门诊医患关系深度量表的评价及医患关系深度影响因素研究

Assessment of Patient- Doctor Depth-of-Relationship Scale and Influencing Factors for the Depth of Patient-doctor Relationship

目的评价门诊医患关系深度量表的信、效度,并进一步探讨门诊医患关系深度的影响因素,为该量表在我国医疗机构的应用提供依据。方法选取2013年6月—2014年2月在北京市某综合性医院所属的专科门诊、社区门诊和全科慢病管理门诊就诊的1 042例患者。采用研究组翻译汉化的"医患关系深度量表"和自行设计的一般情况调查表进行现场调查,并对其中67例患者进行重测信度调查。医患关系深度影响因素分析采用多元线性回归分析。结果医患关系深度量表的Cronbach'sα为0.931,重测信度系数r为0.988,从8个条目中可提取2个因子,可解释总变异的79.85%。门诊性质、年龄、在同一医生处就诊次数是医患关系深度得分的影响因素;医患关系深度得分比较全科慢病管理门诊患者>社区门诊患者>专科门诊患者,在同一医生处就诊次数越高,医患关系深度得分也越高。结论医患关系深度量表的信、效度良好,受门诊性质、患者年龄、在同一医生处就诊次数的影响,可用于评估我国各类医疗机构(尤其是初级卫生保健部门,比如门诊或社区卫生服务机构)的医患关系水平,我国的全科医生和政策制定者们应该更加意识到"连续性照顾"的重要性,了解到全科医学在改善医患关系和促进卫生保健质量方面的重要作用。

Objective To assess the reliability and validity of Patient -Doctor Depth-of-Relationship Scale , and to further investigate the influencing factors for the depth of patient -doctor relationship in clinic department , in order to provide references for the application of the scale in medical settings in China .Methods We enrolled 1 042 patients who received treatment in a special outpatient department , a community clinic and a general practice clinic of chronic disease management of a comprehensive hospital in Beijing .Site investigation was conducted using Patient -Doctor Depth -of -Relationship Scale in Chinese and self -designed questionnaire about general condition .Survey of test -retest reliability was conducted with 67 subjects.Multiple linear regression analysis was employed to analyze the influencing factors for the depth of doctor -patient relation.Results The Cronbach′sαof Patient-Doctor Depth-of-Relationship scale was 0.931, the test-retest reliability r was 0.988.Two factors could be extracted from 8 items and were accountable for 79.85%of total variation.The property of clinic , age and times of visits to the same doctor were influencing factors for the score of the depth of doctor -patient relation.We found the patients of the general practice clinic of chronic disease management had the highest score , followed by the patients of the community clinic and the special outpatient department .More times of visits to the same doctor was associated with higher score of the depth of doctor-patient relationship.Gonclusion Patient-Doctor Depth -of-Relationship Scale has good reliability and validity.The score is influenced by the property of clinic , patients′age, times of visits to the same doctor.The scale could be used to assess doctor -patient relation in various kinds of medical settings （ especially primary health care settings , such as clinics or community health service centers ） .General practitioners and policy makers should attach more importance to＆quot;continuity of care＆quot;and understand the important role of general practice in the improvement of doctor -patient relation and the quality of health care.