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The Verona-Medical Interview Classification System/Patient (VR-MICS/P). The instrument and its reliability

Published online by Cambridge University Press:  11 October 2011

Lidia Del Piccolo ,
Maria Grazia Benpensanti ,
Piero Bonini ,
Paola Cellerino ,
Anna Saltini  and
Christa Zimmermann
Lidia Del Piccolo*
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psicologia Medica, Università di Verona, Verona
Maria Grazia Benpensanti
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psicologia Medica, Università di Verona, Verona
Piero Bonini
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psicologia Medica, Università di Verona, Verona
Paola Cellerino
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psicologia Medica, Università di Verona, Verona
Anna Saltini
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psicologia Medica, Università di Verona, Verona
Christa Zimmermann
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psicologia Medica, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dr.ssa L. Del Piccolo, Dipartimento di Medicina e Sanità Pubblica, di Psicologia Medica, Università di Verona, Ospedale Policlinico, 37134 Verona. Fax +39-045-585.871. E-mail: Lidia@borgoroma.univr.it
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Summary

Objective – To assess the reliability and to describe the categories and the procedure to apply the VRMICS/P (Verona-Medical Interview Classification System/Patient). Setting – The interviews used for the reliability study were audio taped. Five general practitioners (GPs) working in two general practices in South-Verona recorded their consultations. Sample – 50 interviews selected randomly from 120, 10 for each GP. The selection criterion for the participating patients was a GHQ-12 score of 3 and the consultation for a new illness episode. Main outcome measures -The VR-MICS/P classifies patients' verbal behaviours into 21 categories, 15 of them are defined by form (cue or statement) and content. Procedure – Two trained raters classified 50 interviews. Before applying the classification system each interview is divided into units which are numbered to define doctor's and patient's sequence of speech. Results – The reliability of VR-MICS/P was satisfactory (Kappa 0.85). Similarity Index (Dice, 1945) for categories varied between 0.71 and 0.94. Reliability for form and content classification was satisfactory too (Similarity Index between 0.81 and 0.89 and between 0.84 and 0.94, respectively). Conclusions – The VR-MICS/P is a reliable measure for describing patients' verbal behaviours during medical interviews. It can be used together with the VR-MICS/D (Verona-Medical Interview Classification System/Doctor; Saltini et al., 1998) to describe the medical interview, the quality of doctor-patient interview and can be used as a measure of patient centredness.

Riassunto

Scopo – Presentare lo studio di attendibilità, nonché una descrizione riassuntiva delle categorie di classificazione e della procedura per l'applicazione del VR-MICS/P (Verona-Medical Interview Classification System/Patient). Setting – Le interviste utilizzate per lo studio di attendibilità sono state ricavate dalla trascrizione di audio registrazioni relative alle consultazioni di cinque medici di base che svolgono la loro attività in due ambulatori siti nel territorio di Verona-Sud. Campione – 50 interviste, selezionate in modo casuale tra 120, 10 per ciascun medico, relative a pazienti che sono giunti alia consultazione per un problema di salute nuovo e che hanno riportato un punteggio pari o superiore a tre al GHQ-12. Principali misure utilizzate – É stato applicato il VR-MICS/P per classificare i comportamenti verbali messi in atto dal paziente durante l'interazione con il medico. Il VR-MICS/P è composto di 21 categorie, 15 delle quali distinte per formulazione e contenuto. Procedura – Due rater hanno classificato le 50 interviste dopo aver svolto un periodo di formazione sull'utilizzo dello strumento. Ciascuna intervista, prima di essere classificata viene divisa in unità che, numerate, consentono di mantenere la sequenza d'ordine degli interventi di medico e paziente. Risultati – Il VR-MICS/P ha dimostrato una buona attendibilità (Kappa di Cohen pari a 0.85). L'indice di similarità (Dice, 1945) delle categorie è compreso fra 0.71 e 0.94. L'attendibilità, distinguendo la formulazione e il contenuto, è risultata altrettanto buona (indice di similarità compreso rispettivamente fra 0.81 e 0.89 e tra 0.84 e 0.94). Conclusione – Il VR-MICS/P è uno strumento attendibile che permette di classificare il comportamento verbale dei pazienti durante la consultazione medica. Se utilizzato in complemento al VR-MICS/D (Verona-Medical Interview Classification System/Patient; Saltini et al., 1998) consente di descrivere in modo economico e replicabile l'intervista medica, permettendo di evidenziare gli aspetti salienti dell'approccio centrato sul paziente.

Keywords

doctor-patient communicationinteraction analysis systemspatient-centred communicationcomunicazione medico-pazientesistemi di analisi dell'interazionecomunicazione centrata sul paziente.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 8 , Issue 1 , March 1999 , pp. 56 - 67
Copyright
Copyright © Cambridge University Press 1999

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