Family Medicine, UC San Diego School of Medicine, La Jolla, California, USA.
Outcomes Analysis and Scholarship, Information Services, UC San Diego Health, La Jolla, California, USA.
J Am Med Inform Assoc. 2023 Sep 25;30(10):1665-1672. doi: 10.1093/jamia/ocad136.
Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying levers that can be targeted to address burnout.
Survey of physicians of all specialties in an academic health center, using a standard measure of burnout, self-reported EHR work stress, and EHR-based work assessed by the number of messages regarding prescription reauthorization and use of a staff pool to triage messages. Descriptive and multivariable regression analyses examined the relationship among burnout, perceived EHR work stress, and actionable EHR work factors.
Of 1038 eligible physicians, 627 responded (60% response rate), 49.8% reported burnout symptoms. Logistic regression analysis suggests that higher odds of burnout are associated with physicians feeling higher level of EHR stress (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07-1.25), having more prescription reauthorization messages (OR, 1.23; 95% CI, 1.04-1.47), not feeling valued (OR, 3.38; 95% CI, 1.69-7.22) or aligned in values with clinic leaders (OR, 2.81; 95% CI, 1.87-4.27), in medical practice for ≤15 years (OR, 2.57; 95% CI, 1.63-4.12), and sleeping for <6 h/night (OR, 1.73; 95% CI, 1.12-2.67).
Perceived EHR stress and prescription reauthorization messages are significantly associated with burnout, as are non-EHR factors such as not feeling valued or aligned in values with clinic leaders. Younger physicians need more support.
A multipronged approach targeting actionable levers and supporting young physicians is needed to implement sustainable improvements in physician well-being.
所有专业的医生在 COVID-19 大流行期间都经历了前所未有的压力源,加剧了先前存在的倦怠。我们研究了倦怠与感知到的和可采取行动的电子健康记录(EHR)工作量因素以及个人、专业和组织特征之间的关系,目的是确定可以针对倦怠问题的杠杆。
对一家学术医疗中心的所有专业医生进行调查,使用倦怠的标准衡量标准、自我报告的 EHR 工作压力以及通过有关处方重新授权的消息数量和使用员工池来对消息进行分类的 EHR 为基础的工作来评估。描述性和多变量回归分析检查了倦怠、感知到的 EHR 工作压力和可采取行动的 EHR 工作因素之间的关系。
在 1038 名符合条件的医生中,有 627 名(60%的回复率)做出了回应,其中 49.8%报告有倦怠症状。逻辑回归分析表明,倦怠的可能性更高与医生感到 EHR 压力更高(优势比[OR],1.15;95%置信区间[CI],1.07-1.25)、有更多处方重新授权消息(OR,1.23;95%CI,1.04-1.47)、感觉不被重视(OR,3.38;95%CI,1.69-7.22)或与诊所领导价值观不一致(OR,2.81;95%CI,1.87-4.27)、从事医疗工作≤15 年(OR,2.57;95%CI,1.63-4.12)和每晚睡眠<6 小时(OR,1.73;95%CI,1.12-2.67)有关。
感知到的 EHR 压力和处方重新授权消息与倦怠显著相关,而与 EHR 无关的因素,如不被重视或与诊所领导价值观不一致也与倦怠相关。年轻医生需要更多的支持。
需要采取多管齐下的方法来针对可采取行动的杠杆,并支持年轻医生,以实现医生福祉的可持续改善。