Patient involvement in the encounter between general practice and patients with a chronic disease. Results of a scoping review focusing on type 2 diabetes and obstructive pulmonary disease

Research has shown improved health outcomes when patients are involved in managing their health conditions and when their individual needs are considered. This scoping review aimed to map the existing research regarding chronic disease patients’ involvement in their encounters with general practice, with a specific focus on patients with Type 2 diabetes (TD2) or chronic obstructive pulmonary disease (COPD) and from the perspectives of both general practitioners and patients. Studies of any design, date, and language were included. A systematic search was conducted using the following databases: Medline, CINAHL, PsycInfo, Scopus, and EMBASE from August until October 2020 and renewed September 2021. Data were systematically charted by the following study characteristics: bibliographic aims; study aims; setting; area of interest; results; conclusion. Eighteen studies were included; they conducted qualitative methods, surveys or mixed methods. From the patients’ perspectives, the importance of being more involved in treatment discussions during consultations as well as a friendly environment, was underscored. A good relationship and relational continuity make it easier for patients to be more involved in treatment decisions. From the general practitioner (GP) perspectives, they mentioned their high workload, long-standing relationships, knowledge about the patients and prepared patients as factors influencing their ability to involve patients in treatment discussions. A good GP–patient relationship was considered an important aspect to providing and facilitating for involvement of patients with COPD or TD2. Scoping review registration: https://osf.io/ynqt2

研究表明，当患者参与自身健康状况管理且其个体需求得到充分考量时，健康结局可获得显著改善。本次范围综述（scoping review）旨在系统梳理现有关于慢性病患者参与全科医疗诊疗的相关研究，重点聚焦于2型糖尿病（Type 2 diabetes, TD2）或慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者，同时纳入全科医生（general practitioner, GP）与患者双方的视角。本综述纳入任何研究设计、发表年份及语言的相关研究。研究于2020年8月至10月期间，通过Medline、CINAHL、PsycInfo、Scopus及EMBASE数据库开展系统检索，并于2021年9月完成检索更新。研究人员依据以下研究特征对数据进行系统整理：文献目标、研究目标、研究场景、关注领域、研究结果及研究结论。最终纳入18项研究，其研究方法涵盖定性研究、调查研究或混合研究方法。从患者视角来看，研究强调了在诊疗过程中更多参与治疗讨论以及营造友好诊疗环境的重要性；良好的医患关系与诊疗连续性可帮助患者更便捷地参与治疗决策。从全科医生视角来看，他们提及高工作负荷、长期医患关系、对患者的了解以及患者的就诊准备程度，均为影响其引导患者参与治疗讨论能力的相关因素。良好的全科医生-患者关系被视为为COPD或TD2患者提供支持并促进其参与诊疗的重要支撑要素。范围综述注册链接：https://osf.io/ynqt2