The mental health of primary care physicians in Rhineland-Palatinate, Germany: the prevalence of problems and identification of possible risk factors

Bedürfnisorientierte Arbeitswelten im Krankenhaus: Entwicklung und Akzeptanz des HEMI-Architekturkonzepts

Dieser Beitrag in der Zeitschrift Gruppe. Interaktion. Organisation (GIO), Themenheft New Work – Inspirierende, kooperationsfördernde Arbeitsumgebungen beschreibt die Entwicklung und wissenschaftliche Prüfung eines Architekturkonzepts zur evidenzbasierten Gestaltung innovativer und bedürfnisorientierter Arbeitswelten im Krankenhaus. Das Konzept basiert auf einer berufsunabhängigen Neubewertung der Krankenhausumgebung und definiert fünf Umgebungskategorien und architektonische Qualitäten: (H) hands on/off (Arbeiten mit oder ohne direktem Patientenkontakt), (E) eyes on/off (Arbeiten mit oder ohne indirektem Patientenkontakt), (M) mind on (konzentrierte Arbeiten), mind off (Entspannung und Regeneration) und (I) interact on/off (Arbeiten mit oder ohne Kontakt zu Kollegen). Die Kategorien lassen Rückschlüsse auf den psycho-emotionalen Stress und die kognitive Beanspruchung der Mitarbeitenden zu und bestimmen die auf diese reagierende architektonische Gestaltung. Im Unterschied zum bisherigen deutschen Krankenhausentwurf durchbricht das (HEMI) Architekturkonzept veraltete Organisationsstrukturen, geht architekturpsychologisch auf die steigende Belastung der Mitarbeitenden ein und formuliert räumliche Lösungen. Die Akzeptanz der zentralen Arbeitswelt, die das Konzept u. a. vorsieht und die in einer bundesweiten Befragung an Klinikärztinnen und -ärzten durchgeführt wurde, ist hoch und abhängig von Alter‑, Einkommen und Dienstjahren.

Heart rate variability as a strain indicator for psychological stress for emergency physicians during work and alert intervention: a systematic review

Background

The workloads of emergency physicians are severe. The prevalence of burnout among emergency physicians is higher than with other physicians or compared to the general population. The analysis of heart rate variability (HRV) is a valid method for objective monitoring of workload. The aim of this paper is to systematically evaluate the literature on heart rate variability as an objective indicator for mental stress of emergency physicians.

Methods

A systematic literature review examining heart rate variability of emergency physicians in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reporting systematic reviews was performed. PubMed, Ovid, Cochrane Libary, Scopus, and Web of Science electronic databases were used. The methodological quality was evaluated by using a modified STARD for HRV.

Results

Two studies matched the inclusion criteria by using HRV between alert intervention and two other studies were considered that used HRV in other question areas. It showed an adaptation of HRV under stress. The studies were not comparable.

Conclusions

There is a need for occupational health studies that examine strains and stress of emergency physicians. The well-established parasympathetic mediated HRV parameters seem to be suitable parameters to objectify the stress.

Are German family practitioners and psychiatrists sufficiently trained to diagnose and treat patients with alcohol problems?

Background

Harmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol consumption, and about 1.8 million adults in Germany (18–64 years) are classified as alcohol dependent. A treatment rate of 9% of all alcohol dependent patients in Germany implies a lack of supply and misuse of medical care. The aim of the study was to examine whether family practitioners (FPs) and psychiatrists have sufficient skills to diagnose and treat patients with alcohol problems.

Methods

A total of 6324 FPs and psychiatrists in the states of Saxony and Rhineland-Palatinate in Germany were invited to participate in this survey. Nine hundred seventy-four participants (90.3%/FPs) could be included in the statistical analysis (response rate: 14.3%/FPs, 21.6%/psychiatrists). Data was analysed descriptively and logistical regressions were used to identify predictors for physicians’ ability to feel adequately trained to diagnose and treat patients with alcohol problems.

Results

In comparison to psychiatrists, less FPs reported feeling sufficiently trained to counsel patients with alcohol problems (81.5% vs. 44.8%). Regression analysis revealed that FPs who felt not adequately trained had less experience with patients with alcohol dependence (OR 7.4), had attended fewer hours on alcohol addiction in continuing medical education (OR 4.8), and were more likely to be female (OR 1.9). A minimum of 10 h of training was associated with improved self-assessed competence.

Conclusion

Harmful drinking is a serious public health problem, and patients with alcohol dependence represent a large and demanding patient group in primary health care setting. Our study shows that the lack of training is a severe barrier in the work with this patient group in the primary care setting.

Examining self-reported and biological stress and near misses among Emergency Medicine residents: a single-centre cross-sectional assessment in the USA

OBJECTIVES

To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents.

DESIGN

Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses.

SETTING

The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA.

PARTICIPANTS

Residents in Emergency Medicine volunteered to participate. The sample consisted of 32 residents, with complete data on 28 subjects. Residents' supervising physicians assessed the clinical performance of each resident.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants' preshift and postshift stress, biological stress (salivary cortisol, plasma interleukin-6, tumour necrosis factor-alpha (TNF-α) and high-sensitivity C-reactive protein), residents' and supervisors' reports of near misses, number of critically ill and patients with trauma seen during the shift.

RESULTS

Residents' self-reported stress increased from an average preshift level of 2.79 of 10 (SD 1.81) to a postshift level of 5.82 (2.13) (p<0.001). Residents cared for an average of 2.32 (1.52) critically ill patients and 0.68 (1.06) patients with trauma. Residents reported a total of 7 near misses, compared with 11 reported by the supervising physicians. After controlling for baseline work-related exhaustion, residents that cared for more patients with trauma and had higher levels of TNF-α reported a higher frequency of near misses (R²=0.72; p=0.001). Residents' preshift ratings of how stressful they expected the shift to be were related to the supervising physicians' ratings of residents' near misses during the shift.

CONCLUSION

Residents' own ratings of near misses were associated with residents' TNF-α, a biomarker of systemic inflammation and the number of patients with trauma seen during the shift. In contrast, supervisor reports on residents' near misses were related only to the residents' preshift expectations of how stressful the shift would be.

[Subjective job strain and job satisfaction among neurologists in German hospitals]

BACKGROUND

The number of sick leaves due to job strain is increasing.

OBJECTIVE

This study's scope is to examine working conditions of neurologists in hospitals in regard to job strain and job satisfaction.

METHODS

This study is part of the iCEPT-Study. The iCEPT-Study was conducted as a web based survey among physicians (n = 7090) in German hospitals. The focus was on working conditions regarding job strain. Job strain was measured by a questionnaire consisting of items and scales from the short version of the Effort-Reward-Imbalance (ERI) questionnaire and the short questionnaire for working analysis (KFZA). By calculation ratios of distinct scales according to validated stress models a conclusion could be drawn as to whether or not job strain was present.

RESULTS

The total number of n = 354 neurologists were analyzed. The response rate was at 18.2 %. Job strain was encountered by 52.0 % (95 %-KI: 46.7|57.2) of all neurologists and no significant gender difference was present. However, resident neurologists were significantly more often exposed to job strain than attending neurologists (OR = 2.9; 95 %-KI: 1.6-4.7; p < 0.001). Regarding job satisfaction, 59.6 % (95 %-KI: 54.5-64.7) of all respondents stated to be satisfied with their job. Significantly more men were satisfied than women (OR = 1.5; 95 %-KI: 1.0-2.4; p < 0.05). Putting the focus on different occupational positions revealed that significantly more attendings were satisfied with their job than residents (OR = 2.9; 95 %-KI: 1.7-4.8; p < 0.001).

CONCLUSION

The results of this study showed high prevalence of job strain among neurologists in German hospitals. Keeping the negative implications of mental and physical health in mind, the working conditions of neurologists must be improved. As shown in this study, a possible way to do so is to increase job control in order to decrease a major stressor at work.

Factors influencing the suicide intervention skills of emergency medical services providers

BACKGROUND

Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide.

AIMS

To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics).

METHOD

Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout.

RESULTS

Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers' ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills.

CONCLUSIONS

In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention.

ABBREVIATIONS

EMS: Emergency medical services; SIRI: Suicide intervention response inventory.

Aggression and violence against primary care physicians—a nationwide questionnaire survey

BACKGROUND

International studies show that aggressive behavior against primary care physicians is not an uncommon occurrence. There has been no systematic study to date of the nature and frequency of such occurrences in Germany.

METHODS

A four-page questionnaire was sent to a nationwide random sample of 1500 primary care physicians. It contained questions about the type, frequency, severity, and site of aggressive behavior against the physician.

RESULTS

831 (59%) of 1408 correctly delivered questionnaires could be included in the analysis. 91% of the respondents (95% confidence interval [CI], 89%-93%) said they had been the object of aggressive behavior at some time in their career as a primary care physician, 73% (95% CI, 70%-76%) in the previous 12 months. Severe aggression or violence had been experienced by 23% (95% CI, 20%-25%) in their entire career and 11% (95% CI, 8%-13%) in the previous year. The vast majority of respondents said they felt safe in their offices. 66% of female and 34% of male respondents said they did not feel safe making house visits while on on-call duty.

CONCLUSION

The frequency and extent of aggression and violence against primary care physicians in Germany is comparable to those reported by international studies. Strategies for dealing with this problem should be developed. In particular, the issue of safety on emergency call needs to be addressed.

Hospital physicians' work stressors in different medical specialities: a statistical group comparison

Background

Some studies on the occupational health of hospital physicians have found that working conditions have different effects on physician’s well-being and health in different medical specialities. There has been no comparative study of the effects of various work stressors in different specialities. This study aims to close this gap.

Methods

German hospital physicians were asked about their working conditions and aspects of health. The short version of the Instrument for Stress-Related Job Analysis for Hospital Physicians was used to measure working conditions. Irritation and emotional exhaustion were used to assess health. Physicians were also asked for socio-demographic aspects, including their medical speciality.

Results

Data from 763 hospital physicians were included in the analyses. Significant differences between medical specialities were demonstrated for time pressure, uncertainty, frustration about how work needs to be done and social stressors with patients. Physicians in internal medicine showed consistently high levels of stressors. Time pressure, frustration about how work needs to be done, and emotional dissonance were found to be significantly related to both aspects of health.

Conclusions

The results showed that some medical specialities are more affected by specific stressors. It is therefore discussed how improvements can be implemented. Furthermore, it is illustrated which stressors are especially relevant for health. These relationships to health should be investigated in further research and in longitudinal designs to allow hints of causal relationships.

Squeezing blood from a stone: how income inequality affects the health of the American workforce

Income inequality is very topical-in both political and economic circles-but although income and socioeconomic status are known determinants of health status, income inequality has garnered scant attention with respect to the health of US workers. By several measures, income inequality in the United States has risen since 1960. In addition to pressures from an increasingly competitive labor market, with cash wages losing out to benefits, workers face pressures from changes in work organization. We explored these factors and the mounting evidence of income inequality as a contributing factor to poorer health for the workforce. Although political differences may divide the policy approaches undertaken, addressing income inequality is likely to improve the overall social and health conditions for those affected.

The mental health of primary care physicians in Rhineland-Palatinate, Germany: the prevalence of problems and identification of possible risk factors

BACKGROUND

The generally high job-related stress level among physicians may lead to various health impairments in the long run. Apart from job-related stress, stress during leisure time and certain personality traits might be risk factors for health impairments. However, very little research on the health situation of primary care physicians (PCPs) in Germany is available. Therefore, the objective of the present study was to systematically assess the stress experience and the health situation of German PCPs. One main focus was on mental health.

METHODS

In 2009, a state-wide survey among practice-based PCPs in the federal German state of Rhineland-Palatinate (cross-sectional study, n = 2092) was carried out in order to assess stress and strain as well as the health situation.

RESULTS

790 participants (37.7%) were eligible for the analyses. One in four PCPs exceeded the cut-off value ≥ 3 for depression in the PHQ-2 (PHQ, Patient Health Questionaire). Moreover, approximately one in six PCPs stated that he or she had used psychotropic drugs or other psychoactive substances at least once in the preceding year. Stress during leisure time, type D personality and low job satisfaction were associated with the presence of mental health impairments in the binary logistic regression analyses.

CONCLUSION

All in all, it appears that mental health impairments are a common health problem among the PCPs. Target-group-specific measures should be taken in order to reduce the subjective stress level, and to foster mental hygiene. Furthermore, the development of favorable personality profiles and the corresponding behavioral patterns should be supported.