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Association Between Physicians' Workload and Prescribing Quality in One Tertiary Hospital in China
Xiaodong Guan, Bingyu Ni1, Jingyuan Zhang1
1From the Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences.
Insights
Higher physician workload is linked to increased inappropriate prescribing. This study highlights the need to manage physician workload to ensure high-quality medication use and patient safety in China.
Area of Science:
- Medical Informatics
- Clinical Pharmacy
- Healthcare Management
Background:
- Physician workload is increasing globally, potentially impacting patient care quality.
- Previous research identified prescribing error factors but lacked China-specific data on workload's impact.
- This study addresses the gap by examining physician workload and prescription appropriateness in a Chinese tertiary hospital.
Purpose of the Study:
- To investigate the association between physician workload and prescription quality.
- To identify factors influencing inappropriate prescribing in relation to workload.
Main Methods:
- Retrospective analysis of 457,784 outpatient prescriptions from a Beijing tertiary hospital (July-November 2015).
- Physician workload measured by outpatient volume per 5-hour shift.
- Prescribing quality assessed using the Rational Drug Use System; generalized linear models used for analysis.
Main Results:
- A significant positive correlation was found between heavier physician workload and higher rates of inappropriate prescribing (P < 0.001).
- Factors associated with increased inappropriate prescribing under higher workload included afternoon shifts, chief physician status, surgical departments, male gender, and >20 years of experience.
Conclusions:
- Heavier physician workload directly increases the risk of inappropriate prescribing.
- Optimizing physician workloads is crucial to mitigate adverse effects on prescription quality and enhance patient safety.
Background:
Alarming increasing trends in physician workload have attracted much attention in recent years. Heavy workload may compromise the quality of medication use. Previous studies have identified a series of factors contributing to inappropriate prescribing; however, there is no demonstrated evidence supporting an association between workload and the appropriateness of physicians' prescriptions in China. This study aimed to investigate the relationship between physician workload and prescription quality in a tertiary hospital in Beijing, China.
Methods:
Our study was a single-center, retrospective study, with all outpatient electronic health records extracted from hospital information system of a tertiary hospital in Beijing from July 1 to November 30, 2015. We used outpatient volume in each 5-hour shift as the measure of physician workload. The evaluation of prescribing quality was based on the Rational Drug Use System. Generalized linear models with a γ distribution and a log link were used to explore factors associated with inappropriate prescribing, and we undertook a series of robustness tests with respect to different exclusion criteria.
Results:
A total of 457,784 prescriptions from 502 physicians were included in the study. Physicians had an average workload of 34.3 (±19.8) patients per shift, and the mean rate of inappropriate prescribing per shift was 14.1% (±14.6%). Higher rates of inappropriate prescribing were associated with heavier workloads (P < 0.001). Physicians who worked in the afternoon, chief physicians, those working in surgical department, males, and those with more than 20-year experience had higher rates of inappropriate prescribing with increasing workload.
Conclusions:
Heavier workload was associated with higher risk of prescribing inappropriately. It requires great efforts to determine optimal physician workloads and mitigate the potential adverse effects on the prescription quality.
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