School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, China.
Hum Resour Health. 2020 Dec 3;18(1):95. doi: 10.1186/s12960-020-00538-z.
Health workers are at high risk of job burnout. Primary care in China has recently expanded its scope of services to a broader range of public health services in addition to clinical care. This study aims to measure the prevalence of burnout and identify its associated factors among clinical care and public health service providers at primary care facilities.
A cross-sectional survey (2018) was conducted among 17,816 clinical care and public health service providers at 701 primary care facilities from six provinces. Burnout was measured by the Chinese version of the Maslach Burnout Inventory-General Scale, and multilevel linear regression analysis was conducted to identify burnout's association with demographics, as well as occupational and organisational factors.
Overall, half of the providers (50.09%) suffered from burnout. Both the presence of burnout and the proportion of severe burnout among public health service providers (58.06% and 5.25%) were higher than among clinical care providers (47.55% and 2.26%, respectively). Similar factors were associated with burnout between clinical care and public health service providers. Younger, male, lower-educated providers and providers with intermediate professional title, permanent contract or higher working hours were related to a higher level of burnout. Organisational environment, such as the presence of a performance-based salary system, affected job burnout.
Job burnout is prevalent among different types of primary care providers in China, indicating the need for actions that encompass the entirety of primary care. We recommend strengthening the synergy between clinical care and public health services and transforming the performance-based salary system into a more quality-based system that includes teamwork incentives.
卫生工作者面临着职业倦怠的高风险。中国的基层医疗保健除了临床护理外，最近还将服务范围扩大到更广泛的公共卫生服务。本研究旨在衡量临床护理和公共卫生服务提供者在基层医疗保健机构中的倦怠发生率，并确定其相关因素。
对来自六个省的 701 家基层医疗保健机构的 17816 名临床护理和公共卫生服务提供者进行了横断面调查（2018 年）。使用中文版 Maslach 职业倦怠量表测量倦怠，采用多水平线性回归分析确定倦怠与人口统计学、职业和组织因素的关系。
总体而言，有一半的提供者（50.09%）存在倦怠。公共卫生服务提供者中存在倦怠的比例（58.06%）和严重倦怠的比例（5.25%）均高于临床护理提供者（分别为 47.55%和 2.26%）。临床护理和公共卫生服务提供者之间与倦怠相关的因素相似。年轻、男性、教育程度较低的提供者以及具有中级专业职称、永久合同或工作时间较长的提供者，与更高水平的倦怠相关。组织环境，如绩效工资制度的存在，也会影响工作倦怠。
中国不同类型的基层医疗保健提供者中普遍存在职业倦怠，这表明需要采取涵盖基层医疗保健整体的行动。我们建议加强临床护理和公共卫生服务之间的协同作用，并将基于绩效的薪酬制度转变为更注重质量的制度，包括团队合作激励。
