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目的探讨儿童急性呼吸道感染(ARTI)问诊过程中医生交流技巧与抗生素处方关系。方法采取横断面调查2007年11月—2009年4月西雅图10家诊所28名医生对1 285例ARTI患儿的诊疗过程。每次问诊结束后,对医生进行调查,调查内容包括患儿症状、查体结果、诊断和处方。同时对患儿家长进行调查,调查内容为医生的沟通技巧。结果不论是仅提出积极治疗建议〔OR=0.48,95%CI(0.24,0.95)〕,还是同时提出积极治疗建议和消极治疗建议(排除抗生素使用的需要)的医生〔OR=0.15,95%CI(0.06,0.40)〕,使用抗生素处方的概率均降低。结论医生同时提供积极和消极治疗建议可以降低病毒性ARTI患儿使用抗生素处方的风险。随着抗生素耐药的愈发严重,这一交流技巧可作为医生应对该医疗问题的举措之一。
Objective To explore the relationship between doctor communication skills and antibiotic prescription during the inquiry of children with acute respiratory infection (ARTI). Methods A cross-sectional survey of 28 285 physicians from 10 clinics in Seattle from November 2007 to April 2009 was performed on 1,285 ARTI children. After each interview, the doctor will be investigated. The contents of the survey include symptoms of children, examination results, diagnosis and prescription. At the same time, parents of children were investigated, the contents of the investigation for the doctor’s communication skills. The result was either a positive treatment recommendation (OR = 0.48, 95% CI, 0.24, 0.95) or a physician presenting both active treatment recommendations and negative treatment recommendations (excluding the need for antibiotic use) [OR = 0.15, 95% CI (0.06,0.40)〕, the probability of using antibiotics prescriptions are reduced. Conclusions Both physicians’ positive and negative treatment recommendations can reduce the risk of antibiotic prescriptions in children with viral ARTI. As antibiotic resistance becomes more serious, this communication skill can serve as one of the physicians’ responses to the medical issue.