上海市浦东新区家庭医生职业倦怠状况及影响因素分析

Analysis on status and influencing factors of job burnout among family doctors in Pudong New Area of Shanghai

目的探讨上海市浦东新区家庭医生职业倦怠状况及影响因素,为更好的推进家庭医生工作提供参考。方法2020年12月,依据上海市浦东新区城乡地域划分方法,在各区域随机抽取3家社区卫生服务中心,合计9家社区卫生服务中心的350名家庭医生,采用自制的家庭医生基本情况问卷及马斯勒倦怠量表-服务行业版(maslach burnout inventory-human service survey,MBI-HSS)翻译修订而来的职业倦怠量表(包含情绪疲惫感、工作冷漠感、无工作成就感3个维度)进行线上问卷调查,共回收有效问卷347份,有效应答率为99.14%(347/350)。采用χ^(2)检验比较不同特征家庭医生职业倦怠状况的差异,并用有序多分类logistic逐步回归分析家庭医生各维度职业倦怠程度可能的影响因素。结果上海市浦东新区347名家庭医生职业倦怠状况较严重,在家庭医生的情绪疲惫感、工作冷漠感、无工作成就感3个维度中,重度倦怠占比均最高,其中无工作成就感的占比最高,为62.5%。χ^(2)检验和logistic回归分析结果显示,地区、从事家庭医生相关工作年限、是否加班、工资福利待遇满意度、每周参与疫情工作时长是家庭医生情绪疲惫感维度发生重度倦怠的影响因素(均P<0.05)。地区、婚姻、职称、工资福利待遇满意度、每周参与疫情工作时长是家庭医生工作冷漠感维度发生重度倦怠的影响因素(均P<0.05)。地区、学历、成为全科医生的途径、工资福利待遇满意度是家庭医生无工作成就感维度发生重度倦怠的影响因素(均P<0.05)。结论上海市浦东新区家庭医生职业倦怠发生率高,其中,最为突出的是无工作成就感。影响家庭医生职业倦怠的因素较多,建议根据不同地区、人群的特点给予改进策略,通过团队协作及优化疫情防控流程合理安排工作时间,提高家庭医生的薪酬待遇及建立完善的激励制度,重视家庭医生制度建设及职业规划,从而缓解家庭医生的职业倦怠,稳定家庭医生队伍,更好的推进家庭医生工作。

Objective To explore the status and influencing factors of job burnout among family doctors in Pudong New Area of Shanghai,provide reference for better development of family doctors'work.Methods In December 2020,according to the urban and rural regional division method of Pudong New Area in Shanghai,three community health service centers were randomly selected from each district,with a total of 350 family doctors from nine community health service centers.An online questionnaire survey was conducted using the self-made family doctor's basic situation questionnaire and the job burnout scale which the Maslach burnout inventory-human service survey(MBI-HSS)translated and revised(including three dimensions of emotional fatigue,job apaism and no sense of work achievement).A total of 347 valid questionnaires were collected,and the effective response rate was 99.14%(347/350).Theχ^(2)test was used to compare the differences in job burnout among family doctors with different characteristics,and the ordered multi-class logistic stepwise regression analysis was used to analyze the possible influencing factors on the job burnout in various dimensions of family doctors.Results Totally 347 family doctors in Pudong New Area of Shanghai suffered from serious job burnout.Among the three dimensions of emotional fatigue,job apaism and no sense of work achievement,the proportions of serious job burnout were the highest,and the proportion of no sense of work achievement was the highest at 62.5%.Theχ^(2)test and logistic regression analysis showed that region,working years of family doctors,overtime,salary and welfare satisfaction,and working hours per week involved in epidemic were the influential factors for severe burnout of family doctors in terms of emotional fatigue(all P<0.05).The region,marriage,professional title,salary and welfare satisfaction and weekly working hours involved in epidemic situation were the influencing factors for severe burnout of family doctors in terms of job apaism(all P<0.05).The region,educational background,path of becoming a general practitioner and salary and welfare satisfaction were the influencing factors for severe burnout of family doctors with no sense of job achievement(all P<0.05).Conclusions The incidence of job burnout among family doctors in Pudong New Area of Shanghai is high,among which,the most prominent one is no sense of job accomplishment.There are many factors affecting family doctors'burnout,and it is suggested that improvement strategies should be given according to the characteristics of different regions and populations,and the working time should be reasonably arranged through teamwork and optimization of the epidemic prevention and control process,family doctors'remunerationshould be improved and a perfect incentive system should be established,and emphasis should be placed on family doctors'system construction and career planning,so as to alleviate family doctors'burnout,stabilize the family doctors'team,and better promote family doctor work.