中国湖北全科医生离职意愿及其相关因素：一项横断面研究
Turnover intention and related factors among general practitioners in Hubei, China: a cross-sectional study.
作者信息
Gan Yong, Gong Yanhong, Chen Yawen, Cao Shiyi, Li Liqing, Zhou Yanfeng, Herath Chulani, Li Wenzhen, Song Xingyue, Li Jing, Yang Tingting, Yin Xiaoxv, Lu Zuxun
机构信息
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
Department of Management, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China.
出版信息
BMC Fam Pract. 2018 May 24;19(1):74. doi: 10.1186/s12875-018-0752-3.
BACKGROUND
High turnover among general practitioners (GPs) is a significant challenge in China's efforts to build a sustainable, effective primary care system, but little data is available to help understand and address this issue. The study was aiming at assessing the intention to leave their posts among a sample of GPs and investigating associated factors.
METHODS
A cross-sectional survey was conducted between December 12, 2014 and March 10, 2015 in Hubei Province, Central China. A total of 1016 GPs (response rate, 85.67%) were investigated by using a structured self-administered questionnaire. A generalized linear regression model was used to identify the associated factors with turnover intention among GPs.
RESULTS
Based on a full score of 24, the average score for GPs' turnover intention was 15.40 (SD = 3.43). 78.35% of the GPs had a moderate or higher level of turnover intention. Six hundred and thirty one (62.37%) GPs had ever been exposed to abuse of any kind (physical assault, 18.92%; verbal abuse, 54.38%; threat, 33.79%; verbal sexual harassment, 22.66%; and physical sexual harassment, 7.59%). Generalized linear regression analysis indicated that GPs who were male; who had a vocational school or higher; who had a temporary work contract; who were with lower level of job satisfaction; who reported higher scores on emotional exhaustion; who had been exposed to higher frequency of workplace violence were expressed higher intention to leave their present positions.
CONCLUSION
This study shows that GP's intention to leave general practices is high in Hubei, China. In addition, the prevalence of workplace violence is high among GPs, particularly in the verbal abuse and threat. Measures such as offering permanent contract status, increasing overall job satisfaction, and improving doctor-patient relationship, are needed to moderate GP's turnover intention in order to maintain the foundation of China's three-tier health system.
背景
全科医生（GP）的高流动率是中国建立可持续、有效基层医疗体系努力中的一项重大挑战，但有助于理解和解决这一问题的数据很少。本研究旨在评估全科医生样本中的离职意愿，并调查相关因素。
方法
2014年12月12日至2015年3月10日在中国中部的湖北省进行了一项横断面调查。使用结构化自填问卷对1016名全科医生（回复率85.67%）进行了调查。采用广义线性回归模型确定全科医生离职意愿的相关因素。
结果
以满分为24分计算，全科医生离职意愿的平均得分为15.40（标准差=3.43）。78.35%的全科医生有中等或更高水平的离职意愿。631名（62.37%）全科医生曾遭受过任何形式的虐待（身体攻击，18.92%；言语辱骂，54.38%；威胁，33.79%；言语性骚扰，22.66%；身体性骚扰，7.59%）。广义线性回归分析表明，男性全科医生；拥有职业学校及以上学历者；签订临时工作合同者；工作满意度较低者；情绪耗竭得分较高者；遭受工作场所暴力频率较高者表示有更高的离职意愿。
结论
本研究表明，中国湖北省全科医生离开全科医疗岗位的意愿较高。此外，全科医生中工作场所暴力的发生率较高，尤其是言语辱骂和威胁。需要采取诸如提供长期合同身份、提高总体工作满意度以及改善医患关系等措施来降低全科医生的离职意愿，以维持中国三级医疗体系的基础。
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