Vedsted Peter, Sokolowski Ineta, Olesen Frede
The Research Unit for General Practice, Institute of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark.
Int J Family Med. 2013;2013:383602. doi: 10.1155/2013/383602. Epub 2013 Jan 20.
Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without. In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot establish causality, it is recommended to closely monitor possible negative consequences of open access in general practice.
全科医疗中的随诊开放预约可能会影响全科医生的工作，但针对其后果的研究却很少。在这项来自丹麦全科医疗的研究中，我们比较了设有随诊开放预约的全科医生与未设此类预约的全科医生之间职业倦怠的患病率。在一项问卷调查研究（2004年）中，我们联系了丹麦奥胡斯郡所有458名在职全科医生，376名（82.8%）全科医生回复了问卷。随诊开放预约被定义为每个工作日至少有30分钟时间，患者无需预约即可就诊。职业倦怠通过马氏职业倦怠量表进行测量。使用逻辑回归进行的分析针对性别、年龄、婚姻状况、工作满意度、每次诊疗时间、执业机构、工作时长、每位全科医生登记的患者数量、每位全科医生的诊疗接触次数、继续医学教育活动以及全科医生群组进行了调整。总体而言，8%的全科医生设有开放预约，职业倦怠的患病率为24%。设有随诊开放预约的全科医生更易出现职业倦怠。设有开放预约与职业倦怠的可能性增加3倍相关（比值比=3.1（95%置信区间：1.1 - 8.8，P = 0.035））。尽管该设计无法确定因果关系，但建议密切监测全科医疗中开放预约可能产生的负面后果。
