Al Awar Shamsa, Sallam Gehan, Elbiss Hassan
Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
Medicine (Baltimore). 2024 Nov 22;103(47):e40619. doi: 10.1097/MD.0000000000040619.
Health services institutes worldwide are trying to reduce defensive medical practice to limit its negative impact on patient care. We evaluated the factors associated with this defensive medical practice among medical professionals in the United Arab Emirates. This study deployed multivariate logistic regression analysis. Defensive medical practice was defined according to the responses given to questions about potentially unnecessary referral, testing, and additional care in a cross-sectional 23-item questionnaire administered to medical professionals after obtaining ethical committee approval. The factors evaluated were: age, gender, medical specialty, job grade, years of practice, country of medical graduation, country of specialty board, current practice in hospital or private sector, feeling supported by workplace staff, being involved in litigation, and indemnity cover. Multivariate models determined the adjusted odds ratios (aOR) and 95% confidence intervals (CI) after taking account of confounding; aOR > 1 indicated a positive association of factors with defensive practice while aOR < 1 indicated a negative association. There were 562 respondents. The most common defensive medical practice related to referring on a case after sensing the possibility of a complaint (365, 64.9%); the factors associated were senior grades (aOR 0.74, 95% CI 0.56-0.98, P = .04), private sector (aOR 1.27, 95% CI 1.008-1.61, P = .04), and indemnity cover (aOR 0.49, 95% CI 0.26-0.93, P = .03). The second most common defensive practice was calling inpatient admission, delaying discharge, additional testing, etc without medical indication and solely on patient or family request (265, 47.1%); the factors associated were age (aOR 0.46, 95% CI 0.33-0.64, P = .001), private sector (aOR 0.66, 95% CI 0.53-0.83, P = .001), and support by workplace staff (aOR 0.50, 95% CI 0.34-0.73, P = .001). Other defensive practices included refraining from difficult procedures or referring cases to another colleague due to the fear of complications (166, 29.5%) and unwillingness to accept patients in case of previous litigation history (157, 28.1%). This multivariable analysis in the United Arab Emirates found that higher age, higher job grades, indemnity cover and support by workplace staff reduced the odds of defensive medicine practice while working in the private sector had a mixed effect.
世界各地的医疗服务机构都在努力减少防御性医疗行为，以限制其对患者护理的负面影响。我们评估了阿联酋医疗专业人员中与这种防御性医疗行为相关的因素。本研究采用多变量逻辑回归分析。在获得伦理委员会批准后，通过向医疗专业人员发放一份包含23个项目的横断面问卷，根据对有关潜在不必要转诊、检查和额外护理问题的回答来定义防御性医疗行为。评估的因素包括：年龄、性别、医学专业、工作级别、执业年限、医学毕业国家、专科委员会国家、目前在医院或私营部门执业、感觉得到工作场所工作人员的支持、涉及诉讼以及有无赔偿保险。多变量模型在考虑混杂因素后确定了调整后的比值比（aOR）和95%置信区间（CI）；aOR > 1表明因素与防御性医疗行为呈正相关，而aOR < 1表明呈负相关。共有562名受访者。最常见的防御性医疗行为是在感觉到可能会有投诉后转诊病例（365例，64.9%）；相关因素包括高级别（aOR 0.74，95% CI 0.56 - 0.98，P = 0.04）、私营部门（aOR 1.27，95% CI 1.008 - 1.61，P = 0.04）和赔偿保险（aOR 0.49，95% CI 0.26 - 0.93，P = 0.03）。第二常见的防御性医疗行为是在没有医学指征且仅根据患者或家属要求的情况下呼叫住院、延迟出院、进行额外检查等（265例，47.1%）；相关因素包括年龄（aOR 0.46，95% CI 0.33 - 0.64，P = 0.001）、私营部门（aOR 0.66，95% CI 0.53 - 0.83，P = 0.001）和工作场所工作人员的支持（aOR 0.50，95% CI 0.34 - 0.73，P = 0.001）。其他防御性医疗行为包括因担心并发症而避免进行困难的手术或将病例转诊给另一位同事（166例，29.5%）以及因有既往诉讼史而不愿意接收患者（157例，28.1%）。阿联酋的这项多变量分析发现，年龄较大、工作级别较高、有赔偿保险以及得到工作场所工作人员的支持会降低防御性医疗行为的几率，而在私营部门工作则有混合影响。
