调查在英国工作的全科医生的诊断不确定性、情绪耗竭和离职意向之间的联系。
Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom.
作者信息
Zhou Anli Yue, Zghebi Salwa S, Hodkinson Alexander, Hann Mark, Grigoroglou Christos, Ashcroft Darren M, Esmail Aneez, Chew-Graham Carolyn A, Payne Rupert, Little Paul, de Lusignan Simon, Cherachi-Sohi Sudeh, Spooner Sharon, Zhou Andrew K, Kontopantelis Evangelos, Panagioti Maria
机构信息
National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
出版信息
Front Psychiatry. 2022 Jul 26;13:936067. doi: 10.3389/fpsyt.2022.936067. eCollection 2022.
BACKGROUND
General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined.
OBJECTIVES
To examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs.
METHODS
Seventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest.
RESULTS
Almost one-third of GPs ( = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)].
CONCLUSION
Diagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care.
背景
全科医生（GPs）报告称职业倦怠、工作满意度低和离职意愿高。向全科医疗呈现的问题的复杂性使得诊断不确定性成为常见现象，且这一现象与职业倦怠有关。此前尚未研究诊断不确定性与职业倦怠、工作满意度和离职意愿等其他因素之间的相互关系。
目的
研究全科医生中诊断不确定性、情绪耗竭（EE）、去个性化（DP）、工作满意度和离职意愿之间的关联。
方法
通过牛津皇家全科医生学院研究与监测中心（RCGP-RSC）在英格兰随机选择了70家全科医疗机构。这些机构中的67家共有348名全科医生完成了一份包含10个项目的在线问卷，其中包括关于全科医生特征、工作与生活平衡、工作满意度、带病出勤、诊断不确定性、离职意愿以及情绪耗竭和去个性化的问题。在多变量混合效应有序逻辑回归中评估诊断不确定性与情绪耗竭、去个性化、工作满意度和离职意愿之间的关联，同时对协变量进行调整，以考虑三个感兴趣结果中的相关性。
结果
近三分之一的全科医生（n = 101；29%）报告称在过去一年的日常工作中经历了超过10%的诊断不确定性。报告诊断不确定性更高的全科医生情绪耗竭水平更高[比值比（OR）= 3.90；95%置信区间（CI）=（2.54，5.99）]、工作满意度更低[OR = 2.01；95% CI =（1.30，3.13）]以及离职意愿更高[OR = 4.51；95% CI =（2.86，7.11）]。没有带病出勤的全科医生情绪耗竭水平更低[OR = 0.53；95% CI =（0.35，0.82）]、工作满意度更低[OR = 0.56；95% CI =（0.35，0.88）]以及离职意愿更低[OR = 0.61；95% CI =（0.41，0.91）]。
结论
诊断不确定性不仅可能对全科医生的幸福感产生负面影响，还可能对基层医疗的劳动力留存产生不利影响。
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