全科医生--家庭医生对初级保健中心工作不满意的风险预测模型

V. Vozniuk, T. A. Vezhnovets
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引用次数: 0

摘要

本研究旨在根据问卷调查结果,确定全科医生(GP)对其在初级卫生保健中心的工作不满意的风险预测模型。 材料和方法。使用调查问卷对 89 名全科医生进行了工作满意度调查。调查问卷的每个问题都由受访者以 5 分制的李克特总分进行评价。工作满意度分为 4 分和 5 分,不满意度分为 1-3 分。 采用逻辑回归分析法建立了全科医生工作不满意度风险预测模型。为评估各因素在逻辑回归模型中的影响程度,计算了几率比(OR)及其 95 % CI(置信区间)。接收者工作特征分析用于评估逻辑回归模型的质量。对研究结果的分析使用了统计分析软件包 MedCalc v.19.4.1(MedCalc Software Inc, Broekstraat, Belgium, 1993-2020)。 结果显示,76.06% 的全科医生对自己的工作感到满意。绝大多数人对管理人员、全科医生同事、病人的态度、专业发展和进修机会、工作日程、工作条件和团队精神表示满意。同时,半数以上的全科医生(54.92%)对与其他亚专科医生的业务关系是否融洽表示不满,36.61%的医生对工资表示不满,40.84%的医生认为工资与付出不相符,45.07%的医生认为额外的经济补偿不会影响所提供医疗服务的质量。采用逐步纳入/排除变量的方法为多元逻辑回归模型选择了一组特征。通过这种方法,选出了两个因素:工作自豪感和工作条件。我们确定,全科医生对自己选择的专业越自豪,工作条件越好,他对工作的不满意度就越低。我们确定该模型的灵敏度为 76.5 %(95 % CI:50.1 % - 93.2 %),特异度为 85.2 %(95 % CI:72.9 % - 93.4 %),诊断准确度为 83.1 %(CI:72.3 % - 91 %)。 结论在医疗机构的人事管理制度中,有必要考虑全科医生对其工作满意度的许多不同因素,包括工资、与同事和患者的关系、专业发展机会、管理人员的态度、尊重感和工作条件。在预测全科医生对工作不满意的风险时,必须考虑到医生对工作和工作条件的主观自豪感。
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MODELS FOR PREDICTING THE RISK OF DISSATISFACTION OF GENERAL PRACTITIONERS-FAMILY DOCTORS WITH WORK IN PRIMARY HEALTH CARE CENTERS
The aim of the study was to determine the model for predicting the risk of dissatisfaction of general practitioners (GPs) with their work in primary health care centers based on the results of a questionnaire. Materials and methods. A survey of 89 GPs was conducted using a questionnaire to determine job satisfaction. Each question of the questionnaire was evaluated by the respondents on the Likert total ratings on a 5-point scale. Job satisfaction was assessed at 4 and 5 points, dissatisfaction at 1-3 points. The logistic regression analysis was used to build a model for risk prediction of GPs’ job dissatisfaction. To assess the degree of each factor influence in the logistic regression model, the odds ratio (OR) and its 95 % CI (confidence interval) were calculated. Receiver Operating Characteristic analysis was used to assess the quality of the logistic regression model. The analysis of the research results was carried out using the license package the statistical analysis package MedCalc v.19.4.1 (MedCalc Software Inc, Broekstraat, Belgium, 1993-2020). The results show that 76.06 % of GPs are satisfied with their work. The vast majority are satisfied with the attitude of the management staff, fellow GPs, patients, opportunities of professional development and advanced training, work schedule, working conditions, and team spirit. At the same time, more than half of GPs (54.92 %) are dissatisfied with the comfort of business relations with other subspecialists, 36.61 % of doctors are dissatisfied with the salary, 40.84 % believe that the salary does not correspond to the efforts made, and 45.07 % think that additional financial compensation does not affect the quality of medical care provided. The method of stepwise inclusion/exclusion of variables was used to select a set of features for the multivariate logistic regression model. As a result of this method, 2 factors were selected: a sense of pride in work and working conditions. We established that the more a GP is proud of his chosen specialty and the better working conditions he has, the less dissatisfied he feels with his work. We determined the sensitivity of the model as 76.5 % (95 % CI: 50.1 % – 93.2 %), the specificity as 85.2 % (95 % CI: 72.9 % – 93.4 %), and the diagnostic accuracy as 83.1 % (CI: 72.3 % – 91 %). Conclusions. In the personnel management system of health care institutions, it is necessary to consider many different factors of GPs’ satisfaction with their work, including salaries, relationships with colleagues, patients, the opportunities of professional development, the attitude of management staff, a sense of respect, and working conditions. Forecasting the risk of GPs’ dissatisfaction with their work must be carried out taking into account the presence of doctors’ subjective sense of pride in their work and working conditions.
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