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三级医院门诊抑郁症医患共同决策理念调查及影响因素分析

Survey and analysis of the shared decision-making concept and the influencing factors for depression in outpatient clinics of tertiary hospitals
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摘要 目的了解我国门诊抑郁症患者与医生共同决策的意愿现状,分析影响患者与医生共同决策意愿的因素。方法以我国12家三级精神病专科医院和综合医院为调查中心,通过扫描二维码在手机端填写问卷的方式,对抑郁症患者和医生进行问卷调查,内容主要包括:患者基本信息、情绪状态评分、初始诊疗情况、治疗期待及关注点、症状改善需求及药物安全性需求、患者诊断情况(由接诊医生填写);医生基本信息、抑郁诊疗现状、药物关注点及顾虑等。通过单因素及多因素Logistic回归分析,筛选出患者与医生共同决策意愿的影响因素。结果共收集622份有效患者问卷和45份有效医生问卷。调查中患者和医生在共同决策方面均展现出较强的意愿[80.39%(500/622)比60.00%(27/45)]。多因素Logistic回归分析显示,居住地[城镇比农村:OR(95%CI)=1.895(1.087~3.305)]、能接受的每月诊疗费用[≥1000~<2000元比<300元:OR(95%CI)=0.194(0.088~0.427);≥2000元比<300元:OR(95%CI)=0.267(0.094~0.754)]、是否接受线上治疗与咨询[是比否:OR(95%CI)=3.196(2.024~5.046)]和是否了解心理治疗[是比否:OR(95%CI)=1.711(1.003~2.921)]是患者共同决策意愿的影响因素(均P<0.05);而首诊患者诊疗时间是医生共同决策意愿的影响因素[OR(95%CI)=1.090(1.004~1.184),P=0.040]。结论我国三级医院门诊抑郁症患者和医生的共同决策意愿均较强,具有良好的临床应用基础;但临床实践中,需重视居住地、能接受的每月诊疗费用、是否接受线上治疗与咨询和是否了解心理治疗对患者共同决策意愿的影响,以及首诊患者诊疗时间对医生共同决策意愿的影响。 Objectives:To investigate the current willingness of depressive outpatients and their doctors in China to engage in shared decision-making(SDM),and to analyze the factors influencing this willingness.Methods:A questionnaire survey was conducted among doctors and patients with depression in 12 tertiary psychiatric hospitals and general hospitals by scanning two-dimensional code and filling in the questionnaire on the mobile terminal.The questionnaire covered patient demographics,emotional state scores,initial diagnosis and treatment,treatment expectations and concerns,symptom improvement needs,medication safety requirements,and diagnosis details(completed by the attending physician).Doctors provided basic information,current depression diagnosis and treatment status,and concerns regarding medications.Logistic regression analysis(univariate and multivariate)was used to identify factors influencing patients′and doctors′willingness to engage in SDM.Results:A total of 622 valid patient questionnaires and 45 valid physician questionnaires were collected.Both patients and doctors had a strong willingness to make shared decisions(80.39%(500/622)vs.60.00%(27/45)).Multivariate binary logistic regression analysis showed that residential location(town versus rural areas:OR(95%CI)=1.895(1.087-3.305)),acceptable monthly medical expenses(≥1000-<2000 CNY vs.<300 CNY:OR(95%CI)=0.194(0.088-0.427);≥2000 CNY vs.<300 CNY:OR(95%CI)=0.267(0.094-0.754)),acceptance of online treatment and consultation(accept versus not accept:OR(95%CI)=3.196(2.024-5.046)),and knowing about psychotherapy(yes versus no:OR(95%CI)=1.711(1.003-2.921))were the factors influencing the willingness of shared decision-making in patients(all P<0.05).For the doctors,the time spent on initial consultation was the factor influencing the willingness to engage in SDM(OR(95%CI)=1.090(1.004-1.184),P=0.040).Conclusions:Both depression patients and doctors in tertiary outpatient clinics in China show a strong willingness to engage in SDM,providing a solid foundation for clinical application.However,it is necessary to pay attention to the influence of residential location,acceptable monthly medical expenses,acceptance of online treatment and consultation,and knowledge of psychotherapy should be considered for patients,while the time spent on initial consultations should be considered for doctors.
作者 崔夕龙 王小平 张宁 季建林 许秀峰 彭代辉 宁玉萍 李洁 蒋国庆 张瑞岭 王强 陆峥 安翠霞 中国神经科学学会精神病基础与临床分会三级医院门诊抑郁症医患共同决策理念调查专家组 Cui Xilong;Wang Xiaoping;Zhang Ning;Ji Jianlin;Xu Xiufeng;Peng Daihui;Ning Yuping;Li Jie;Jiang Guoqing;Zhang Ruiling;Wang Qiang;Lu Zheng;An Cuixia;on the behalf of Chinese Society of Neuroscience Psychiatry,Expert Panel of Survey on the Concept of Shared Decision-Making in Outpatients with Depression in Tertiary Hospitals(The Second Xiangya Hospital of Central South University,Changsha410011,China;The Affiliated Brain Hospital of Nanjing Medical University,Nanjing210029,China;Zhongshan Hospital of Fudan University,Shanghai200032,China;The First Affiliated Hospital of Kunming Medical University,Kunming650032,China;Mental Health Center Affiliated,Shanghai Jiao Tong University School of Medicine,Shanghai200030,China;The Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou510370,China;Tianjin Anding Hospital,Tianjin300222,China;Chongqing Mental Health Center,Chongqing401147,China;Henan Mental Health Center,Xinxiang453002,China;West China Hospital of Sichuan University,Chengdu610041,China;Tongji Hospital Affiliated of Tongji University,Shanghai,200030,China;Mental Health Center,the First Hospital of Hebei Medical University,Shijiazhuang050031,China;不详)
出处 《中华精神科杂志》 CAS CSCD 北大核心 2024年第12期819-827,共9页 Chinese Journal of Psychiatry
关键词 抑郁症 医患共同决策 问卷调查 多中心 三级医院 精神病专科医院 综合医院 Depressive disorder Shared decision-making Questionnaire survey Multi-center Tertiary hospital Psychiatric specialist hospital General hospital
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