2010—2019年我国城市社区医生职业倦怠现状的meta分析

Meta-analysis on occupational job burnout of urban community physicians in China from 2010 to 2019

目的了解2010—2019年我国城市社区医生的职业倦怠现状,为制定合理的社区医生心理干预政策提供参考依据。方法检索中国知网数据库、万方数据库和维普中国科技期刊数据库,并辅以文献追溯法收集2010年1月1日—2019年6月30日公开发表的关于我国城市社区医生职业倦怠检出率的相关文献,应用Stata 15软件进行meta分析。结果最终纳入10篇文献,累计研究对象3 824例。Meta分析结果显示,我国城市社区医生职业倦怠检出率为74.6%,95%CI=69.0%~80.3%;情绪耗竭检出率为36.2%,95%CI=25.4%~47.1%;去人格化检出率为43.4%,95%CI=39.1%~47.6%;个人成就感降低检出率为54.4%,95%CI=47.0%~61.8%。敏感性分析提示meta分析结果较为稳定,漏斗图分析提示可能存在发表偏倚。亚组分析显示,发表年份为2015年及以前、2016年以后的分别为68.7%和80.9%,发表年份比较差异有统计学意义(χ2=35.90,P<0.05);调查对象所属城市为直辖市、非直辖市、无法分类的检出率分别为71.0%、73.5%和72.8%,样本量<200、200~400、>400的分别为76.2%、71.9%和75.2%,调查所用问卷为CMBI、MBI-GS的分别为77.5%和71.7%,对象所属城市、样本量及调查所用问卷版本的差异均无统计学意义(χ2=2.03、5.66、3.54,P均>0.05)。结论 2010—2019年我国城市社区医生职业倦怠检出率较高,且呈现日益加剧的态势,职业倦怠三方面表现中,尤以成就感降低为剧,当前,应深入研究影响城市社区医生职业倦怠的因素,针对影响因素采取必要的心理干预措施,以降低城市社区医生职业倦怠率,减少其危害。

Objective To estimate the prevalence of occupational burnout among urban community physicians in China from 2010 to2019,provide reference for making reasonable psychological intervention policy for community physicians. Methods Supplemented by literature review,the studies on the detection rate of occupational burnout among urban community physicians in China published from January 1,2010 to June 30,2019 were searched from the databases of WanFang,VIP,and CNKI. A metaanalysis was performed with Stata 15 software. Results A total of 10 eligible studies,with 3 824 respondents,were finally included.Meta-analysis results showed that the detection rate of occupational burnout among urban community physicians in China was74.6%,95% CI =69.0%-80.3%,the detection rates of burnout-emotional exhaustion,depersonalisation,and low personal accomplishment were 36.2%(95% CI =25.4%-47.1%),43.4%(95% CI =39.1%-47.6%),and 54.4%(95% CI =47.0%-61.8%),respectively. Sensitivity analysis suggested that the results of meta-analysis were relatively stable,while funnel plot analysis suggested that publication bias might exist. Subgroup analysis showed that the prevalence in articles published in 2015 and before and after 2016 was respectively 68.7% and 80.9%,and the difference was statistically significant (χ2=35.90,P<0.05). The detection rate of community physicians in municipalities directly under the central government, non-municipalities directly under the central government,and unclassifiable cites was 71.0%,73.5% and 72.8%,respectively,the detection rate of community physicians with sample size +<200,200-400 and >400 was 76.2%,71.9% and 75.2%,respectively,the detection rate of community physicians with questionnaire of CMBI and MBI-GS was 77.5% and 71.7% respectively,and there were no statistically significant differences among different cities,sample sizes and questionnaire versions (χ2=2.03,5.66,3.54,all P>0.05). Conclusion From 2010 to 2019,the detection rate of occupational burnout among urban community physicians in China is relatively high,and the situation is getting worse and worse. Among the three manifestations of occu pational burnout,the worst is low personal accomplishment. At present,it is necessary to deeply study the factors affecting the occupational burnout of physicians in urban communities and take targeted measures to reduce the prevalence rate and harm of occupational burnout among urban community physicians.