社区心血管疾病患者对医生解答内容理解程度的影响因素研究

Risk Factors of Understanding Doctors’ Explanation for Patients with Cardiovascular Diseases in Communities

背景 近年来心血管疾病发病率持续增长,严重危害人类健康,然而在心血管疾病患者就诊过程中患者不能理解医生解答内容的现象普遍存在,目前国内鲜有研究探讨社区心血管疾病患者对医生解答内容理解的影响因素.目的 分析社区心血管疾病患者对医生解答内容理解程度的影响因素.方法 选择2012年10-12月在首都医科大学附属北京安贞医院、北京市西城区金融街社区卫生服务中心门诊就诊的社区患者为调查对象.对符合入选标准的258例心血管疾病患者进行调查,将其分为两组,一组为可以完全理解医生解答内容(完全理解组),另一组为不能完全理解或完全不理解医生解答内容(不能完全理解或完全不理解组).分析影响心血管疾病患者对医生解答内容理解程度的因素;心血管疾病患者对医生解答内容理解程度与执行医嘱的关系.结果 本研究共调查258例患者,平均年龄为64.1岁,男性为144例(55.8%).106例患者纳入完全理解组,152例患者纳入不能完全理解或完全不理解组.多因素Logistic回归分析显示,文化程度为高中以下〔OR=3.185,95%CI(1.703,5.959),P<0.001〕、日常生活受疾病影响明显〔OR=2.436,95%CI(1.227,4.835),P=0.011〕、医生初次接诊〔OR=5.330,95%CI(2.710,10.483),P<0.001〕、诊疗医生性别为男性〔OR=2.080,95%CI(1.155,3.744),P=0.015〕是社区心血管病患者对医生解答内容理解程度的影响因素.完全理解组患者中95例(89.6%)会执行医嘱,不能完全理解或完全不理解组患者中121例(79.6%)会执行医嘱,两组患者医嘱执行情况比较,差异有统计学意义(χ2=4.598,P=0.032).结论 文化程度低于高中水平、日常生活受疾病影响明显、医生为患者初次诊治、诊疗医生为男性是心血管疾病患者不能完全理解或完全不理解医生解答内容的影响因素.

Background Incidence of cardiovascular disease keeps increasing in recent years,severely jeopardizing human health.However,the incomprehension of doctors'explanation is very common among patients in clinical practice.To date,few studies have investigated factors affecting the understanding of doctors'explanation in patients with cardiovascular disease.Objective To analyze the influencing factors of understanding doctors'explanation in patients with cardiovascular disease in communities.Methods Patients with cardiovascular disease in Beijing Anzhen Hospital,Capital Medical University and Financial Street Community Health Service Center of Xicheng District were enrolled in this investigation from October to December 2012.Questionnaires were administered in 258 eligible patients.Patients were divided into two groups,one group that can fully understand doctors'explanation and the other group that cannot fully understand or completely fail to understand doctors'explanation.Factors influencing the understanding of doctors'explanation by patients with cardiovascular diseases,and the relationship between understanding doctors'explanation and following doctors'advice by patients with cardiovascular diseases were analyzed.Results Among 258 patients(mean age of 64.1 years,55.8%were male),106 patients completely understood doctors'explanation while 152 patients could not or partly understood the explanation.Multivariate Logistic regression showed that low education level(lower than high school educational level)〔OR=3.185,95%CI(1.703,5.959),P<0.001〕,daily life affected by disease〔OR=2.436,95%CI(1.227,4.835),P=0.011〕,primary consultation〔OR=5.330,95%CI(2.710,10.483),P<0.001〕,male doctors〔OR=2.080,95%CI(1.155,3.744),P=0.015〕were individual risk factors for poor understanding of doctors'explanation.Ninety-five patients(89.6%)in the group with complete understanding followed the doctor's advice,while 121 patients(79.6%)in the group with incomplete understanding or incomprehension followed the doctor's advice,with significant difference(χ2=4.598,P=0.032).Conclusion Low education level(lower than high school educational level),daily life affected by disease,primary consultation,male doctors are independent risk factors for low-level understanding of doctors'explanation.