北京市西城区家庭医生职业倦怠现状及影响因素研究

Burnout Prevalence and Associated Factors among Family Doctors in Xicheng District of Beijing

背景国内外研究表明,家庭医生是职业倦怠高风险人群。家庭医生作为医疗服务的直接提供者,其职业倦怠情况直接关系到签约服务的质量。目的调查北京市西城区社区卫生服务机构家庭医生的职业倦怠情况,探讨焦虑、抑郁与职业倦怠的关系,分析职业倦怠影响因素,为进一步综合管理及对策的提出提供参考。方法于2019年5—7月对北京市西城区15家社区卫生服务中心及附属卫生站的家庭医生进行问卷调查,调查内容包括:一般情况调查表、职业倦怠量表(MBI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)。采用Spearman秩相关分析SAS、SDS得分与职业倦怠各维度得分的相关性。采用多因素Logistic回归分析家庭医生职业倦怠的影响因素。结果共发放问卷282份,回收有效问卷275份,有效回收率为97.5%。本研究中的家庭医生以女性(85.5%,235/275)、已婚(86.9%,239/275)、本科学历(72.4%,199/275)、中级职称(63.6%,175/275)为主。职业倦怠检出率为56.0%(154/275)。Spearman秩相关分析结果显示SAS、SDS得分与职业倦怠各维度得分相关(P<0.05)。多因素Logistic回归分析结果显示SAS、SDS得分是职业倦怠的影响因素(P<0.05);SAS、SDS得分是情绪衰竭的影响因素(P<0.05);气质类型、收入水平、签约患者总数、医患关系满意度、SAS得分、SDS得分是去个性化的影响因素(P<0.05);SDS得分是个人成就感降低的影响因素(P<0.05)。结论北京市西城区家庭医生职业倦怠情况不容乐观。为了减少职业倦怠应关注和干预家庭医生焦虑、抑郁情绪,注重多血质气质类型者稳定性格的培养,适当减少签约患者人数,提高薪资待遇,并进一步改善医患关系。

Background Studies show that family doctors are a population at high risk of job burnout.Job burnout may closely related to the quality of contracted services delivered by family doctors as they are the direct provider of medical services.Objective To investigate the prevalence of job burnout and its associated factors based on analyzing its associations with anxiety and depression in family doctors from community health organizations of Beijingo inicheng District,providing a reference for the development of comprehensive management and countermeasures for job burnout.Methods From May to July 2019,a questionnaire survey was conducted among family doctors from 15 community health centers and affiliated health stations in Xicheng District,Beijing using the General Demographic Questionnaire,Maslach Burnout Inventory(MBI),Zung Self-Rating Anxiety Scale(SAS)and Zung Self-Rating Depression Scale(SDS).Spearman correlation analysis was used to analyze the correlation of the dimension scores of SAS and SDS with those of MBI.Multivariate Logistic regression analysis was used to analyze the influencing factors of job burnout.Results A total of 282 cases attended the survey,and 275 of them(97.5%)responded effectively.The respondents were mostly women(85.5%,235/275),married(86.9%,239/275),with attainment of university education(72.4%,199/275)and intermediate professional title(63.6%,175/275).The prevalence of job burnout was 56.0%(154/275).Spearman correlation analysis found that the domain scores of SAS and SDS were significantly correlated with those of MBI.Multivariate analysis revealed that the scores of SAS and SDS were associated with the prevalence of job burnout(P<0.05).The scores of SAS and SDS were associated with emotional exhaustion(P<0.05).Factors affecting depersonalization included temperament type,monthly income,number of contracted patients,satisfaction with doctor-patient relationship,and the scores of SAS and SDS(P<0.05).The SDS score was associated with low personal accomplishment(P<0.05).Conclusion The job burnout in family doctors in Xicheng District of Beijing is not optimistic.To reduce job burnout prevalence,attention should be paid to the anxiety and depression prevalence in this group,and interventions should be given to those with these symptoms timely.Moreover,efforts should be made to increase the steadiness of sanguine family doctors.Furthermore,the specified number of contracted patients for a family doctor may be reduced appropriately,and the monthly income for family doctors as well as family doctor-patient relationship should be improved.