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医生职业倦怠减少职业投入并降低患者的护理质量
作者:小柯机器人 发布时间:2022/9/18 16:43:48

英国曼彻斯特大学Alexander Hodkinson团队对医生职业倦怠与职业投入和病人护理质量的相关性进行了系统回顾和荟萃分析。2022年9月14日出版的《英国医学杂志》发表了这项成果。

为了研究全球范围内医生职业倦怠与职业投入和患者护理质量之间的相关性,研究组在Medline、PsycINFO、Embase和CINAHL等大型数据库中检索从建库至2021年的相关文献,纳入评估医生职业倦怠(包括极度情绪衰竭、愤世嫉俗和对工作的脱离感,定义为人格分裂,以及低效感和个人成就感差)与职业投入(工作满意度、职业选择后悔、离职意向、职业发展和产出损失)和患者护理质量(患者安全事件、低专业性和患者满意度)相关性的观察性研究,进行系统回顾和荟萃分析。

数据由独立审查员双重提取,并通过联系所有作者进行检查,其中170人中有84人(49%)确认了他们的数据。随机效应模型用于计算合并优势比,预测区间表示异质性的数量,并使用P<0.10的保守水平评估具有显著性设置的潜在调节因素的荟萃回归。

研究组共鉴定了4732篇文章,其中涉及239246名医生的170篇观察性研究被纳入荟萃分析。与工作满意度增加相比,医生的总体倦怠与工作满意度下降近四倍相关(优势比为3.79,I2=97%,73项研究,146980名医生)。与对职业选择感到满意相比,职业选择后悔增加了三倍以上(3.49,I2=97%,16项研究,33871名医生)。与继续留下工作相比,离职倾向也增加了三倍以上(3.10,I2=97%,25项研究,32271名医生)。产出有一个小但显著的影响(1.82,I2=83%,7项,9581名医生),职业倦怠也影响了两项研究的汇总关联(3.77,I2=0%,3411名医生)。

与无患者安全事件相比,医生的总体工作倦怠使患者安全事件增加了一倍(2.04,I2=87%,35项研究,41059名医生)。低专业性是保持专业性的两倍(2.33,I2=96%,40项研究,32321名医生),患者不满意是患者满意的两倍(2.22,I2=75%,8项研究,1002名医生)。在医院环境(1.88)、31-50岁的医生(2.41)以及急诊和重症监护工作(2.16)中,工作倦怠和工作满意度最差;但全科医生的职业倦怠最低(0.16)。

然而,这些关联在多变量回归中并不显著。20-30岁的医生(1.88)和急诊医生(2.10)的职业倦怠和患者安全事件最多。在50岁以上的医生中(0.36),职业倦怠与低专业性的关联最小,在规培生或住院医生(2.27),在医院工作的医生(2.16),尤其是在急诊医学专业(1.48),或位于中低收入国家(1.68)的医生中,职业倦怠与低专业性的关联最大。

总之,这项荟萃分析提供了令人信服的证据,证明医生职业倦怠与医疗保健组织的功能和可持续性差相关,主要原因是导致医生职业脱离感和离职,其次是降低患者护理质量。医疗保健组织应投入更多的时间和精力实施循证策略,以减轻各专业的医生倦怠,尤其是在急诊医学和培训或住院医师方面。

附:英文原文

Title: Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis

Author: Alexander Hodkinson, Anli Zhou,, Judith Johnson, Keith Geraghty, Ruth Riley, Andrew Zhou, Efharis Panagopoulou, Carolyn A Chew-Graham, David Peters, Aneez Esmail, Maria Panagioti,

Issue&Volume: 2022/09/14

Abstract:

Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally.

Design Systematic review and meta-analysis.

Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021.

Eligibility criteria for selecting studies Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10.

Results 4732 articles were identified, of which 170 observational studies of 239246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08).

Conclusions This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency.

DOI: 10.1136/bmj-2022-070442

Source: https://www.bmj.com/content/378/bmj-2022-070442

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj