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Nau LM, Laux G, Altiner A, Szecsenyi J, Leutgeb R. The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study. JMIR Res Protoc 2024; 13:e54002. [PMID: 38598281 PMCID: PMC11043931 DOI: 10.2196/54002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non-life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate. OBJECTIVE The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics' assessment of alternative treatment options or alternative methods of rescue transportation. METHODS This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis. RESULTS Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients' reasons for calling a rescue coordination center. CONCLUSIONS To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics' assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances. TRIAL REGISTRATION German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54002.
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Affiliation(s)
- Lara Maria Nau
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
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Küppers L, Göbel J, Aretz B, Rieger MA, Weltermann B. Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study. Healthcare (Basel) 2024; 12:479. [PMID: 38391854 PMCID: PMC10888352 DOI: 10.3390/healthcare12040479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel. METHODS This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods. RESULTS Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation. CONCLUSION In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.
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Affiliation(s)
- Lucas Küppers
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian Göbel
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Benjamin Aretz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Voltmer E, Rosta J, Köslich-Strumann S, Goetz K. Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study. PLoS One 2024; 19:e0296703. [PMID: 38181025 PMCID: PMC10769063 DOI: 10.1371/journal.pone.0296703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Physicians' health and wellbeing are important albeit often neglected quality indicators of health care systems. The aims of the study were to compare job satisfaction and work stress among doctors in Germany and Norway, and to identify predictors for job satisfaction. METHODS All active physicians in Schleswig-Holstein, Germany (N = 13,304) and a nationwide sample of Norwegian physicians (N = 2,316) were surveyed in a cross-sectional design in 2021. Response rates of German and Norwegian physicians were n = 4,385 (33%) and n = 1,639 (70.8%), respectively. In addition to age, sex, and work-hours, the main outcome measures were the validated Job Satisfaction Scale (JSS) and the short form of the Effort-Reward Imbalance Questionnaire (ERI). RESULTS There were significant differences between Norwegian and German physicians in job satisfaction but with small effect sizes. All effort scores of German physicians were significantly higher and four of seven reward scores significantly lower than for their Norwegian colleagues. The proportion of German physicians in the state of a gratification crisis was significantly higher (67%) than in their Norwegian colleagues (53%). In both countries, physicians with a gratification crisis scored significantly lower on all items of job satisfaction. There were only minor gender differences in job satisfaction and effort-reward balance. Age, effort, and reward accounted for 46% of the explained variance of job satisfaction. CONCLUSIONS Lower job satisfaction and reward in some areas and higher perceived effort of physicians in Germany than in Norway are still in favor of Norwegian working conditions, but the differences seem to diminish. The high proportions of gratification crises in both countries warrants appropriate measures for prevention and health promotion.
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Affiliation(s)
- Edgar Voltmer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
| | | | - Katja Goetz
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Lübeck, Germany
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El Mouaddib H, Sebbani M, Mansouri A, Adarmouch L, Amine M. Job satisfaction of primary healthcare professionals (public sector): A cross-sectional study in Morocco. Heliyon 2023; 9:e20357. [PMID: 37809365 PMCID: PMC10560041 DOI: 10.1016/j.heliyon.2023.e20357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Healthcare professionals (HCPs) are indispensable for improving the availability and quality of healthcare services. Therefore, the present cross-sectional study aimed to measure the job satisfaction of HCPs working in primary care (PC) centers in Marrakech, according to the job satisfaction scale. Using census sampling, this study involved HCPs working in PC centers. Data were collected using an electronic questionnaire and analyzes were performed using Jamovi (version 1.6). The Warr-Cook-Wall scale was used to assess the satisfaction of these professionals. Student's t-test, Kruskal-Wallis test and Mann-Whitney non-parametric tests were used for group comparisons (p < 0.05). The lowest satisfaction scores were recorded for general practitioners (GPs) and nurses. These were work safety (1.54 ± 0.85 vs. 1.51 ± 0.82), salary (1.58 ± 0.79 vs. 1.72 ± 0.87), chance of promotion (1.68 ± 0.87 vs. 1.80 ± 0.93), possibility of using its capacities (1.90 ± 1.04 vs. 2.01 ± 1.08), and workload (1.88 ± 1.10 vs. 2.05 ± 1.06). A statistically significant difference was observed between different professional statuses regarding facility management (p = 0.049). The overall job satisfaction of HCPs was low, especially among GPs and nurses: the scores for intrinsic job satisfaction with respect to sociodemographic characteristics were low, whereas they were medium for extrinsic job satisfaction. Further research is warranted to clarify the intrinsic and extrinsic factors of job satisfaction in Morocco's healthcare sector.
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Affiliation(s)
- Hicham El Mouaddib
- Bioscience & Health Laboratory, BHL, Cadi Ayyad University, 40000, Marrakesh, Morocco
| | - Majda Sebbani
- Bioscience & Health Laboratory, BHL, Cadi Ayyad University, 40000, Marrakesh, Morocco
- Clinical Research Unit, Mohammed VI University Hospital, 40000, Marrakesh, Morocco
- Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Sidi Abbad, 40000, Marrakesh, Morocco
- Unit of Development and Research in Medical Education, Geneva University, Switzerland
| | - Adil Mansouri
- Clinical Research Unit, Mohammed VI University Hospital, 40000, Marrakesh, Morocco
- Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Sidi Abbad, 40000, Marrakesh, Morocco
| | - Latifa Adarmouch
- Bioscience & Health Laboratory, BHL, Cadi Ayyad University, 40000, Marrakesh, Morocco
- Clinical Research Unit, Mohammed VI University Hospital, 40000, Marrakesh, Morocco
- Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Sidi Abbad, 40000, Marrakesh, Morocco
| | - Mohamed Amine
- Bioscience & Health Laboratory, BHL, Cadi Ayyad University, 40000, Marrakesh, Morocco
- Clinical Research Unit, Mohammed VI University Hospital, 40000, Marrakesh, Morocco
- Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Sidi Abbad, 40000, Marrakesh, Morocco
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Noack EM, Zajontz D, Friede T, Antweiler K, Hummers E, Schmidt T, Roddewig L, Schröder D, Müller F. Evaluating an app for digital medical history taking in urgent care practices: study protocol of the cluster-randomized interventional trial 'DASI'. BMC PRIMARY CARE 2023; 24:108. [PMID: 37106447 PMCID: PMC10133907 DOI: 10.1186/s12875-023-02065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND In out-of-hours urgent care practices in Germany, physicians of different specialties care for a large number of patients, most of all unknown to them, resulting in a high workload and challenging diagnostic decision-making. As there is no common patient file, physicians have no information about patients' previous conditions or received treatments. In this setting, a digital tool for medical history taking could improve the quality of medical care. This study aims to implement and evaluate a software application (app) that takes a structured symptom-oriented medical history from patients in urgent care settings. METHODS We conduct a time-cluster-randomized trial in two out-of-hours urgent care practices in Germany for 12 consecutive months. Each week during the study defines a cluster. We will compare participants with (intervention group) and without app use (control group) prior to consultation and provision of the self-reported information for the physician. We expect the app to improve diagnostic accuracy (primary outcome), reduce physicians' perceived diagnostic uncertainty, and increase patients' satisfaction and the satisfaction with communication of both physician and patient (secondary outcomes). DISCUSSION While similar tools have only been subject to small-scale pilot studies surveying feasibility and usability, the present study uses a rigorous study design to measure outcomes that are directly associated with the quality of delivered care. TRIAL REGISTRATION The study was registered at the German Clinical Trials Register (No. DRKS00026659 registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659.
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Affiliation(s)
- Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Dagmar Zajontz
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany
| | - Kai Antweiler
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Tobias Schmidt
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Performance, Neuroscience, Therapy and Health, MSH Medical School Hamburg, Kaiserkai 1, 20457, Hamburg, Germany
| | - Lea Roddewig
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Occupational stress and associated factors among general practitioners in China: a national cross-sectional study. BMC Public Health 2022; 22:1061. [PMID: 35624478 PMCID: PMC9145167 DOI: 10.1186/s12889-022-13484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occupational stress among general practitioners (GPs) is a public health concern. This study aimed to investigate the prevalence and factors associated with occupational stress among GPs in China. METHODS A cross-sectional design was used. Data were collected from 3,236 GPs in eastern, central, and western China (response rate, 99.75%) between October 2017 and February 2018 using a structured self-administered questionnaire. An ordinal logistic regression model was used to identify the factors associated with occupational stress among GPs. RESULTS Among these respondents, 313 (9.67%), 1,028 (31.77%), and 1,895 (58.56%) of GPs had a low, medium, and high level of occupational stress, respectively. GPs from central China, with temporary work contracts, without management responsibility, receiving a moderate level of income, and with moderate occupational development opportunities had a lower level of occupational stress. GPs with greater than 40 working hours per week and those who worked overtime occasionally or frequently had a higher level of occupational stress. CONCLUSIONS The prevalence of occupational stress among GPs is high in China. Substantial regional variation in determinants of occupational stress among GPs was observed. These findings should inform the design of policies to reduce the occupational stress of GPs.
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7
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Meta-analysis of effort–reward imbalance prevalence among physicians. Int Arch Occup Environ Health 2022; 95:559-571. [DOI: 10.1007/s00420-021-01784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022]
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Morgan T, Tapley A, Davey A, Holliday E, Fielding A, van Driel M, Ball J, Spike N, FitzGerald K, Morgan S, Magin P. Influence of rurality on general practitioner registrars' participation in their practice's after-hours roster: A cross-sectional study. Aust J Rural Health 2022; 30:343-351. [PMID: 35196416 PMCID: PMC9305465 DOI: 10.1111/ajr.12850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate whether practice rurality and rural training pathway are associated with general practitioner registrars' participation in their practice's after‐hours care roster. Design A cross‐sectional analysis of data (2017‐2019) from the Registrar Clinical Encounters in Training study, an ongoing inception cohort study of Australian general practitioner registrars. The principal analyses used logistic regression. Setting Three national general practitioner regional training organisations across 3 Australian states. Participants General practitioner registrars in training within regional training organisations. Main outcome measure Involvement in practice after‐hours care was indicated by a dichotomous response on a 6‐monthly Registrar Clinical Encounters in Training study questionnaire item. Results 1576 registrars provided 3158 observations (response rate 90.3%). Of these, 1574 (48.6% [95% confidence interval: 46.8‐50.3]) involved registrars contributing to their practice's after‐hours roster. In major cities, 40% of registrar terms involved contribution to their practice's after‐hours roster; in regional and remote practices, 62% contributed to the after‐hours roster. On multivariable analysis, both level of rurality of practice (odds ratio(OR) 1.75, P = .007; and OR 1.74, P = .026 for inner regional and outer regional/remote locations, respectively, versus major city) and rural training pathway of registrar (OR 1.65, P = .008) were significantly associated with more after‐hours roster contribution. Other associations were registrars' later training stage, larger practices and practices not routinely bulk billing. Significant regional variability in after‐hours care was identified (after adjusting for rurality). Conclusion These findings suggest that registrars working rurally and those training on the rural pathway are more often participating in practice after‐hours rosters. This has workforce implications, and implications for the educational richness of registrars' training environment.
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Affiliation(s)
- Tobias Morgan
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia.,Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia
| | - Kristen FitzGerald
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,General Practice Training Tasmania, Regional Training Organisation, Hobart, Tasmania, Australia
| | - Simon Morgan
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Mayfield West, New South Wales, Australia.,Elermore Vale General Practice, Elermore Vale, New South Wales, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Mayfield West, New South Wales, Australia
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Werdecker L, Esch T. Burnout, satisfaction and happiness among German general practitioners (GPs): A cross-sectional survey on health resources and stressors. PLoS One 2021; 16:e0253447. [PMID: 34143849 PMCID: PMC8213182 DOI: 10.1371/journal.pone.0253447] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/02/2021] [Indexed: 12/21/2022] Open
Abstract
Well-being is a major issue among health care professionals, especially physicians. Less job satisfaction and impaired health can have an impact on health care quality. Our aim was to examine the association of stressors (illegitimate tasks) and health related resources (work-related sense of coherence; recovery experience) with life satisfaction, happiness, job satisfaction and burnout among German general practitioners (GPs). We conducted a cross-sectional survey among general medical practices in Germany. Main outcome measures were life satisfaction, happiness (Subjective Happiness Scale), job satisfaction (Work Satisfaction Scale) and burnout (Copenhagen Burnout Inventory). 548 GPs from across Germany participated (53.6% males, 45.6% females; mostly representative of German GPs). One third (35.2%) of the participants reported a high prevalence of personal, and one quarter (26.5%) indicated a high prevalence of work-related burnout symptoms. Illegitimate tasks are negatively associated with life and job satisfaction and are positively associated with personal, work-related and patient-related burnout among GPs. Work-SoC and recovery experience are positively associated with life satisfaction, happiness, and job satisfaction and are negatively associated with personal, work-related and patient-related burnout. Female physicians have a higher job satisfaction than male physicians. Being female and working as an employed physician is associated with a higher prevalence of personal burnout symptoms. GPs working in a group practice are happier and more satisfied with their job than GPs in single practices. Personal, work-related and patient-related burnout symptoms are stronger in GPs working in a single practice than in GPs in group practices. Our results highlight that Work-SoC, recovery experience and illegitimate tasks are important for creating work-related well-being among GPs. Introducing health promotion activities which aim to strengthen recovery experience and Work-SoC, as well as interventions to restructure tasks, may increase life satisfaction, happiness, and job satisfaction and reduce burnout symptoms in this health care profession.
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Affiliation(s)
- Lena Werdecker
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- * E-mail:
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Zhang T, Feng J, Jiang H, Shen X, Pu B, Gan Y. Association of professional identity, job satisfaction and burnout with turnover intention among general practitioners in China: evidence from a national survey. BMC Health Serv Res 2021; 21:382. [PMID: 33902579 PMCID: PMC8074426 DOI: 10.1186/s12913-021-06322-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background The complex interrelationships between professional identity, job satisfaction, burnout, and turnover intention among general practitioners (GPs) are insufficiently understood in China. This study aimed to investigate the interrelationships between professional identity, job satisfaction, burnout, and turnover intention in China, and to examine whether job satisfaction and burnout played mediating roles between professional identity and turnover intention. Methods A cross-sectional survey was conducted between October, 2017 and February, 2018 in China. The participants were selected using a multistage stratified random sampling method. Data were collected with a self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China. Professional identity was measured by the 13 items scale, and job satisfaction scale with an 11-item designed by Shi et al. was employed. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey, and turnover intention was measured with a 6 items scale. Descriptive statistics were calculated and groups’ differences were estimated Student’s t-test and analyses of variance. Pearson’s correlation analysis was used to assess the degree of correlation among different dimensions of professional identity, job satisfaction, burnout, and turnover intention. Structural equation modeling analysis was applied to examine the interrelationships among these study variables based on the hypothesized model. Results The proposed model achieved a good model fit. Job satisfaction had a direct negative effect on turnover intention (β = − 0.38, P < 0.001), burnout had a direct positive effect on turnover intention (β = 0.37, P < 0.001), and professional identity had an indirect negative effect on turnover intention through the mediating effect of job satisfaction and burnout. Conclusions Our study elucidated the pathways linking professional identity, job satisfaction, and burnout to turnover intention of GPs. This revealed that turnover intention was significantly affected by job satisfaction and burnout, and the effects of professional identity on turnover intention can be mediated by job satisfaction and burnout. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06322-6.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Social Medicine and Health Service Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Bo Pu
- School of Business and Tourism, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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Steeman L, Uijen M, Plat E, Huibers L, Smits M, Giesen P. Out-of-hours primary care in 26 European countries: an overview of organizational models. Fam Pract 2020; 37:744-750. [PMID: 32597962 PMCID: PMC7699311 DOI: 10.1093/fampra/cmaa064] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Various models exist to organize out-of-hours primary care (OOH-PC). We aimed to provide an up-to-date overview of prevailing organizational models in the European Union (EU), implemented changes over the last decade and future plans. This baseline overview may provide information for countries considering remodelling their OOH-PC system. METHODS A cross-sectional web-based questionnaire among 93 key informants from EU countries, Norway and Switzerland. Key informants with expertise in the field of primary health care were invited to participate. Themes in the questionnaire were the existing organizational models for OOH-PC, model characteristics, major organizational changes implemented in the past decade and future plans. RESULTS All 26 included countries had different coexisting OOH-PC models, varying from 3 to 10 models per country. 'GP cooperative was the dominant model in most countries followed by primary care centre and rota group'. There was a large variation in characteristics between the models, but also within the models, caused by differences between countries and regions. Almost all countries had implemented changes over the past 10 years, mostly concerning the implementation of telephone triage and a change of organizational model by means of upscaling and centralization of OOH-PC. Planned changes varied from fine-tuning the prevailing OOH-PC system to radical nationwide organizational transitions in OOH-PC. CONCLUSIONS Different organizational models for OOH-PC exist on international and national level. Compared with a decade ago, more primary care-oriented organizational models are now dominant. There is a trend towards upscaling and centralization; it should be evaluated whether this improves the quality of health care.
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Affiliation(s)
- Luca Steeman
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Maike Uijen
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Erik Plat
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Linda Huibers
- Research Unit for General Practice Aarhus, University of Aarhus, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Paul Giesen
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Mosler T, Flägel K, Steinhäuser J. [Reasons for Encounter in Out-of-Hours Care in Emergency Departments and Emergency Practices - A Mixed Methods Trial]. DAS GESUNDHEITSWESEN 2020; 83:432-442. [PMID: 33096581 DOI: 10.1055/a-1236-3570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Since 2006, with the opening of emergency practices (EP) in Germany, out-of-hours patient care has been carried out by general practitioners. Additionally, emergency departments (ED) of the hospitals ensure acute care. Thus, optimal coordination of care is a much discussed subject. The aim of this study was to provide reasons for encounter and subjective reasons to visit each of these institutions. METHODS In a mixed method trial, patients with non-urgent conditions (Manchester Triage System level 4 and 5) were interviewed in 2 ED in Schleswig-Holstein and 2 EP in Baden-Württemberg regarding their reasons for encounter from July 2015 to August 2016 during the out of hours primary care practices. Data collection was carried out using a paper-based questionnaire and a semi-structured interview. The statistical program SPSS was used for descriptive analysis, text data analysis was carried out with the method of qualitative content analysis. RESULTS In total, 398 patients were interviewed. Most frequently, reasons for encounter in ED and EP were related to musculoskeletal complaints (39%, n=116 and 23%, n=23, respectively). Within technical examination services, the laboratory diagnostics were used as a priority in ED (59%, n=175). In the EP, one patient (2%) underwent laboratory diagnostics. The main reasons for encounter in both facilities were increasing complaints (50%, n=147 in ED; 70%, n=70 in EP) and a desire for quick diagnosis (73%, n=217 in ED; 48%, n=48 in EP). In total, 112 patients (28%) had a medication plan, and 67 (60%) brought it into the facility. Two-thirds of ED patients (n=197) were handed over to outpatient care. In EP, 89% (n=89) continued as outpatient. Qualitative content analysis revealed similar complaint categories in both facilities, but with significant differences in the severity and experienced urgency. In both facilities, patients expected to have their symptoms clarified. In ED, the desire for a rapid and specific diagnosis was expressed more frequently. CONCLUSION Indications for medical treatment were seen in most consultations in both care facilities. There was a distinction between the ED and EP in the urgency of the consultations.
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Li L, Gan Y, Yang Y, Jiang H, Lu K, Zhou X, Nie Z, Opoku S, Zheng Y, Yu F, Lu Z. Analysis on professional identity and related factors among Chinese general practitioners: a National Cross-sectional Study. BMC FAMILY PRACTICE 2020; 21:80. [PMID: 32375674 PMCID: PMC7201728 DOI: 10.1186/s12875-020-01155-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs' perceptions of their professional identity. METHODS A multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups' differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs. RESULTS Based on a total score of 65 on the professional identity scale, the average score for GPs' professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity. CONCLUSIONS Professional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.
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Affiliation(s)
- Liqing Li
- Department of Management Science and Engineering, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China.,Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yudi Yang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kai Lu
- Office of Student Affairs, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaogang Zhou
- School of Economics and Management, East China JiaoTong University, Nanchang, Jiangxi, China
| | - Zhiqiang Nie
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Sampson Opoku
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yanling Zheng
- Shouyilu Street Community Health Service Center of Wuchang District, Wuhan, Hubei, China
| | - Fang Yu
- Shouyilu Street Community Health Service Center of Wuchang District, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.
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Leutgeb R, Berger S, Szecsenyi J, Laux G. Patients with somatoform disorders: More frequent attendance and higher utilization in primary Out-of-Hours care? PLoS One 2018; 13:e0202546. [PMID: 30161150 PMCID: PMC6116940 DOI: 10.1371/journal.pone.0202546] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/05/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND One significant health policy challenge in many European countries at present is developing strategies to deal with the increase in patient attendance at Out-of-Hours care (OOHC), whether this is at OOHC-Centres in primary care settings or hospital emergency departments (ED). FAs (FAs) presenting in OOHC are a known challenge and previous studies have shown that FAs present more often with psychological problems and psychiatric comorbidities rather than severe physical complaints. FAs may be also contributing to the rising workload in OOHC-Centres in primary care. The aim of this study was to determine attendance frequencies and health problem presentation patterns for patients with and without somatoform disorders (ICD-10 F45 diagnoses) in OOHC-Centres in primary care. Some of these somatoform disorders may have a psychiatric character. Moreover, we wanted to compare health care utilization patterns (pharmacotherapy and hospitalizations) between these patients groups. METHODS Routine OOHC data from a large German statutory health insurance company in the federal state of Baden-Wuerttemberg were evaluated. 3,813,398 health insured persons were included in the data set from 2014. The data were initially made available for our study group in order to evaluate a comprehensive evaluation programme in German primary care, the "Hausarztzentrierte Versorgung" (HZV), loosely translated as "family doctor coordinated care". We used the ICD-10 codes F45.0-F45.9 in regular care to identify patients with somatoform disorders and compared their health care utilization patterns (attendance rates, diagnoses, prescriptions, hospitalization rates) in OOHC to patients without somatoform disorders. Attendance rates were calculated with multivariable regression models in order to adjust for age, gender, comorbidities and for participation in the HZV intervention. RESULTS 350,528 patients (9.2%) of the 3,813,398 insured persons had an F45-diagnosis. In comparison with the whole study-sample, patients with an F45-diagnosis were on average seven years older (51.7 vs. 44.0 years; p<0,0001) and the percentage of women was significantly higher (70.1% vs 53.3%; p<0,0001). In OOHC, as opposed to normal office hours, the adjusted rate of patients with an F45-diagnosis was 60.6% higher (adjusted for age, gender and co-morbidity) than in the general study-sample. Accordingly, in OOHC, prescriptions for antidepressants, hypnotics, anxiolytics but also opioids were significantly higher than in the general study population i.e. those without F45- diagnoses. However, an F45 diagnosis was only made in 3.45% of all F45 patients seen in OOHC in 2014. CONCLUSIONS Patients with somatoform disorders were more FAs in both regular office hours and in OOHC in primary care settings. In OOHC, they are normally not identified as such because the somatoform illness is secondary to other acutely presenting symptoms such as pain. While it is acknowledged that it is difficult to make an exact diagnosis in this complex group of somatoform disorders in an OOHC setting, it is still important to develop continuing education programmes for medical staff working in OOHC, to support effective recognition and response to the specific needs of this complex patient group.
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Affiliation(s)
- Ruediger Leutgeb
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
- * E-mail:
| | - Sarah Berger
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Joachim Szecsenyi
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Gunter Laux
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
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