中国一家三甲医院医生工作量与处方质量的关联。

Association Between Physicians' Workload and Prescribing Quality in One Tertiary Hospital in China.

机构信息

From the Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences.

Peking University Third Hospital.

出版信息

J Patient Saf. 2021 Dec 1;17(8):e1860-e1865. doi: 10.1097/PTS.0000000000000753.

DOI:10.1097/PTS.0000000000000753

PMID:32773646

Abstract

BACKGROUND

Alarming increasing trends in physician workload have attracted much attention in recent years. Heavy workload may compromise the quality of medication use. Previous studies have identified a series of factors contributing to inappropriate prescribing; however, there is no demonstrated evidence supporting an association between workload and the appropriateness of physicians' prescriptions in China. This study aimed to investigate the relationship between physician workload and prescription quality in a tertiary hospital in Beijing, China.

METHODS

Our study was a single-center, retrospective study, with all outpatient electronic health records extracted from hospital information system of a tertiary hospital in Beijing from July 1 to November 30, 2015. We used outpatient volume in each 5-hour shift as the measure of physician workload. The evaluation of prescribing quality was based on the Rational Drug Use System. Generalized linear models with a γ distribution and a log link were used to explore factors associated with inappropriate prescribing, and we undertook a series of robustness tests with respect to different exclusion criteria.

RESULTS

A total of 457,784 prescriptions from 502 physicians were included in the study. Physicians had an average workload of 34.3 (±19.8) patients per shift, and the mean rate of inappropriate prescribing per shift was 14.1% (±14.6%). Higher rates of inappropriate prescribing were associated with heavier workloads (P < 0.001). Physicians who worked in the afternoon, chief physicians, those working in surgical department, males, and those with more than 20-year experience had higher rates of inappropriate prescribing with increasing workload.

CONCLUSIONS

Heavier workload was associated with higher risk of prescribing inappropriately. It requires great efforts to determine optimal physician workloads and mitigate the potential adverse effects on the prescription quality.

摘要

背景

近年来，医生工作量的惊人增长趋势引起了广泛关注。工作量过大可能会影响用药质量。先前的研究已经确定了一系列导致处方不当的因素；然而，在中国，没有证据表明工作量与医生处方的适当性之间存在关联。本研究旨在调查北京市一家三级医院医生工作量与处方质量之间的关系。

方法

我们的研究是一项单中心、回顾性研究，从 2015 年 7 月 1 日至 11 月 30 日，从北京市一家三级医院的医院信息系统中提取所有门诊电子健康记录。我们使用每个 5 小时班次的门诊量来衡量医生的工作量。处方质量的评估基于合理用药系统。使用具有γ分布和对数链接的广义线性模型来探索与不当处方相关的因素，并针对不同的排除标准进行了一系列稳健性测试。

结果

共纳入 502 名医生的 457784 张处方。医生的平均工作量为每个班次 34.3（±19.8）名患者，每个班次的不当处方率平均为 14.1%（±14.6%）。更高的不当处方率与更大的工作量相关（P < 0.001）。下午工作的医生、主任医生、外科医生、男性以及有 20 年以上工作经验的医生，随着工作量的增加，不当处方率更高。