上海市家庭医生沟通行为现状调查与分析

A Survey and Analysis on Communication Behavior of Family Doctors in Shanghai

目的了解上海市家庭医生的沟通行为现状,找到患者与家庭医生沟通中存在的问题,为家庭医生沟通技巧培训提出建议与参考依据。方法选取上海市区、郊区和城乡结合部3个行政区16家社区卫生服务中心的1 300名家庭医生进行问卷调查,调查内容包括人口统计学特征和沟通行为特征两部分,回收有效问卷1 268份,有效回收率为97.5%;选取18名家庭医生进行个人访谈,访谈内容包括沟通过程中主要存在的问题、产生这些问题的主要原因及认为可以改善的途径。结果 1 268名家庭医生中,有1 246人(98.3%)有沟通技能培训需求。总体沟通行为优良的家庭医生有967人(76.3%),其中沟通行为非常好、较好、一般、不好、非常不好的家庭医生分别有177人(14.0%)、790人(62.3%)、292人(23.0%)、8人(0.6%)和1人(0.1%)。让患者完整诉说病情、检查过程中温和有礼、探讨患者关心的问题、尊重患者意见和感受、诚实坦白、在必要时让专科医生加入沟通等项目的优良率均达到70%以上,但与患者有目光交流(43.4%)、让患者感到舒适与关怀(33.0%)、当患者需要时提供相应帮助(13.6%)等项目的优良率还比较低。Logistic分析筛选出对家庭医生沟通能力的影响因素是:探讨患者关心的问题、尊重患者的意见和感受、让患者感到舒适与关怀、诚实坦白(P<0.05)。结论上海市家庭医生工作过程中的沟通能力基本能够满足医患沟通需求,但是仍然存在许多问题,有待进一步的加强和提升。同时家庭医生希望得到沟通技巧方面的培训。因此通过系统的沟通技巧培训以提高家庭医生的沟通技能水平非常必要。

Objective To investigate the status of communication behavior of family doctors in Shanghai to find out the existing problems in communication between patients and family doctors. Do as to provide a reference for training on communication skills of family doctors. Methods A questionnaire survey was conducted among 1 300 family doctors selected from 16 community health service centers of 3 districts in Shanghai about characteristics in demography and communication behavior. The eligible re- trieval rate was 97. 5% （ 1 268/1 300） . Then 18 family doctors were interviewed about the main problems existing in communica- tion, major causes to result in the problems, and the way that may to reduce or solve them. Results Among the 1 268 respond- ents there were 1 246 （98.3%） who had the demand for skill training. And there were 967 （76. 3% ） whose communication be- havior was generally good, and of which there were 177 （ 14. 0% ）, 790 （62. 3% ）, 292 （23.0%）, 8 （0. 6% ） and 1 （0. 1% ） whose communication behavior was respectively very good, relatively good, moderate, bad and very bad. The excellent rates were all more than 70% in letting the patients to tell their conditions, being gentle during examination, discussing the is- sues concerned by the patients, respecting the patients＇ opinions and feelings, being truthful and frank, and asking the special- ists to participate in communication in necessary. However, the excellent rates were lower in eye communication with patients （43.4%）, letting the patients to feel comfortable and solicitudinous （ 33.0% ）, giving necessary help needed by the patients （ 13. 6% ） . The influencing factors on power of family doctor communication behavior screened by Logistic analysis discussing the issues concerned by the patients,, respecting patients＇ opinions and feelings, letting patients to feel comfortable and solicitudinous, and being truhful and frank. （P 〈0. 05） . Concl tsion The power of the family doctors in Shanghai generally can meet the demand for communication between patients and doctors. However, there is still something that needs to be further improved. Meanwhile, family doctors hope to get training on communication skills, so, it is very necessary to improve family doctors＇ communication skills through systematic training on communication skills.