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Health services for an aging society. 老龄化社会的保健服务。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900102
T G Rundall
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引用次数: 6
Vertical integration in hospitals: a framework for analysis. 医院垂直整合:一个分析框架。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900105
M Arndt, B Bigelow
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引用次数: 21
Adherence to medication regimens: updating a complex medical issue. 坚持药物治疗方案:更新一个复杂的医疗问题。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900403
M K O'Brien, K Petrie, J Raeburn

Clinicians face nonadherence as the norm in everyday medical practice. The literature suggests a number of techniques that are likely to increase adherence when incorporated into regular clinical practices and routines. Central to these guidelines appears to be the doctor-patient relationship. For instance, the physician who uses understandable language, encourages open doctor-patient exchange, fosters participation by patients in their own medical care, and creates a friendly and efficient environment should increase the likelihood of adherence. Clinicians can also check adherence to medication regimens by requesting patients to bring in their pill bottles (or other prescription containers) for a discussion on how the medication appears to be working for them. This should elicit information from the patient about problems related to medication adherence. Since patient variables and social support affect adherence behaviors, eliciting information from patients about their understanding and beliefs regarding their particular illness and treatment, as well as enlisting the support of family and friends, may encourage adherence. Identifying what individual patients perceive as obstacles in following treatment regimens decreases their likelihood of nonadherence; these are difficulties that can be negotiated during the medical interview. Individualizing the treatment and minimizing its complexity may provide the solution that encourages adherent behavior. Frequent reeducation, reinforcement, and encouragement, as well as training in self-management and self-monitoring, will at the very least maximize the patient's comprehension of the illness and his or her motivation for adherence--an especially important requisite for living with a chronic condition. Some patients may even wish to openly solicit family and friends for help in the management and monitoring of their illness and treatment, and to structure their environment to support adherence. Education programs for the patient featuring handouts and pamphlets that provide information about the illness in written and illustrated form have been used successfully. Education programs such as patient-oriented package inserts to accompany the medications and brief written summaries of complex treatment plans may also be useful. The purpose of such patient education adjuncts to illness and treatment lie in the hope that they will enhance the likelihood of following treatment recommendations. Through their use, the reason for the treatment and its potential effectiveness will, it is hoped, be better understood (Ley 1988). Overall, significant advances have been made in adherence research. Measurement systems have become more finely tuned, and the definitions and criteria for adherent behaviors are more clear and precise.(ABSTRACT TRUNCATED AT 400 WORDS)

临床医生在日常医疗实践中面临不依从的常态。文献表明,当纳入常规临床实践和常规时,一些技术可能会增加依从性。这些指导方针的核心似乎是医患关系。例如,使用可理解的语言,鼓励开放的医患交流,促进患者参与自己的医疗护理,并创造一个友好和有效的环境的医生应该增加依从性的可能性。临床医生还可以通过要求患者带来他们的药瓶(或其他处方容器)来检查药物治疗方案的依从性,讨论药物对他们的效果如何。这应该从患者那里引出与药物依从性有关的问题的信息。由于患者变量和社会支持影响依从性行为,从患者那里了解他们对特定疾病和治疗的理解和信念,以及争取家人和朋友的支持,可能会鼓励依从性。确定个体患者在遵循治疗方案时认为的障碍可以减少他们不遵守治疗方案的可能性;这些都是在医疗面谈中可以协商的困难。个体化治疗和最小化其复杂性可能提供鼓励依从性行为的解决方案。频繁的再教育、强化和鼓励,以及自我管理和自我监控方面的培训,至少可以最大限度地提高患者对疾病的理解以及他或她坚持治疗的动机——这对患有慢性疾病的患者来说是特别重要的必要条件。一些患者甚至可能希望公开请求家人和朋友帮助管理和监测他们的疾病和治疗,并构建他们的环境来支持坚持。针对患者的教育计划,包括以书面和插图形式提供疾病信息的讲义和小册子,已经成功地使用了。教育项目,如以患者为导向的药物说明书和复杂治疗计划的简短书面摘要也可能是有用的。这种患者教育辅助疾病和治疗的目的在于希望它们将提高后续治疗建议的可能性。通过它们的使用,治疗的原因及其潜在的有效性将被更好地理解(Ley 1988)。总的来说,依从性研究取得了重大进展。测量系统已经变得更加精细,附着行为的定义和标准也更加清晰和精确。(摘要删节为400字)
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引用次数: 196
Physician-patient satisfaction: equity in the health services encounter. 医患满意度:卫生服务遇到的公平性。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900404
W F Koehler, M D Fottler, J E Swan
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引用次数: 35
Containing health care costs in the United States. 控制美国的医疗保健费用。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900103
T Rice
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引用次数: 28
Cost methodology in long-term care evaluations. 长期护理评估的成本方法。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900303
J Ehreth
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引用次数: 1
The U.S. medical liability system: conceptual model and proposals for reform. 美国医疗责任制度:概念模型与改革建议。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900402
J M Bronstein, L J Nelson
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引用次数: 1
Projected responses to changes in physician RBRVS reimbursement: induced-demand theory versus contingency theory. 对医生RBRVS报销变化的预期反应:诱导需求理论与权变理论。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900104
D F Fahey
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引用次数: 7
A poignant absence: sexual harassment in the health care literature. 令人心酸的缺失:医疗文献中的性骚扰。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900202
J Genovich-Richards
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引用次数: 4
Speaking in tongues: integrating economics and psychology into health and mental health services outcomes research. 说方言:将经济学和心理学纳入健康和精神健康服务成果研究。
Pub Date : 1992-01-01 DOI: 10.1177/002570879204900204
K A Phillips, A Rosenblatt
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引用次数: 11
期刊
Medical care review
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