论文部分内容阅读
背景和目的糖尿病患者需要更有效的护理,尤其是少数民族患者。医务人员的文化素养可能是缩小糖尿病患者治疗效果差异的重要因素。此研究评估了文化素养在糖尿病患者就诊中所起的作用。方法暗访的标准化患者(SPs)到29位家庭医学、内科住院医生处或开业医生的诊所就医。SPs假装成刚刚被诊断为2型糖尿病的美籍墨西哥女性患者。SPs采用西班牙/拉丁美洲医疗保健和文化素养专家制定的清单评估医生的文化素养、糖尿病护理和一般的沟通技巧。结果清单评分范围为43.9%~90.2%,平均(70.7±11.0)%。医生们在一般沟通技巧维度得分较高(95.9%),而询问社会史较少(比如家庭和社区支持相关问题的询问分别为51.9%和48.1%)。有67%的医生开具了糖化血红蛋白化验单,44%的医生将患者转诊至眼科,15%的医生进行了单尼龙丝检查。医生询问SPs对疾病的解释模式(如询问SPs对所患疾病及治疗的观念)与医生的糖尿病治疗行为相关(r=0.466)。结论此研究结果表明询问患者对疾病的解释模式与有效的糖尿病护理相关。社会史和解释模式的启发技能是医生文化素养培训的关键,且可能是缩小保健差异的有效手段。
Background and Objective Diabetes patients need more effective care, especially for ethnic minority patients. Cultural literacy of medical staff may be an important factor in reducing the difference in the therapeutic effect of diabetic patients. This study assesses the role of cultural literacy in the treatment of diabetic patients. Methods Unannounced standardized patients (SPs) were referred to 29 home-based medicine, medical residencies, or medical practitioners’ clinics. SPs pretend to be Mexican-American women who have just been diagnosed with type 2 diabetes. The SPs use the list developed by Spanish / Latin American healthcare and cultural literacy experts to assess the doctor’s literacy, diabetes care, and general communication skills. The results list score ranged from 43.9% to 90.2% with an average of (70.7 ± 11.0)%. Physicians scored higher on general communication skills (95.9%) and asked less about social history (for example, 51.9% and 48.1% respectively on questions related to family and community support issues). Sixty-seven percent of doctors prescribe HbA1c, 44% of physicians refer patients to ophthalmology and 15% perform monylon tests. The physician inquired about the mode of interpretation of the disease (such as asking SPs for the concept of illness and treatment) and the physician’s diabetes treatment behavior (r = 0.466). Conclusions The results of this study indicate that querying patients for patterns of illness is associated with effective diabetes care. The inspirational skills of social history and interpretation models are the key to a doctor’s cultural literacy training and may be an effective means of narrowing health care differences.