Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52 Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
BMC Health Serv Res. 2020 Apr 15;20(1):311. doi: 10.1186/s12913-020-05183-9.
In response to the rising burden of cardiovascular risk factors, the Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinic level to improve management and clinical outcomes of type 2 diabetes and hypertensive patients. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs' job satisfaction. However, studies evaluating HCPs' job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs' job satisfaction.
This is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all HCPs who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were assessed on a scale of 1-4 at baseline (April and May 2017) and post-intervention phase (March and April 2019). Unadjusted intervention effect was calculated based on absolute differences in mean scores between intervention and control groups after implementation. Difference-in-differences analysis was used in the multivariable linear regression model and adjusted for providers and clinics characteristics to detect changes in job satisfaction following EnPHC interventions. A negative estimate indicates relative decrease in job satisfaction in the intervention group compared with control group.
A total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress with adjusted differences of - 0.139 (95% CI -0.266,-0.012; p = 0.032). Nurses, being the largest workforce in public clinics were the only group experiencing dissatisfaction at post-intervention. In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions with adjusted differences of - 0.223 (95% CI -0.419,-0.026; p = 0.026). Additionally, the same group were less likely to perceive their profession as well-respected at post-intervention (β = - 0.175; 95% CI -0.331,-0.019; p = 0.027).
Our findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs' job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.
为应对心血管危险因素负担不断增加，马来西亚政府于 2017 年 7 月在公立诊所层面实施了增强型初级医疗保健（EnPHC）干预措施，以改善 2 型糖尿病和高血压患者的管理和临床结局。医疗保健提供者（HCPs）在医疗服务提供和卫生系统改革中发挥着至关重要的作用，他们的工作满意度可以影响到医疗保健服务的提供。然而，在中低收入国家，评估初级保健转型后 HCPs 工作满意度的研究仍然很少。本研究旨在评估 EnPHC 干预措施对 HCPs 工作满意度的影响。
这是一项准实验研究，在 20 个干预诊所和 20 个匹配对照诊所进行。我们调查了所有直接参与患者管理的 HCPs。在基线（2017 年 4 月和 5 月）和干预后阶段（2019 年 3 月和 4 月），使用包括 6 个关于工作满意度问题的自我管理问卷进行评估。在实施后，根据干预组和对照组之间平均分数的绝对差异计算未调整的干预效果。采用差异中的差异分析在多变量线性回归模型中，调整提供者和诊所特征，以检测 EnPHC 干预后工作满意度的变化。负估计值表示与对照组相比，干预组的工作满意度相对降低。
基线和干预后分别有 1042 名和 1215 名 HCPs 做出回应。干预后，干预组报告的压力水平更高，调整后的差异为-0.139（95%CI-0.266，-0.012；p=0.032）。护士是公立诊所中最大的劳动力群体，是唯一在干预后感到不满的群体。在亚组分析中，干预组的护士在接受 EnPHC 干预后工作压力增加，调整后的差异为-0.223（95%CI-0.419，-0.026；p=0.026）。此外，同一组的人认为自己的职业受到尊重的可能性较小（β=-0.175；95%CI-0.331，-0.019；p=0.027）。
我们的研究结果表明，EnPHC 干预措施对 HCPs 的工作满意度产生了一些不利影响。工作满意度低会对组织和医疗保健系统产生不利影响。因此，在引入医疗服务改革之前，应考虑提供者的经验和幸福感，以避免给 HCPs 带来过重的负担。
