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基层医疗中行政责任的负担:定性研究。

Burden of administrative responsibilities in primary care: Qualitative study.

作者信息

Brown Judith Belle, Thorpe Cathy, Bal Sharon, George Catherine, Jan Saadia Hameed, Mathews Maria, Premji Kamila, Ryan Bridget L, Terry Amanda L

机构信息

Professor in the Centre for Studies in Family Medicine, Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University in London, Ont.

Research Associate-Manager at the Centre for Studies in Family Medicine, Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University.

出版信息

Can Fam Physician. 2025 Jun;71(6):e148-e153. doi: 10.46747/cfp.7106e148.

DOI:10.46747/cfp.7106e148
PMID:40523739
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12264511/
Abstract

OBJECTIVE

To describe family physicians' experiences of administrative burden in practice.

DESIGN

Qualitative study using constructivist grounded theory.

SETTING

Ontario.

PARTICIPANTS

Family physicians.

METHOD

In-depth virtual interviews with family physicians practising in Ontario who completed postgraduate training between 2017 and 2022.

MAIN FINDINGS

A total of 36 family physicians were interviewed. Without external prompting, all participants raised the issue of administrative burden, offering specific contextual factors contributing to their administrative burden. These included volume of paperwork, inbox management, and lack of compensation for the hours of administrative tasks performed. In addition to these contextual factors, 2 main themes were identified: the first revealed the impact of administrative burden on both the time available for patient care and physicians' well-being. This latter issue was exacerbated by deteriorating relationships with specialist colleagues, contributing to family physicians' administrative burden and burnout. A lack of exposure to the volume of administrative duties during training added to this issue. The second theme described participants' personal strategies (eg, creating flex time, setting boundaries) and system solutions (eg, need for compensation for administrative time, funding to increase clinic staff, and interventions by regulatory bodies) to address administrative burden.

CONCLUSION

Administrative burden negatively impacts physician well-being and reduces time for direct patient care. These findings highlight 2 new sources contributing to administrative burden: deteriorating relationships between family physicians and specialist colleagues and a lack of exposure to managing administrative responsibilities during medical training. Study findings provide personal strategies and system solutions to guide practitioners, policy-makers, and educators.

摘要

目的

描述家庭医生在实际工作中行政负担的经历。

设计

采用建构主义扎根理论的定性研究。

背景

安大略省。

参与者

家庭医生。

方法

对2017年至2022年期间在安大略省完成研究生培训的家庭医生进行深入的虚拟访谈。

主要发现

共访谈了36名家庭医生。在没有外部提示的情况下,所有参与者都提出了行政负担问题,并提供了导致其行政负担的具体背景因素。这些因素包括文书工作量、收件箱管理以及对所执行行政任务时间缺乏补偿。除了这些背景因素外,还确定了两个主要主题:第一个主题揭示了行政负担对可用于患者护理的时间和医生幸福感的影响。与专科同事关系的恶化加剧了后一个问题,增加了家庭医生的行政负担和职业倦怠。培训期间对行政职责工作量缺乏接触加剧了这个问题。第二个主题描述了参与者应对行政负担的个人策略(例如,创造弹性工作时间、设定界限)和系统解决方案(例如,需要对行政时间进行补偿、增加诊所工作人员的资金以及监管机构的干预)。

结论

行政负担对医生的幸福感产生负面影响,并减少了直接为患者提供护理的时间。这些发现突出了导致行政负担的两个新来源:家庭医生与专科同事之间关系的恶化以及医学培训期间缺乏管理行政职责的接触。研究结果提供了个人策略和系统解决方案,以指导从业者、政策制定者和教育工作者。