Jt Comm J Qual Patient Saf. 2022 May;48(5):287-297. doi: 10.1016/j.jcjq.2022.01.011. Epub 2022 Feb 4.
The National Academy of Medicine's 2019 consensus study on clinician burnout identified a need for research evaluating the impact of clinician distress on health care quality. This study examined the association between clinician distress and the inappropriate use of antibiotic prescriptions for acute respiratory tract infections (RTIs) in adult outpatients.
A retrospective cohort study was conducted using electronic health record visit data linked to annual wellness surveys administered to all clinicians at Boston Medical Center from May 4 to June 20, 2017, and June 5 to July 6, 2018. Included were outpatient visits occurring in Family Medicine, General Internal Medicine, or the emergency department in which an acute RTI for an otherwise healthy adult was listed as a primary diagnosis. The study examined the association of clinician depression, anxiety, and burnout with the visit-level odds of a clinician inappropriately prescribing an antibiotic for an acute RTI.
Out of the 2,187 visits eligible for inclusion, 1,668 visits were included in the final sample. Overall, 33.8% and 51.0% of clinicians reported depression/anxiety and burnout symptoms, respectively. Each 1 standard deviation increase in a clinician's composite depression and anxiety score was associated with a 28% increase (odds ratio = 1.28, 95% confidence interval = 1.02-1.61) in the adjusted odds of an inappropriate antibiotic prescription for an acute RTI. Clinician burnout had no significant association with inappropriate antibiotic prescribing for acute RTIs.
These findings suggest that clinician depression and anxiety may be important indicators of health care quality in routine outpatient care.
美国国家医学院 2019 年关于临床医生倦怠的共识研究确定了需要评估临床医生痛苦对医疗质量的影响的研究。本研究调查了临床医生痛苦与急性呼吸道感染（RTI）成年门诊患者抗生素处方不当使用之间的关联。
使用电子健康记录就诊数据进行回顾性队列研究，这些数据与 2017 年 5 月 4 日至 6 月 20 日和 2018 年 6 月 5 日至 7 月 6 日期间向波士顿医疗中心的所有临床医生进行的年度健康调查进行了链接。纳入的是在家庭医学、普通内科或急诊科就诊的患者，这些患者的主要诊断为急性 RTI 的健康成年人。本研究调查了临床医生抑郁、焦虑和倦怠与急性 RTI 就诊中临床医生不当开具抗生素的就诊水平几率之间的关联。
在符合纳入条件的 2187 次就诊中，有 1668 次就诊纳入最终样本。总体而言，分别有 33.8%和 51.0%的临床医生报告了抑郁/焦虑和倦怠症状。临床医生综合抑郁和焦虑评分每增加 1 个标准差，与急性 RTI 不适当使用抗生素的几率增加 28%（比值比=1.28，95%置信区间=1.02-1.61）相关。临床医生倦怠与急性 RTIs 不适当的抗生素处方无显著相关性。
这些发现表明，临床医生的抑郁和焦虑可能是常规门诊护理中医疗质量的重要指标。
