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背景全科医生许多咨询问题覆盖了多种疾病学科,然而怎样了解和量化这种现象还缺乏有效的工具和技术。此研究目的是,为初级保健咨询所讨论问题的数量和类型研发一种测量工具。方法对全科开业者与患者之间的13个咨询过程做了录像和复习,识别讨论的问题和维度。包括临床医生和研究人员重复检测并开发的迭代方法,可用于评估录像所记录的咨询的测量方式及代码手册。针对60例咨询,对此工具的评定者间信度进行了检测。结果需采取措施的问题可迅速识别。然而,问题的不同维度及如何处理还需对维度加以识别和定义。编码方式的开发可量化所讨论的健康问题和类型、维度数量。最终识别和定义了10个维度类型。在咨询水平上,评定者间达成协议:讨论问题(±1内)、问题和维度类型数目分别为98.3%、96.5%和90.0%。随即利用此工具对229例咨询进行了分析。结论开发工具迭代方法反映了医患间互动的复杂性。所研发的有效工具可用于初级保健咨询评估,对处理问题的数目及范围做出分析。
Background Many GPs cover many disease topics, however, there is a lack of effective tools and techniques to understand and quantify this phenomenon. The purpose of this study was to develop a measurement tool for the number and type of issues discussed in primary care counseling. Methods Video and review of 13 counseling sessions between practitioners and patients were conducted to identify the issues and dimensions of the discussion. This includes an iterative approach that is repeatedly tested and developed by clinicians and researchers to assess how the counseling is recorded and the code book is recorded. For 60 cases of counseling, the reliability of this tool was evaluated. As a result, the issues that need to be taken can be quickly identified. However, the different dimensions of the problem and how to deal with it need to be identified and defined. Development of coding methods quantifies the health issues and types discussed, the number of dimensions. Finally, 10 dimension types were identified and defined. At the consultation level, an agreement was reached among assessors: Discussion questions (within ± 1), Number of questions and dimensions types were 98.3%, 96.5% and 90.0%, respectively. This tool was then used to analyze 229 cases of counseling. Conclusion The development tool iteration method reflects the complexity of the interaction between doctors and patients. Effective tools developed can be used in the primary health care consultation assessment to analyze the number and scope of problems addressed.