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标题：Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions
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作者：David T Eton ; Jennifer L Ridgeway ; Mark Linzer 等
期刊名称：Patient Preference and Adherence
印刷版ISSN：1177-889X
电子版ISSN：1177-889X
出版年度：2017
卷号：11
页码：1635-1646
DOI：10.2147/PPA.S145942
语种：English
出版社：Dove Medical Press Ltd
摘要：Purpose: Having multiple chronic conditions (MCCs) can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ) – the communicative and interpersonal skill of the provider – may mitigate treatment burden and promote self-management. The objectives of this study were to 1) identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2) determine if certain indicators of HPRQ are more strongly associated than others with these outcomes. Patients and methods: This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples t -tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes. Results: Most respondents (69%) were diagnosed with ≥3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes ( P <0.001), even after controlling for physical and mental health. Those reporting 100% adherence to prescribed medications had higher HPRQ scores than those reporting less than perfect adherence ( P <0.001). HPRQ items showing the strongest associations with outcomes were “my healthcare provider spends enough time with me”, “my healthcare provider listens carefully to me”, and “I have trust in my healthcare provider”. Conclusion: Good communication and interpersonal skills of healthcare providers may lessen feelings of treatment burden and empower patients to feel confident in their self-management. Patient trust in the provider is an important element of HPRQ. Educating healthcare providers about the importance of interpersonal and relational skills could lead to more patient-centered care.
关键词：patient–provider relationship; multi-morbidity; adherence; patient-centered care; trust