Violence against health care workers in China, 2013-2016: evidence from the national judgment documents
Violence against health care workers in China, 2013-2016: evidence from the national judgment documents
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DOI：
10.1186/s12960-019-0440-y
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发表时间：
2019-12-26
影响因子：
4.5
通讯作者：
Pan, Jay
中科院分区：
文献类型：
--
作者：
Cai, Ruilie;Tang, Ji;Pan, Jay
在中国，由患者发起的针对医护人员的工作场所暴力事件一直是公众关注的一个话题。患者发起的暴力不仅有可能对卫生保健提供者造成伤害，而且还表明医生和患者之间普遍存在紧张关系，这对改善卫生系统的可及性和质量构成挑战。本研究旨在对中国卫生保健工作者遭受的严重工作场所暴力进行系统的、国家层面的定性分析。方法本研究从中国裁判文书综合数据库中国裁判文书在线系统中提取数据。在2013年1月1日至2016年12月31日期间，我们使用“刑事案件”、“医疗机构”和“医护人员”三个关键词在中国判决书在线系统中搜索相关案件。从确定的案例中提取的数据用于记录发生情况、风险程度以及与严重工作场所暴力相关的因素。结果共受理459起由患者发起的针对医护人员的工作场所暴力犯罪案件。分析显示，严重工作场所暴力事件的发生存在地域差异，西部省份的发生率低于中部和东部省份。初级医院的严重工作场所暴力发生率最高，与其他部门和卫生工作者相比，急诊科和医生面临的风险更高。肇事者主要是18至44岁的男性农民，受教育程度较低。最常报告的由病人发起的严重工作场所暴力的原因包括：在病人死亡后，行为人认为自己有医疗事故；在没有给出其他原因的情况下，病人死亡；在病人死亡后，赔偿谈判失败；以及对治疗结果不满意。结论：在中国不同地区、不同类型的卫生保健机构中，针对医务人员的严重工作场所暴力存在差异。据报道，对低质量护理的认知是导致暴力的最主要原因。要努力提高基层医疗机构的服务质量，加强服务全过程的医患沟通。
Background Incidents of patient-initiated workplace violence against health care workers have been a subject of substantial public attention in China. Patient-initiated violence not only represents a risk of harm to health care providers but is also indicative of general tensions between doctors and patients which pose a challenge to improving health system access and quality. This study aims to provide a systematic, national-level characterization of serious workplace violence against health care workers in China. Methods This study extracted data from the China Judgment Online System, a comprehensive database of judgment documents. Three key phrases, "criminal case," "health care institution," and "health care worker" were used to search the China Judgment Online System for relevant cases between January 1, 2013, and December 31, 2016. Data extracted from identified cases was used to document the occurrence, the degree of risk, and the factors associated with serious workplace violence. Results In total, 459 criminal cases involving patient-initiated workplace violence against health care workers in China were reported and processed. The analysis revealed geographic heterogeneity in the occurrence of serious workplace violence, with lower incidence in western provinces compared to central and eastern provinces. Primary hospitals experienced the highest rates of serious workplace violence and emergency departments and doctors were at higher risk compared with other departments and health workers. Perpetrators were primarily male farmers aged 18 to 44 with low levels of education. The most frequently reported reasons of serious patient-initiated workplace violence included perceived medical malpractice by the perpetrator after the death of a patient, death of a patient with no other reason given, failures of the compensation negotiations after the death of a patient, and dissatisfaction with the treatment outcomes. Conclusions Serious workplace violence against providers varies across regions and types of health care institutions in China. Perception of low-quality care is the most reported reason for violence. Efforts should be made to improve quality of care in the low-level health institutions and strengthen the doctor-patient communication during the whole course of service.