医生中疲劳的普遍性:一个系统的审查
Lisa S Rotenstein1,2,3, Matthew Torre1,4, Marco A Ramos5
1Harvard Medical School, Boston, Massachusetts.
JAMA
|October 17, 2018
概括
由于182项研究的定义和评估方法不同,医生倦怠率尚不清楚. 制定共识定义和标准化工具对于理解职业压力影响至关重要.
科学领域:
- 职业健康问题
- 精神病学
- 医学教育
背景情况:
- 医生倦怠症是影响医疗质量的已知的综合症.
- 准确的流行数据对于卫生政策至关重要,但目前缺乏.
- 研究方法的变化阻碍了对倦怠范围的清晰理解.
研究的目的:
- 系统地审查和描述用于评估医生疲劳的方法.
- 估计全球执业医生的倦怠率.
- 在研究中发现倦怠定义和测量的不一致性.
主要方法:
- 在2018年6月1日之前发表的研究中,对五个主要数据库 (EMBASE,ERIC,MEDLINE/PubMed,psycARTICLES,psycINFO) 的系统文献搜索.
- 包括来自45个国家的109,628名执业医生参与的182项研究.
- 描述性和定性综合由于研究设计和倦怠评估的异质性,排除了元分析.
主要成果:
- 患病率的估计差异很大,报告的整体倦怠率从0%到80.5%.
- 超过142个独特的定义燃烧和其子组件 (情绪疲,非个性化,低个人成就) 被确定.
- 在85.7%的研究中使用了Maslach Burnout Inventory (MBI),但在基于MBI的研究中至少发现了47个不同的整体倦怠率定义.
- 不一致性使得无法可靠地确定倦怠与人口或临床因素之间的联系.
结论:
- 医生对倦怠率的估计,定义和评估方法存在显著的差异.
- 由于缺乏标准化的测量工具和共识定义,因此无法得出最终结论.
- 制定标准化的倦怠评估工具和达成共识的定义对于医生应对职业压力至关重要.
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