van den Hombergh Pieter, Künzi Beat, Elwyn Glyn, van Doremalen Jan, Akkermans Reinier, Grol Richard, Wensing Michel
Center for Quality of Care Research, University of Nijmegen, the Netherlands.
BMC Health Serv Res. 2009 Jul 15;9:118. doi: 10.1186/1472-6963-9-118.
The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands.
Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations.
Workload and job stress are associated with practice performance.Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care.Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35).
Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP.
高医生工作量和工作压力对医疗服务质量及结果的影响尚不清楚。我们的研究探讨了高工作量和工作压力是否与荷兰全科医疗中的较低绩效相关。
对来自239家全科医疗的数据进行二次分析，这些数据于2003年至2006年在荷兰通过一套全面的医疗管理措施在实际走访中收集。数据由一名医疗走访员收集，该走访员是一名经过培训的非医生观察员，使用患者问卷、医生和工作人员提供的数据。在本研究中，我们选择了五项医疗绩效指标作为结果，六项全科医生工作量和工作压力指标作为预测因素。在303个可用指标中总共使用了79个指标。应用随机系数回归模型来检验相关性。
工作量和工作压力与医疗绩效相关。工作量：作为全科医生工作时间越长，患者在可及性和可用性方面的体验越积极（b = 0.16）。在调整患者名单规模后，每位患者获得更多全科医生诊疗时间的医疗机构在全科医疗方面得分更高（b = 0.45）。当全科医生每周每1000名患者提供超过20小时的服务时，患者在欧洲全科医疗质量问卷上的得分超过80%。工作压力：高全科医生工作压力与较低的可及性和可用性（b = 0.21）以及不足的医疗管理（b = 0.25）相关。更高的全科医生投入度和对工作的更多满意度与更多的预防和疾病管理相关（b = 0.35）。
在医疗机构中提供更多时间、每位患者更多诊疗时间以及经历更少工作压力均与患者对更好医疗服务和更好医疗绩效的认知相关。应使用调整患者名单规模后的数据来评估工作量和工作压力，以实现更高的医疗质量。利用此类数据反馈进行组织发展可能使患者和全科医生都受益。
