RESUMO
OBJECTIVE: To evaluate the impact of interpersonal communication (IPC) training on practice and patient satisfaction and to determine the acceptability of this training to providers in a developing country. DESIGN: The study used a pre-post design with treatment and control groups. Data collection methods included interaction analysis of audio-taped clinical encounters, patient exit interviews, and a self-administered questionnaire for health providers. STUDY PARTICIPANTS: Interaction analysis was based on an experimental group of 24 doctors and a control group of eight with multiple observations for each provider). Exit interviews were carried out with 220 pre-test patients and 218 post-test patients. All 87 health providers who received training responded to the self-administered questionnaire. INTERVENTION: A brief in-service training programme on interpersonal communications was presented in three half-day sessions; these focused on overall socio-emotional communication, problem solving skills and counselling. MAIN OUTCOME MEASURES AND RESULTS: The IPC intervention was associated with more communication by trained providers (mean scores of 136.6 versus 94.4; P = 0.001), more positive talk (15.93 versus 7.99; P = 0.001), less negative talk (0.11 versus 0.59; P = 0.018), more emotional talk (15.7 versus 5.5; P = 0.021), and more medical counselling (17.3 versus 11.3; P = 0.026). Patients responded by communicating more (mean scores of 113.8 versus 79.6; P = 0.011) and disclosing more medical information (54.7 versus 41.7; P = 0.002). Patient satisfaction ratings were higher for providers who had received the training and providers reported training to be relevant and useful. CONCLUSIONS: Further validation of IPC skills and simplification of assessment methods are needed if IPC is to be an area for routine monitoring and quality improvement.
Assuntos
Assistência Ambulatorial/normas , Comunicação , Pessoal de Saúde/educação , Capacitação em Serviço/normas , Satisfação do Paciente/estatística & dados numéricos , Relações Profissional-Paciente , Atitude do Pessoal de Saúde , Honduras , Humanos , Capacitação em Serviço/métodos , Competência Profissional , Avaliação de Programas e Projetos de Saúde/métodos , Projetos de Pesquisa , Inquéritos e Questionários , Gravação de VideoteipeRESUMO
This study investigates the effects of a brief training programme on the communication skills of doctors in ambulatory care settings in Trinidad and Tobago. Evaluation of doctor performance is based on analysis of audiotapes of doctors with their patients during routine clinic visits and on patient satisfaction ratings. A pre-test/post-test quasi-experimental study design was used to evaluate the effects of exposure to the training programme. Doctors were assigned to groups based on voluntary participation in the programme. Audiotapes of the 15 participating doctors (nine trained and six control) with 75 patients at baseline and 71 patients at the post-training assessment were used in this analysis. The audiotapes were content-coded using the Roter Interaction Analysis System (RIAS). Doctors trained in communication skills used significantly more target skills post-training than their untrained colleagues. Trained doctors used more facilitations in their visits and more open-ended questions than other doctors. There was also a trend towards more emotional talk, and more close-ended questions. Patients of trained doctors talked more overall, gave more information to their doctors and tended to use more positive talk compared to other patients. Trained doctors were judged as sounding more interested and friendly, while patients of trained doctors were judged as sounding more dominant, responsive and friendly than patients of untrained doctors. Consistent with these communication differences, patient satisfaction tended to be higher in visits of trained doctors.
Assuntos
Comunicação , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/educação , Satisfação do Paciente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Relações Médico-Paciente , Trinidad e TobagoRESUMO
PIP: Interpersonal communication skills are not often emphasized during the professional training of health workers. Accordingly, many people who visit health facilities do not receive the attention and information they need due to poor interpersonal communication. The Quality Assurance Project developed a course to train 26 health workers in Honduras in one-to-one communication skills under the assumption that people who are relatively better satisfied with the service they receive from health workers will be more likely to follow health workers' advice and enjoy improved health. The course addressed good social skills, problem solving skills, and counseling and education methods. Participants practiced their new skills through role play and discussion with their peers of tape-recorded consultations with an actual patient. New communication skills were then summarized in a pocket-sized booklet given to all participants as a reminder of what they learned, while each participant was also given a more detailed training manual. Initial results indicate that training resulted in a significant improvement in communication skills and a decrease in poor communication behavior such as criticizing people or interrupting them. The Ministry of Health expressed interest in incorporating the training course into its ongoing staff training. The course has now been adapted and run in Egypt and Trinidad, demonstrating that it can be adapted to suit different settings and cultures.^ieng