PHQ9-量表打印版-1

CMEes....SUMMARYApatienthealthquestionnairewasdevelopedforuseinfamilypraticetohelpidentifylifestyleriskfactors,assesshealthcareneeds,andbetterunderstandpatients.Thisarticlediscussesthequestionnaire'sdevelopmentandpracticalapplication.RESUMENousavonselaboreunquestionnairedesantedestineauxpatientsetapplicableenpratiquefamilialeafind'identifierlesfacteursderisqueentourantlemodedevie,d'evaluerlesbesoinsensoinsdesanteetdemieuxcomprendrelespatients.Cetarticlediscutedel'elaborationduquestionnaireetdesonapplicationpratique.(onFamPhysician1996;42:505-511.Patienthealth.0questionnalreUsingapatient-focusedassessmenttoolJOAND.MITCHELL,RNROMOTINGHEALTHANDPRE-ventingillnessisanintegralpartoffamilypractice.However,evi-dencesuggeststhatmanyhigh-riskbehavioursandhealthcareneedsarenotbeingidentifiedinfamilypractice.'7Becausewemustassesspatients'riskfactorsandhiddenhealthissuesthoroughlybeforeweintervene,wemustidentifytheseissuesandneedsinafamilyprac-ticepopulation.Understandingfamilypracticepatientsfromtheirownperspectiveisthekeytogivinggoodqualitypatient-centredcare.8Asmuchinformationaspossibleshouldflowfromthepatienttoprovideasenseofwhothepatientis.Thisarticlepresentsatool,ahealthquestion-naire,designedtoassistfamilypracticehealthprofessionalsingatheringthisinformation.Thedevelopmentandpracticalap-plicationofthequestionnaireisdiscussed.MsMitchellisaFamilyPracticeNurseattheByronFamilyMedicalCentre,LondonHealthSciencesCentre,Victoriacampus,inLondon,Ont.DevelopmentofthequestionnaireTheneedforahealthassessmenttoolbecameapparentwhenthenumberofnewpatientsseenattheByronFamilyMedicalCentrebeganincreasing.Afterthesepatientswereinitiallyassessed,moreinformationwasneededabouttheminaholisticsense.Theirlifestylerisks,healthcareneeds,andanyotherfactorsthatmightinfluencetheircareneededtobeidentifiedasquicklyandefficientlyaspossible.Afterdeterminingareastoaddress,screeningtoolsandques-tionnairesusedforspecificriskassessmentswerereviewed.Thepatienthealthquestionnaire(PHQ)incorporatedtheseinstrumentsandincludedquestionsonotherareasofperceivedneed.CompletedPHQsprovideinfor-mationonpatients'demographics,lifestyleriskfactors,generalstateofwell-being,andfamilyandpersonalmedicalhistoryataglance.Becausethequestionnaireisself-adminis-tered,allthisinformationisrecord-edfromthepatient'sperspective.Thevaluablefeaturethatdifferenti-atesthishealthassessmenttoolfromVOL42:MARCH*MARS1996*CanadianFamilyPhysician.IeMidecindefamillecanadien505--K-FORPRESCRIBINGINFORMATIONSEEPAGE562CMEPatienthealthquestionnaireothers,suchastheFANTASTICLifestyleAssessment,9isthatitcapturesacomprehensiveanddescriptivedatabaseaspresentedbypatients.DescriptionofthePHQDemographics.ThePHQisadouble-sideddocument.Thefrontofthepage(Figure1)beginsbyaskingquestionsondemographics:age,sex,maritalstatus,andoccupation.Weaskthepatient'slevelofeducationsothatwecanmodifyhealthteachingaccordingly.Knowledgeofmembersofthepatient'shouseholdandnextofkingivesusaglimpseofthefamilyunitandisausefulreferenceinemergencies.Documentationofdrugallergiesallowsustodouble-checkbeforeprescribing.Medication.Themedicationsectionhaspro-videdlessusefulinformationtodate,mostlybecauseoffrequentdrugchanges.However,thesectionremindsustoencourageourpatientstoknow(andcarryalistof)thenamesoftheircur-rentmedications.Lifestylerisks.Studiesreportthatmostfamilypracticepatientsacceptandappreciatebeingscreenedforlifestylebehaviours4,9,10andsuggestthatpatientswillnotbeoffendedevenifaskedaboutrisksateveryvisit.4Aswell,evidencesug-geststhatmedicalpractitionerscaninfluencetheirpatientstochangeriskybehaviours.2Thelifestyleriskassessmentsectionofthequestionnairebeginsbyaskingwhetherpatientshaveusedstreetdrugswithinthepast5years.Iftheresponseisaffirmative,weseekamoredetailedhistoryandexploretheneedforhealtheducationandnecessaryintervention.Smoking.Smokersareidentifiednext.Thissec-tionalsoremindsustoensurethatthesmoker'schartbearsaredsmokersticker.Weknowthatearlymeasurestoconvincetobaccouserstostopsmokingcanpreventillnessanddeath.7However,beforewecaninitiateanyformofsmokingcessationintervention,wemustdeter-minethepatient'slevelofnicotinedependence.'3SmokingassessmentquestionsaretakenfromTheFagerstromNicotineToleranceScale.'3Particularlyimportantforfamilypracticehealthprofessionalsisidentifyingpatientswhowouldliketoquitsmoking.Fortimeandenergyefficiency,interventionshouldfocusonthosewhoaremotivated.Alcohol.Aparticularlyimportantresponsibilityinfamilypracticeisearlydetectionandmanage-mentofexcessivealcoholusetopreventthesevereconsequencesthatresultfromtheprogres-sionofthisdisorder.Interventionandsecondarypreventionhavebeenprovenhighlyeffectiveifbegunearly.4,1WallaceandHaines2foundthataself-adminis-teredhealthsurveyquestionnairesubstantiallyincreasedrecognitionofpatientswithexcessiveconsumptionofalcohol.Studieshaveshownthatplacingalcohol-screeningquestionsbesideotherhealth-relatedquestionsproducesmoreaccurateresponses.'Becausequestionsaboutquantityorfrequencyofalcoholintakehavenotbeenshowntogivereliableresults,'6thesewerenotincluded.ThePHQ