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目的探讨初级保健医生支持患者行为改变的有效临床策略。方法与先锋负责医疗组织——费尔韦健康服务中心(Fairview Health Services)合作,采用混合研究方法收集7 144例接受了初级保健医生治疗患者的激活措施(PAM)分数。选取患者分数增加较多和较少的初级保健医生各10名进行访谈,分析患者PAM分数增加较多初级保健医生的关键临床策略。结果共整理出患者PAM分数增加较多初级保健医生使用的关键临床策略5种,分别为:强调患者所有权;与患者合作;制定小步骤;频繁随访,以鼓励患者进步,并帮其解决问题;对患者表示关心。患者PAM分数增加较多初级保健医生使用中位关键临床策略数量为3.9种/人,而患者PAM分数增加较少初级保健医生使用的中位关键临床策略数量为1.3种/人。大部分初级保健医生使用自身方式对患者进行干预。与患者PAM分数增加较少初级保健医生相比,患者PAM分数增加较多初级保健医生与患者的沟通时间较长。结论不同初级保健医生使用的患者行为改变支持策略和花费时间不同,患者PAM分数增加较多初级保健医生使用的5种关键临床策略可能是支持患者行为改变的潜在有效方法。
Objective To explore effective clinical strategies for primary care physicians to support behavioral changes in patients. Methodology In collaboration with Pioneer’s responsible medical organization, Fairview Health Services, a pool of 7 144 PAM measures was collected using a hybrid study of patients treated with primary care physicians. 10 interviews with primary care physicians with more and less primary scores were conducted to analyze the key clinical strategies of increasing primary PAMM scores. Results A total of five key clinical strategies for the primary care physicians, including more emphasis on patient ownership, greater increase in PAM scores, were collapsed; cooperation with patients; development of small steps; frequent follow-up to encourage patient progress and help with problem resolution; Concerned about the patient. Patients ’PAM scores increased significantly. The number of primary clinics who used the median key clinical strategy was 3.9 / person while the patients’ PAM scores increased less. The number of primary key clinical strategies used by primary care physicians was 1.3 / person. Most primary care physicians use their own ways to intervene. The patient’s PAM score increased more than the patient’s PAM score increased less than that of the primary care physician The primary care physician spent longer time communicating with the patient. CONCLUSIONS Different strategies used by different primary care physicians for behavioral change support and time spent on different patients increased their PAM scores. The five key clinical strategies used by primary care physicians may be potentially effective ways to support behavioral changes in patients.