基于医患多方访谈的心身疾病认知和就医行为特点分析
R749.92; 背景 心身疾病在社区患病率高,疾病负担大.当前各医疗卫生机构的不同学科对于其诊治职能不明及流程策略不足,导致医患多方对疾病的认知差异和就医行为特点影响到社区疾病的诊治管理.目的 从医患多方了解并分析心身疾病患者的就医认知和行为特点及影响因素,为改善社区心身疾病的诊治和管理提供策略方向.方法 2022-02-01-06-31选取上海市杨浦区1家综合性医院(H1)的内科医生(n=5),杨浦区2家市区社区卫生服务中心(H2、H3)、嘉定区和浦东新区 2 家社区卫生服务中心(H4、H5)的全科医生(n=12),杨浦区 1 家精神卫生中心医院的医护人员(n=2),以及就诊于以上各医院的...
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| Published in | 中国全科医学 Vol. 27; no. 13; pp. 1630 - 1644 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
200090 上海市全科医学与社区卫生发展研究中心%200090 上海市,同济大学附属杨浦医院全科医学科
05.05.2024
200090 上海市全科医学临床质量控制中心 200090 上海市全科医学与社区卫生发展研究中心 200090 上海市,同济大学附属杨浦医院全科医学科%201209 上海市浦东新区曹路社区卫生服务中心%200090 上海市,同济大学附属杨浦医院全科医学科 200092 上海市,同济大学医学院全科医学系 |
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| Online Access | Get full text |
| ISSN | 1007-9572 |
| DOI | 10.12114/j.issn.1007-9572.2023.0194 |
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| Abstract | R749.92; 背景 心身疾病在社区患病率高,疾病负担大.当前各医疗卫生机构的不同学科对于其诊治职能不明及流程策略不足,导致医患多方对疾病的认知差异和就医行为特点影响到社区疾病的诊治管理.目的 从医患多方了解并分析心身疾病患者的就医认知和行为特点及影响因素,为改善社区心身疾病的诊治和管理提供策略方向.方法 2022-02-01-06-31选取上海市杨浦区1家综合性医院(H1)的内科医生(n=5),杨浦区2家市区社区卫生服务中心(H2、H3)、嘉定区和浦东新区 2 家社区卫生服务中心(H4、H5)的全科医生(n=12),杨浦区 1 家精神卫生中心医院的医护人员(n=2),以及就诊于以上各医院的心身疾病患者或其家属(n=10)进行微信、面谈、电话等方式的访谈调查,内容包括对心身疾病的认知、就医行为、疾病态度、问题及建议,访谈时间为 15～30 min,访谈内容记录后转录成文字,编码、归纳生成主题,最后引用具有代表性的受访者发言.结果(1)全科医生和精神科医生疾病认知程度较高,内科医生认知度较低,患者普遍缺乏认识.(2)全科医生和精神科医生对于心身疾病具有较多诊治经验,但整体而言,开展工作不足,治疗效果不佳.(3)医患多方态度不一,总体缺乏积极性.全科医生对于心身疾病的诊治态度最为积极.(4)不同的学科医生均面临困难,包含患者基数大、精神卫生资源不足、心理知识不够扎实、缺乏规范诊治指南、业务繁忙等.(5)大部分患者未接受过心理治疗,但也不排斥心理治疗,然而存在不信任全科医生、担心治疗副作用、就医行为受多种因素影响等问题.(6)医患均提出了建设性意见,包括加强对社会公众的宣传和政策引导,促进心身医学不断发展,提高医生对心理障碍的识别,开设慢性病心理科联合门诊,改善就医体验感,设置舒适诊疗环境,协调转诊等建议.结论 医患多方存在认知和态度差异、医疗资源不对等、行为不规范等障碍.需加强全科医生对社区心身疾病诊疗管理的优势和功能,充分落实相关资源并加以利用,改善医患双方的消极态度,促使患者正确就医,提高心理健康水平. |
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| AbstractList | R749.92; 背景 心身疾病在社区患病率高,疾病负担大.当前各医疗卫生机构的不同学科对于其诊治职能不明及流程策略不足,导致医患多方对疾病的认知差异和就医行为特点影响到社区疾病的诊治管理.目的 从医患多方了解并分析心身疾病患者的就医认知和行为特点及影响因素,为改善社区心身疾病的诊治和管理提供策略方向.方法 2022-02-01-06-31选取上海市杨浦区1家综合性医院(H1)的内科医生(n=5),杨浦区2家市区社区卫生服务中心(H2、H3)、嘉定区和浦东新区 2 家社区卫生服务中心(H4、H5)的全科医生(n=12),杨浦区 1 家精神卫生中心医院的医护人员(n=2),以及就诊于以上各医院的心身疾病患者或其家属(n=10)进行微信、面谈、电话等方式的访谈调查,内容包括对心身疾病的认知、就医行为、疾病态度、问题及建议,访谈时间为 15～30 min,访谈内容记录后转录成文字,编码、归纳生成主题,最后引用具有代表性的受访者发言.结果(1)全科医生和精神科医生疾病认知程度较高,内科医生认知度较低,患者普遍缺乏认识.(2)全科医生和精神科医生对于心身疾病具有较多诊治经验,但整体而言,开展工作不足,治疗效果不佳.(3)医患多方态度不一,总体缺乏积极性.全科医生对于心身疾病的诊治态度最为积极.(4)不同的学科医生均面临困难,包含患者基数大、精神卫生资源不足、心理知识不够扎实、缺乏规范诊治指南、业务繁忙等.(5)大部分患者未接受过心理治疗,但也不排斥心理治疗,然而存在不信任全科医生、担心治疗副作用、就医行为受多种因素影响等问题.(6)医患均提出了建设性意见,包括加强对社会公众的宣传和政策引导,促进心身医学不断发展,提高医生对心理障碍的识别,开设慢性病心理科联合门诊,改善就医体验感,设置舒适诊疗环境,协调转诊等建议.结论 医患多方存在认知和态度差异、医疗资源不对等、行为不规范等障碍.需加强全科医生对社区心身疾病诊疗管理的优势和功能,充分落实相关资源并加以利用,改善医患双方的消极态度,促使患者正确就医,提高心理健康水平. |
| Abstract_FL | Background Psychosomatic disorders present high prevalence and disease burden in the community.Currently,different disciplines of medical institutions possess unclear functions and inadequate process strategies for the diagnosis and treatment of psychosomatic disorders,resulting in differences in the perceptions of disease and behavioral characteristics of doctors and patients,which affects the management of disease in the community.Objective To understand and analyze the cognitive and behavioral characteristics as well as the influencing factors of psychosomatic disorders from multiple perspectives of doctors and patients,and then provide strategic directions to improve the diagnosis and management of psychosomatic patients in the community.Methods During the period from 2022-02-01 to 06-31,5 internists from a general hospital(H1)in Yangpu District,12 general practitioners from 2 community health centers(H2,H3)in Yangpu District,and 2 community health centers(H4,H5)in Jiading and Pudong New Districts,2 healthcare professionals from a mental health center hospital in Yangpu District,and 10 patients and with psychosomatic disorders who had been treated in the above hospitals or their relatives.The interview was performed by WeChat,face-to-face as well as telephone and other methods,with the content including perceptions of psychosomatic disorders,healthcare seeking behaviors,disease attitudes,problems and suggestions,and lasted 15-30 min.The interview content was recorded and transcribed into text,coded,summarized to generate themes,and finally quoted from representative interviewees.Results(1)There was a high level of disease awareness among general practitioners and psychiatrists,a low level of awareness among internists,and a general lack of awareness among patients.(2)General practitioners and psychiatrists possessed more experience in the diagnosis and treatment of psychosomatic disorders,but lacking sufficient work and effective treatment results.(3)The attitudes of multiple doctors and patients were varied with an overall lack of positivity.General practitioners had the most positive attitudes toward the diagnosis and treatment of psychosomatic disorders.(4)Doctors of different disciplines faced difficulties,including large patient bases,insufficient mental health resources,lack of solid psychological perceptions,lack of standardized guidelines for diagnosis and treatment,and busy practices,etc.(5)Most patients had not received psychotherapy,but they didn't exclude it either,while there were problems such as distrust of general practitioners,fear of treatment side effects,and health seeking behavior affected by many factors.(6)Both doctors and patients offered constructive suggestions,which included strengthening publicity and policy guidance to the public,promoting the continuous development of psychosomatic medicine,improving doctors'identification of psychological disorders,opening joint clinic for chronic disease and psychology,improving the experience of medical treatment,setting up a comfortable treatment environment,and coordinating referrals,etc.Conclusion Barriers such as differences in perceptions and attitudes between doctors and patients,unequal medical resources,and irregularities in behavior exist between doctors and patients.In the community,it is necessary to strengthen the advantages and functions of general practitioners on the management of psychosomatic disorders;fully implement and utilize relevant resources;and improve the negative attitudes of both doctors and patients,so that patients can seek proper medical treatment and improve their mental health. |
| Author | 刘怀磊 彭杨杨 于德华 张含之 |
| AuthorAffiliation | 200090 上海市,同济大学附属杨浦医院全科医学科%201209 上海市浦东新区曹路社区卫生服务中心%200090 上海市,同济大学附属杨浦医院全科医学科;200092 上海市,同济大学医学院全科医学系;200090 上海市全科医学与社区卫生发展研究中心%200090 上海市,同济大学附属杨浦医院全科医学科;200092 上海市,同济大学医学院全科医学系;200090 上海市全科医学与社区卫生发展研究中心;200090 上海市全科医学临床质量控制中心 |
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| Author_FL | PENG Yangyang ZHANG Hanzhi YU Dehua LIU Huailei |
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| Keywords | 认知 Psychological 心身疾病 Psychosomatic disorders Health care behavior 多方访谈 就医行为 心身医学 Cognition Psychosomatic medicine 心理 Multi-party interviews |
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| Snippet | R749.92; 背景 心身疾病在社区患病率高,疾病负担大.当前各医疗卫生机构的不同学科对于其诊治职能不明及流程策略不足,导致医患多方对疾病的认知差异和就医行为特点影响到社区疾病的诊治管理.目的 从医患多方了解并分析心身疾病患者的就医认知和行为特点及影响因素,为改善社区心身疾病的诊治和管理提供策略方向.方法... |
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| Title | 基于医患多方访谈的心身疾病认知和就医行为特点分析 |
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