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目的目前,临床接诊时常用到电子病历(EHR)。由于使用EHR能给医患关系带来不利影响,因此就“以患者为中心”使用HER已发表了相关推荐方案。然而,当前培训对提高临床接诊EHR应用率的效果尚不明确。本研究旨在调查培训对全科住院医生使用EHR时与患者沟通技巧的影响,并探究其沟通技巧是否因接诊内容而变化。方法本研究在瑞士日内瓦大学医院全科医学科进行,研究对象为全科住院医生。干预措施为为期3个月的培训,包括基于观看接诊录像进行的2个大型的小组培训以及2~4个个性化辅导培训。使用自填式问卷调查全科住院医生对使用EHR的态度。使用Roter沟通互动分析系统以及EHR具体项目评估干预前后全科住院医生执业的情况。干预效果以全科住院医生对使用EHR的态度和在接诊过程前10 min内客观需要使用EHR的情况进行评价。结果招募的27名全科住院医生有17名参与了本研究。研究对象在约30%的接诊里应用了EHR。干预后,认为使用EHR使医患关系变差的全科住院医生数量减少,而且其能够更加放松地使用EHR。全科住院医生使用光标定位EHR的比例在干预后有所增加[干预前:0.77(SD=1.69);干预后:1.80(SD=3.35),P=0.035]。当接诊社会心理疾病的患者时,全科住院医生使用EHR的比例下降(干预前:24.5%,干预后:9.76%,P<0.001)。结论本研究表明,培训可提高全科住院医生接诊时使用EHR的沟通技巧,与敏感的社会心理疾病患者的沟通改善尤其显著。今后,相关的研究可侧重于以患者视角探讨全科医生沟通技巧与其关联性,以及这些沟通技巧的有效性。
Objective Currently, electronic medical records (EHRs) are commonly used in clinical admissions. Since the use of EHR can have a negative impact on patient-patient relationships, recommendations have been published on the use of HER as a “patient-centered” recommendation. However, the effect of current training on improving the rate of clinical admissions to EHR is unclear. The purpose of this study was to investigate the impact of training on communication skills of patients with general practitioners using EHR and to explore whether their communication skills change as a result of admissions. Methods The study was conducted in the General Practice Department of the University Hospital Geneva, Switzerland, and the subjects studied were general practitioners. The intervention consisted of three months of training including two large group training sessions and two to four personalized counseling sessions based on the video of the consultation sessions. Self-administered questionnaires were used to survey general hospital resident attitudes towards the use of EHR. Use the Roter Interactive Interactive Analysis System and EHR-specific projects to assess the practice of general practitioners before and after interventions. The effect of the intervention was evaluated by the general resident’s attitude toward the use of EHR and the objective need of EHR within 10 min of the admissions. As a result, 17 general practitioners enrolled in the program were enrolled in this study. Subjects applied EHR in about 30% of admissions. After the intervention, the number of general practitioners who used EHR to reduce their doctor-patient relationship was reduced, and their use of EHR was more relaxed. The proportion of all resident residents using EHR with cursor was increased after intervention [before intervention: 0.77 (SD = 1.69); after intervention: 1.80 (SD = 3.35), P = 0.035]. The proportion of general hospital resident physicians who used EHR decreased (24.5% before intervention, 9.76% after intervention: P <0.001) when patients with psychosocial disorders were treated. Conclusions This study shows that training improves the communication skills of general practitioners using EHR during admissions and improves communication with sensitive patients with psychosocial disorders. In the future, relevant research may focus on the perspective of the patient as a general practitioner of communication skills and their relevance, as well as the effectiveness of these communication skills.