Sawyer School of Business at Suffolk University, Boston, Massachusetts, and the Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Larry A. Green Center for the Advancement of Primary Health Care for the Public Good and the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
J Healthc Manag. 2024;69(3):190-204. doi: 10.1097/JHM-D-23-00102. Epub 2024 May 10.
This study was developed to explicate underlying organizational factors contributing to the deterioration of primary care clinicians' mental health during the COVID-19 pandemic.
Using data from the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good's national survey of primary care clinicians from March 2020 to March 2022, a multidisciplinary team analyzed more than 11,150 open-ended comments. Phase 1 of the analysis happened in real-time as surveys were returned, using deductive and inductive coding. Phase 2 used grounded theory to identify emergent themes. Qualitative findings were triangulated with the survey's quantitative data.
The clinicians shifted from feelings of anxiety and uncertainty at the start of the pandemic to isolation, lack of fulfillment, moral injury, and plans to leave the profession. The frequency with which they spoke of depression, burnout, and moral injury was striking. The contributors to this distress included crushing workloads, worsening staff shortages, and insufficient reimbursement. Consequences, both felt and anticipated, included fatigue and demoralization from the inability to manage escalating workloads. Survey findings identified responses that could alleviate the mental health crisis, namely: (1) measuring and customizing workloads based on work capacity; (2) quantifying resources needed to return to sufficient staffing levels; (3) promoting state and federal support for sustainable practice infrastructures with less administrative burden; and (4) creating patient visits of different lengths to rebuild relationships and trust and facilitate more accurate diagnoses.
Attention to clinicians' mental health should be rapidly directed to on-demand, confidential mental health support so they can receive the care they need and not worry about any stigma or loss of license for accepting that help. Interventions that address work-life balance, workload, and resources can improve care, support retention of the critically important primary care workforce, and attract more trainees to primary care careers.
本研究旨在阐明导致初级保健临床医生在 COVID-19 大流行期间心理健康恶化的潜在组织因素。
利用拉里 A. 格林中心促进公共利益初级保健的全国性初级保健临床医生调查在 2020 年 3 月至 2022 年 3 月期间收集的数据，一个多学科团队分析了 11150 多条开放式评论。分析的第一阶段是在调查返回时实时进行的，使用演绎和归纳编码。第二阶段使用扎根理论来确定新兴主题。定性发现与调查的定量数据进行了三角剖分。
临床医生从大流行开始时的焦虑和不确定性转变为孤立、缺乏满足感、道德伤害和离开该行业的计划。他们谈到抑郁、倦怠和道德伤害的频率令人震惊。导致这种痛苦的原因包括工作量过大、员工短缺恶化以及报酬不足。由此产生的后果，无论是实际感受到的还是预期到的，都包括因无法管理不断增加的工作量而导致的疲劳和士气低落。调查结果确定了可以缓解心理健康危机的应对措施，即：(1) 根据工作能力测量和定制工作量；(2) 量化恢复充足人员配备水平所需的资源；(3) 倡导州和联邦支持具有较少行政负担的可持续实践基础设施；(4) 创造不同长度的患者就诊机会，重建关系和信任，促进更准确的诊断。
应迅速关注临床医生的心理健康，为他们提供按需、保密的心理健康支持，以便他们能够获得所需的护理，而不必担心任何耻辱感或因接受帮助而失去执照。解决工作与生活平衡、工作量和资源的干预措施可以改善护理，支持保留至关重要的初级保健劳动力，并吸引更多的受训者从事初级保健工作。
