their Health-Related Behaviors: What System Changes Do We Need?

机译：帮助患者改善与健康有关的行为：我们需要哪些系统更改？

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A large gap separates actual clinical outcomes of patients with chronic disease from optimal outcomes. This gap may be attributable to physician problems (physicians unaware of practice guidelines), patient problems (patients who choose not to follow medical advice) or system problems (physicians lack time to assist patients in managing their chronic condition). A goal for chronic illness care is to assist people with chronic conditions to become informed, activated patients. Patients who are informed and activated (activated = participating in health-related decisions) have better health-related behaviors and clinical outcomes. Primary care is often conducted within a 15-minute, multi-agenda visit between physician and patient. Such a structure has led to (1) patients being inadequately informed about their chronic conditions and (2) patients being passive recipients of medical advice rather than active participants in medical decisions. The result has been poorly informed, passive patients. This situation constitutes a system problem. Three redesign elements have the potential to address this system problem: (1) Pre-activating patients prior to the clinical visit appears to encourage more active patients and—in one study—improved clinical outcomes. (2) Planned visits, with a care manager spending time with patients, individually or in groups, providing education and medical management, have been shown to improve clinical outcomes. (3) Regular sustained follow-up, by face-to-face visits, telephone, or electronic means, is associated with healthier behaviors. Not all patients receiving disease management through redesigned primary care will adopt healthier behaviors because many factors outside the medical care system influence personal choices. However, until the medical care system regularly offers adequate information and encourages collaborative decision-making, it is improper to place the responsibility for unhealthy behaviors onto patients.
机译：巨大的差距将慢性病患者的实际临床结果与最佳结果区分开来。这种差距可能归因于医师问题（医师不了解实践指南），患者问题（患者选择不遵从医疗建议）或系统问题（医师缺乏时间来帮助患者管理慢性病）。慢性疾病护理的目标是帮助患有慢性疾病的人成为知情的，活跃的患者。被告知并被激活（已激活=参与健康相关决策）的患者具有更好的健康相关行为和临床结局。初级保健通常在医师和患者之间的15分钟多议程访问中进行。这样的结构导致（1）患者对其慢性病的了解不充分，以及（2）患者是被动接受医疗建议而不是主动参与医疗决策的。结果是知情的被动患者。这种情况构成系统问题。重新设计的三个要素有可能解决该系统问题：（1）在临床就诊之前预先激活患者似乎可以鼓励更活跃的患者，并且在一项研究中可以改善临床效果。 （2）事实证明，按计划进行的就诊可以使临床护理效果得到改善，计划的就诊时间是由护理经理单独或分组陪伴患者，以提供教育和医疗管理。 （3）通过面对面的访问，电话或电子方式进行的定期持续随访与更健康的行为有关。并非所有通过重新设计的初级保健接受疾病管理的患者都会采取更健康的行为，因为医疗保健系统之外的许多因素都会影响个人选择。但是，直到医疗保健系统定期提供足够的信息并鼓励进行协作决策之前，将不健康行为的责任置于患者身上是不合适的。

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