Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; National Research and Safety Institute (INRS), Vandœuvre-lès-Nancy, France.
Br J Gen Pract. 2020 Aug 27;70(698):e657-e667. doi: 10.3399/bjgp20X710909. Print 2020 Sep.
Job stress among GPs is an issue of growing concern.
To investigate whether the structural and organisational features of GPs' practices were associated with job stress in 11 countries.
Secondary analysis of the 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, an international cross-sectional study. A total of 11 Western countries participated in the 2015 edition.
Random samples of practising GPs were drawn from government or private lists in each country ( = 12 049). Job stress was measured by the question: 'How stressful is your job as a GP?' (5-point Likert scale). Numerous practices' organisation and functioning characteristics were considered. Multilevel mixed-effects ordered logistic regression was performed.
The prevalence of job stress varied from 18% to 59% according to country. Job stress was higher among GPs aged 45-54 years (middle age) (odds ratio [OR] 1.35, 95% confidence interval [CI] = 1.07 to 1.70) and those practising in an urban area (OR 1.23, 95% CI = 1.15 to 1.31). It was also associated with a high weekly workload (OR 2.88, 95% CI = 2.38 to 3.50) if >50 hours/week workload, large administrative burden (OR 1.65, 95% CI = 1.44 to 1.89), long delays in receiving hospital discharge, poor possibilities in offering same-day appointments (OR 1.74, 95% CI = 1.18 to 2.56), and performance assessment (OR 1.15, 95% CI = 1.05 to 1.24). Finally, long consultations (OR 0.64, 95% CI = 0.53 to 0.76) and working with a case manager attached to the practice were associated with a lower job stress. The vast majority of results were consistent across the countries.
Heavy workloads and time pressure are clearly associated with GP job stress. However, organisational changes such as employing case managers and allowing longer consultations could potentially reduce this burden.
全科医生的工作压力是一个日益受到关注的问题。
调查 11 个国家的全科医生实践的结构和组织特征是否与工作压力有关。
对 2015 年英联邦基金国际初级保健医师政策调查的二次分析，这是一项国际横断面研究。共有 11 个西方国家参加了 2015 年的调查。
从每个国家的政府或私人名单中抽取在职全科医生的随机样本（=12049）。工作压力通过以下问题来衡量：“作为一名全科医生，你的工作压力有多大？”（5 分李克特量表）。考虑了许多实践的组织和功能特征。采用多水平混合效应有序逻辑回归进行分析。
根据国家的不同，工作压力的患病率从 18%到 59%不等。45-54 岁（中年）的全科医生（优势比 [OR] 1.35，95%置信区间 [CI] = 1.07 至 1.70）和在城市地区工作的医生（OR 1.23，95% CI = 1.15 至 1.31）工作压力更高。如果每周工作时间超过 50 小时（OR 2.88，95% CI = 2.38 至 3.50），工作量大（OR 1.65，95% CI = 1.44 至 1.89），延迟接收医院出院时间长，提供当日预约的可能性差（OR 1.74，95% CI = 1.18 至 2.56），以及绩效评估（OR 1.15，95% CI = 1.05 至 1.24），工作压力也会增加。最后，较长的咨询时间（OR 0.64，95% CI = 0.53 至 0.76）和与实践相关的个案经理合作与较低的工作压力有关。这些结果在绝大多数国家都是一致的。
工作量大和时间压力显然与全科医生的工作压力有关。然而，组织变革，如雇用个案经理和允许更长的咨询时间，可能会减轻这种负担。
