Panella M, Rinaldi C, Leigheb F, Donnarumma C, Kul S, Vanhaecht K, Di Stanislao F
Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
Rev Calid Asist. 2016 Jul;31 Suppl 2:20-5. doi: 10.1016/j.cali.2016.04.010. Epub 2016 Jun 30.
Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear.
To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians.
DESIGN, SETTING AND PARTICIPANTS: A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event.
A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians' experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty.
Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine.
防御性医疗影响着全球的医疗体系。对医疗责任的担忧和认知可能导致从业者采取防御性医疗行为。“二次受害者”指的是卷入意外不良患者事件的医护人员。作为“二次受害者”的角色以及防御性医疗的其他可能决定因素大多尚不清楚。
研究作为意大利医院医生防御性医疗可能决定因素的“二次受害者”状况。
设计、地点和参与者：本研究对2014年4月至2014年6月在意大利55家医院进行的关于意大利防御性医疗的患病率和成本的全国性调查研究数据库进行了二次分析。选择了问卷中的人口统计学部分，包括医生的年龄、性别、专业、工作量、职称以及不良事件后成为“二次受害者”这一变量。
数据分析共使用了1313名医生的样本（回复率为87.5%）。参与者的特征包括平均年龄49.2岁和平均19.4年的工作经验。实施防御性医疗最显著的预测因素是医生在不良事件后成为“二次受害者”的经历（比值比=1.88；95%置信区间，1.38 - 2.57）。其他决定因素包括年龄、工作经验、工作量和专业风险。
医疗事故改革、在医院为“二次受害者”提供有效支持以及系统使用基于证据的临床指南，成为减少防御性医疗的可能建议。
