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探讨初级保健医生倦怠和幸福感对患者护理的影响:一项焦点小组研究。

Exploring the Impact of Primary Care Physician Burnout and Well-Being on Patient Care: A Focus Group Study.

机构信息

Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford.

From the School of Psychology, University of Leeds, Leeds.

出版信息

J Patient Saf. 2020 Dec;16(4):e278-e283. doi: 10.1097/PTS.0000000000000438.

Abstract

OBJECTIVES

The aims of the study were (1) to explore whether primary care physicians (general practitioners [GPs]) perceive burnout and well-being to impact on the quality and safety of patient care and (2) to determine potential mechanisms behind these associations.

METHOD

Five focus groups with 25 practicing GPs were conducted in England, either in the participants' practice or in a private meeting room outside of their workplace.An interview schedule with prompts was followed with questions asking how participants perceive GP burnout and poor well-being could impact on patient care delivery. Audio recordings were transcribed verbatim and analyzed using thematic analysis.

RESULTS

General practitioners believed that poor well-being and burnout affect the quality of care patients receive through reducing doctors' abilities to empathize, to display positive attitudes and listening skills, and by increasing the number of inappropriate referrals made. Participants also voiced that burnout and poor well-being can have negative consequences for patient safety, through a variety of mechanisms including reduced cognitive functioning and decision-making abilities, a lack of headspace, and fatigue. Furthermore, it was suggested that the relationship between well-being/burnout and mistakes is likely to be circular.

CONCLUSIONS

Further research is needed to ascertain the validity of these perceptions. If found, physicians, healthcare organizations, and policy makers should examine how they can improve physician well-being and prevent burnout, because this may be a route to ensure high-quality and safe patient care.

摘要

目的

本研究旨在(1)探讨初级保健医生(全科医生)是否认为倦怠和幸福感会影响患者护理的质量和安全性,以及(2)确定这些关联背后的潜在机制。

方法

在英格兰进行了 5 次焦点小组讨论,共有 25 名执业全科医生参加,讨论地点在参与者的诊所或工作场所外的私人会议室。采用带提示的访谈方案,询问参与者如何看待全科医生的倦怠和幸福感不佳如何影响患者护理的提供。对音频记录进行逐字转录,并使用主题分析进行分析。

结果

全科医生认为,幸福感差和倦怠会通过降低医生的同理心、积极态度和倾听技巧能力,并增加不适当转诊的数量,从而影响患者接受的护理质量。参与者还表示,倦怠和幸福感差会通过多种机制对患者安全产生负面影响,包括认知功能和决策能力下降、缺乏思考空间和疲劳。此外,有人认为幸福感/倦怠和错误之间的关系可能是循环的。

结论

需要进一步研究来确定这些看法的有效性。如果发现这些看法是正确的,医生、医疗保健组织和政策制定者应该研究如何改善医生的幸福感并预防倦怠,因为这可能是确保高质量和安全的患者护理的途径。

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