Storseth Oliver, McNeil Karen, Grudniewicz Agnes, Correia Rebecca H, Gallant François, Thelen Rachel, Lavergne M Ruth
Medical student at Dalhousie University in Halifax, NS.
Family physician and Assistant Professor in the Department of Family Medicine at Dalhousie University.
Can Fam Physician. 2025 Jun;71(6):417-423. doi: 10.46747/cfp.7106417.
Administrative burden contributes to the current primary care crisis. This critical review of the literature explores how primary care administrative burden is discussed, including how it is defined and what drivers and solutions have been identified.
A systematic search of MEDLINE and CINAHL electronic databases for peer-reviewed original research articles, literature reviews, and commentaries that discuss administrative burden in the context of primary care or primary health care.
Searches identified 321 articles in MEDLINE and 109 in CINAHL, resulting in a total of 351 articles after duplicates were removed. Based on title and abstract screening, 228 articles were retained for full-text screening; 136 were ultimately included in the analysis.
Most articles focused on perspectives of physicians (72.8%), followed by those of other primary care clinicians (14.7%) and patients (12.5%). Few articles explicitly defined administrative burden (n=6), although most illustrated the concept with examples. One relevant definition of administrative burden distinguishes compliance, learning, and psychological costs. This definition was proposed in the context of people interacting with bureaucracies generally, but these categories are also relevant to primary care specifically. Primary care administrative burdens most often included compliance costs (forms and information management), but learning costs (finding information, navigating processes, and adapting to and implementing new technology) and psychological costs (stress and burnout) were also discussed in the literature. Identified drivers of administrative burden included health system requirements, technological tools available to do administrative work, and complexity of patients or patient populations. Technology and task shifting were discussed as both drivers of administrative burden and solutions to administrative workload.
Examples of administrative burden in primary care underscore that this work often supports central functions of continuity and coordination of care. Attention often focuses on compliance costs, but learning costs (eg, finding information and learning new technology) and psychological costs must not be overlooked. That technology and task shifting can function as both drivers of and solutions to administrative burden highlights why this issue is challenging to address. Solutions should consider costs broadly and evaluate implications from multiple perspectives, including those of patients and caregivers.
行政负担加剧了当前的基层医疗危机。本文献综述探讨了基层医疗行政负担是如何被讨论的，包括其定义方式以及已确定的驱动因素和解决方案。
对MEDLINE和CINAHL电子数据库进行系统检索，查找在基层医疗或初级卫生保健背景下讨论行政负担的同行评审原创研究文章、文献综述和评论。
检索发现MEDLINE中有321篇文章，CINAHL中有109篇文章，去除重复后共351篇文章。基于标题和摘要筛选，保留228篇文章进行全文筛选；最终136篇文章纳入分析。
大多数文章关注医生的观点（72.8%），其次是其他基层医疗临床医生的观点（14.7%）和患者的观点（12.5%）。很少有文章明确界定行政负担（n = 6），尽管大多数文章通过实例阐释了这一概念。行政负担的一个相关定义区分了合规成本、学习成本和心理成本。这个定义是在人们与官僚机构互动的一般背景下提出的，但这些类别也特别适用于基层医疗。基层医疗行政负担最常包括合规成本（表格和信息管理），但文献中也讨论了学习成本（查找信息、熟悉流程以及适应和实施新技术）和心理成本（压力和倦怠）。已确定的行政负担驱动因素包括卫生系统要求、用于行政工作的技术工具以及患者或患者群体的复杂性。技术和任务转移既被讨论为行政负担的驱动因素，也被视为解决行政工作量的方案。
基层医疗行政负担的实例强调，这项工作通常支持连续性和协调性医疗的核心功能。人们的注意力往往集中在合规成本上，但学习成本（如查找信息和学习新技术）和心理成本绝不能被忽视。技术和任务转移既可以是行政负担的驱动因素，也可以是解决行政负担的方案，这凸显了为何这个问题难以解决。解决方案应广泛考虑成本，并从多个角度评估影响，包括患者和护理人员的角度。
