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医生参与解决与健康相关的社会需求和职业倦怠问题。

Physician Engagement in Addressing Health-Related Social Needs and Burnout.

作者信息

Tabata-Kelly Masami, Hu Xiaochu, Dill Michael J, Alberti Philip M, Bullock Karen, Crown William, Fair Malika, May Peter, Ortega Pilar, Perloff Jennifer

机构信息

The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.

Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.

出版信息

JAMA Netw Open. 2024 Dec 2;7(12):e2452152. doi: 10.1001/jamanetworkopen.2024.52152.

Abstract

IMPORTANCE

Previous research suggests that a greater capacity of health care organizations to address patients' health-related social needs (HRSNs) is associated with lower physician burnout. However, individual physician-level engagement in addressing HRSNs has not been fully characterized, and its association with physician burnout remains understudied.

OBJECTIVE

To characterize physicians' engagement in addressing HRSNs and examine its association with burnout.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2022 Association of American Medical Colleges National Sample Survey of Physicians (NSSP), a nationally representative survey of active, practicing physicians in the US conducted from May to November 2022 that measured a diverse array of physician workforce characteristics.

MAIN OUTCOME AND MEASURES

HRSN engagement was defined by physicians' responses to the NSSP item, "During the past 12 months, how often did you spend work time helping your patients meet their social needs?" Engagement levels were categorized as no engagement, low to moderate engagement (monthly or <1 time per month), or high engagement (weekly or daily). Burnout was measured using a single-item measure from the emotional exhaustion domain of the Maslach Burnout Inventory (high was defined as weekly or more). HRSN engagement was examined by physician characteristics, and multivariate logistic regression was conducted to explore associations between HRSN engagement and burnout. Data were weighted by age, gender, international medical graduate status, and specialty group.

RESULTS

In the study cohort of 5447 physicians, the mean (SD) age was 50.9 (11.7) years, and 3735 (68.6%) identified as men or transgender men. Overall, 34.3% of physicians reported high HRSN engagement, with variability based on physician characteristics. Compared with no HRSN engagement, low to moderate HRSN engagement (adjusted odds ratio [AOR], 1.33; 95% CI, 1.03-1.72; P = .03) and high HRSN engagement (AOR, 1.72; 95% CI, 1.39-2.27; P < .001) were significantly associated with high burnout.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of 5447 nationally representative physicians in the US, 34.3% regularly dedicated time to addressing HRSNs. The study identified variability in physicians' engagement in addressing HRSNs and found that higher engagement was associated with a greater likelihood of burnout. The findings suggest the need for thorough assessment of the potential unintended consequences of physicians' engagement in addressing HRSNs on their well-being.

摘要

重要性

先前的研究表明,医疗保健组织满足患者健康相关社会需求(HRSN)的能力越强,医生的职业倦怠程度越低。然而,个体医生层面参与满足HRSN的情况尚未得到充分描述,其与医生职业倦怠的关联仍未得到充分研究。

目的

描述医生参与满足HRSN的情况,并研究其与职业倦怠的关联。

设计、背景和参与者:这项横断面研究使用了2022年美国医学院协会全国医生样本调查(NSSP),这是一项于2022年5月至11月对美国在职执业医生进行的具有全国代表性的调查,测量了各种各样的医生劳动力特征。

主要结果和指标

HRSN参与度由医生对NSSP项目“在过去12个月中,你有多少次花费工作时间帮助患者满足他们的社会需求?”的回答来定义。参与程度分为无参与、低至中度参与(每月或每月少于1次)或高度参与(每周或每天)。职业倦怠使用马氏职业倦怠量表情绪耗竭领域的单项测量指标(每周或更频繁被定义为高)进行测量。通过医生特征来研究HRSN参与度,并进行多因素逻辑回归以探讨HRSN参与度与职业倦怠之间的关联。数据按年龄、性别、国际医学毕业生身份和专业组进行加权。

结果

在5447名医生的研究队列中,平均(标准差)年龄为50.9(11.7)岁,3735名(68.6%)被认定为男性或变性男性。总体而言,34.3%的医生报告有高度的HRSN参与度,且因医生特征而异。与无HRSN参与相比,低至中度HRSN参与(调整后的优势比[AOR],1.33;95%置信区间,1.03 - 1.72;P = 0.03)和高度HRSN参与(AOR,1.72;95%置信区间,1.39 - 2.27;P < 0.001)与高职业倦怠显著相关。

结论和意义

在这项对5447名具有全国代表性的美国医生的横断面研究中,34.3%的医生定期投入时间来满足HRSN。该研究发现医生在满足HRSN方面的参与存在差异,并发现更高的参与度与更高的职业倦怠可能性相关。研究结果表明需要全面评估医生参与满足HRSN对其幸福感可能产生的意外后果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9a98/11686412/91309b06973e/jamanetwopen-e2452152-g001.jpg

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