Helfrich Christian D, Simonetti Joseph A, Clinton Walter L, Wood Gordon B, Taylor Leslie, Schectman Gordon, Stark Richard, Rubenstein Lisa V, Fihn Stephan D, Nelson Karin M
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA.
Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
J Gen Intern Med. 2017 Jul;32(7):760-766. doi: 10.1007/s11606-017-4011-4. Epub 2017 Feb 23.
Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.
To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.
We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.
Primary care personnel at VA clinics responding to a national survey.
Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).
There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.
Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.
工作倦怠在基层医疗中很常见，并且与较差的患者安全、患者满意度和员工心理健康相关。工作量、人员配备稳定性和团队完整性可能是倦怠的驱动因素。然而，很少有研究在团队层面评估这些关联，而且更少的研究将医生以外的团队成员纳入其中。
研究基层医疗服务提供者（初级保健医生）、护理经理、临床助理（医疗助理、执业护士）和行政文员的倦怠与他们所在团队的人员配备和工作量之间的关联。
我们在2014年对调查数据和行政数据进行了个体层面的横断面分析。
对全国性调查做出回应的退伍军人事务部诊所的基层医疗人员。
倦怠通过一项经过验证的单项调查测量指标进行衡量，该指标被二分法处理以表明倦怠的存在。自变量是团队人员配备的调查指标（拥有满员团队、在多个团队任职以及团队人员流动），以及来自调查项目（延长工作时间）和行政数据（患者名单超量和平均名单合并症）的工作量。
有4610名受访者（估计回应率为20.9%）。倦怠的总体患病率为41%。在调整分析中，与倦怠关联最强的因素是拥有满员团队（优势比[OR]=0.55，95%置信区间0.47 - 0.65）、团队有人员流动（OR = 1.67，95%置信区间1.43 - 1.94）以及患者名单超量（OR = 1.19，95%置信区间1.01 - 1.40）。与处于相反情况的受访者相比，在没有人员流动且患者名单在容量范围内的满员团队中工作的受访者，观察到的倦怠患病率低30.1%（28.5%对58.6%）。
完整的团队人员配备、团队成员流动和名单超量与倦怠有强烈的累积关联。需要进一步研究以了解改善这些因素是否会降低倦怠。
