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基层医疗医生的工作条件及其对管理多种疾病的信心:使用工作要求-资源模型的定量分析。

Primary care physicians' work conditions and their confidence in managing multimorbidity: a quantitative analysis using Job Demands-Resources Model.

作者信息

Zhao Ruixue, Zhang Jinnan, Li Mengyao, Loban Ekaterina, Nicolas Stephen, Martiland Elizabeth, Wang Wenhua

机构信息

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China.

Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada.

出版信息

Fam Pract. 2024 Dec 2;41(6):977-984. doi: 10.1093/fampra/cmad099.

Abstract

BACKGROUND

Multimorbidity is a global issue that presents complex challenges for physicians, patients, and health systems. However, there is a lack of research on the factors that influence physicians' confidence in managing multimorbidity within primary care settings, particularly regarding physicians' work conditions.

OBJECTIVES

Drawing on the Job Demands-Resources Model, this study aims to investigate the level of confidence among Chinese primary care physicians in managing multimorbidity and examine the predictors related to their confidence.

METHODS

Data were collected from 224 physicians working in 38 Community Healthcare Centres (CHCs) in Shanghai, Shenzhen, Tianjin, and Jinan, China. Work-family conflict (WFC) perceived organizational support (POS), self-directed learning (SDL), and burnout were measured. Physicians' confidence was assessed using a single item. Mediation effect analysis was conducted using the Baron and Kenny method.

RESULTS

The results showed that the mean confidence score for physicians managing multimorbidity was 3.63 out of 5, only 20.10% rating their confidence level as 5. WFC negatively related physicians' confidence and POS positively related physicians' confidence in multimorbid diagnosis and treatment. Burnout fully mediated the relationship between WFC and physicians' confidence, and SDL partially mediated the relationship between POS and physicians' confidence.

CONCLUSIONS

The confidence level of Chinese primary care physicians in managing multimorbidity needs improvement. To enhance physicians' confidence in managing multimorbid patients, CHCs in China should address WFC and burnout and promote POS and SDL.

摘要

背景

多病共存是一个全球性问题,给医生、患者和卫生系统带来了复杂挑战。然而,对于影响医生在基层医疗环境中管理多病共存的因素,尤其是与医生工作条件相关的因素,缺乏研究。

目的

本研究借鉴工作需求-资源模型,旨在调查中国基层医疗医生管理多病共存的信心水平,并检验与其信心相关的预测因素。

方法

数据收集自中国上海、深圳、天津和济南38个社区卫生服务中心(CHC)的224名医生。测量了工作-家庭冲突(WFC)、感知到的组织支持(POS)、自主学习(SDL)和职业倦怠。使用单项指标评估医生的信心。采用Baron和Kenny方法进行中介效应分析。

结果

结果显示,医生管理多病共存的平均信心得分为3.63(满分5分),只有20.10%的医生将其信心水平评为5分。WFC与医生的信心呈负相关,POS与医生对多病共存诊断和治疗的信心呈正相关。职业倦怠完全中介了WFC与医生信心之间的关系,SDL部分中介了POS与医生信心之间的关系。

结论

中国基层医疗医生管理多病共存的信心水平有待提高。为增强医生管理多病共存患者的信心,中国的社区卫生服务中心应解决工作-家庭冲突和职业倦怠问题,并促进组织支持和自主学习。

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