Loerbroks A, Glaser J, Vu-Eickmann P, Angerer P
Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, 40225 Düsseldorf, Germany.
Institute of Psychology, University of Innsbruck, A-6020 Innsbruck, Austria.
Occup Med (Lond). 2017 Jul 1;67(5):356-362. doi: 10.1093/occmed/kqx051.
Research suggests that burnout in physicians is associated with poorer patient care, but evidence is inconclusive. More recently, the concept of work engagement has emerged (i.e. the beneficial counterpart of burnout) and has been associated with better care. Evidence remains markedly sparse however.
To examine the associations of burnout and work engagement with physicians' self-perceived quality of care.
We drew on cross-sectional data from physicians in Germany. We used a six-item version of the Maslach Burnout Inventory measuring exhaustion and depersonalization. We employed the nine-item Utrecht Work Engagement Scale to assess work engagement and its subcomponents: vigour, dedication and absorption. We measured physicians' own perceptions of their quality of care by a six-item instrument covering practices and attitudes. We used continuous and categorized dependent and independent variables in linear and logistic regression analyses.
There were 416 participants. In multivariable linear regression analyses, increasing burnout total scores were associated with poorer perceived quality of care [unstandardized regression coefficient (b) = 0.45, 95% confidence interval (CI) 0.37, 0.54]. This association was stronger for depersonalization (b = 0.37, 95% CI 0.29, 0.44) than for exhaustion (b = 0.26, 95% CI 0.18, 0.33). Increasing work engagement was associated with higher perceived quality care (b for the total score = -0.20, 95% CI -0.28, -0.11). This was confirmed for each subcomponent with stronger associations for vigour (b = -0.21, 95% CI -0.29, -0.13) and dedication (b = -0.16, 95% CI -0.24, -0.09) than for absorption (b = -0.12, 95% CI -0.20, -0.04). Logistic regression analyses yielded comparable results.
Physician burnout was associated with self-perceived poorer patient care, while work engagement related to self-reported better care. Studies are needed to corroborate these findings, particularly for work engagement.
研究表明，医生的职业倦怠与较差的患者护理相关，但证据并不确凿。最近，工作投入的概念出现了（即职业倦怠的有益对应面），并与更好的护理相关。然而，证据仍然明显不足。
研究职业倦怠和工作投入与医生自我感知的护理质量之间的关联。
我们利用了德国医生的横断面数据。我们使用了马氏职业倦怠量表的一个六项版本来测量疲惫和去人格化。我们采用了九项乌得勒支工作投入量表来评估工作投入及其子成分：活力、奉献和专注。我们通过一个涵盖实践和态度的六项工具来测量医生对自己护理质量的看法。我们在线性和逻辑回归分析中使用了连续和分类的因变量及自变量。
共有416名参与者。在多变量线性回归分析中，职业倦怠总分的增加与自我感知的护理质量较差相关[非标准化回归系数（b）=0.45，95%置信区间（CI）0.37，0.54]。这种关联在去人格化方面（b = 0.37，95% CI 0.29，0.44）比在疲惫方面（b = 0.26，95% CI 0.18，0.33）更强。工作投入的增加与自我感知的更高护理质量相关（总分的b = -0.20，95% CI -0.28，-0.11）。每个子成分都得到了证实，活力（b = -0.21，95% CI -0.29，-0.13）和奉献（b = -0.16，95% CI -0.24，-0.09）的关联比专注（b = -0.12，95% CI -0.20，-0.04）更强。逻辑回归分析得出了类似的结果。
医生的职业倦怠与自我感知的较差患者护理相关，而工作投入与自我报告的更好护理相关。需要进行研究来证实这些发现，特别是对于工作投入。
