Primary Care Physician Stress Driven by Social and Financial Needs of Complex Patients.
Primary Care Physician Stress Driven by Social and Financial Needs of Complex Patients.
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复杂患者的社会和财务需求驱动初级保健医生的压力。
DOI：
10.1007/s11606-018-4815-x
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发表时间：
2019
影响因子：
5.7
通讯作者：
Grant,RichardW
中科院分区：
文献类型：
--
作者：
Weiner,JonathanZ;McCloskey,JodiK;Uratsu,ConnieS;Grant,RichardW
方法 来自北加州大型综合医疗保健系统的 DSPCP 完成了一项调查，作为与复杂患者护理管理相关的质量改进项目的一部分。印刷版调查问卷分发给来自 3 个医疗机构的 6 个社区初级保健机构的 156 名 PCP，这些医疗机构也获得了类似的病例管理服务。该调查促使 PCP 考虑 10-15 名最复杂、最具挑战性的患者，并要求他们报告压力水平和护理协调的难易程度。 PCP 还被要求评估预先定义的患者因素的重要性，这些因素导致复杂的患者难以管理（表 1）。在我们的分析中，我们将响应分为非常高或高度重要性与中等或低重要性，并比较了报告“极端”压力与较低压力水平（中等、轻微或低）的 PCP。我们使用多元逻辑回归来控制与雇主的多年经验，以调整对实践环境的熟悉程度。这项研究经过了北加州 Kaiser Permanente 研究确定办公室的审查，并被认为是质量改进，免除了 KP 机构审查委员会的全面审查。
METHODSPCPs from a large integrated health care system in Northern California completed a survey as part of a quality improvement project related to complex patient care management. Printed surveys were distributed to 156 PCPs from 6 community primary care practices across 3 medical facilities with similar access to case management services. The survey prompted PCPs to consider their 10–15 most complex, challenging patients and asked them to report levels of stress and ease of care coordination. PCPs were also asked to rate the importance of pre-defined patient factors that contribute to making complex patients challenging to manage (Table 1). For our analysis, we dichotomized responses as very high or high importance vs. moderate or low importance and compared PCPs reporting “extreme” stress vs. lower stress levels (moderate, somewhat, or low). We used multivariate logistic regression to control for years’ experience with their employer to adjust for familiarity with practice setting. This study was reviewed by the Research Determination Office of Kaiser Permanente of Northern California and deemed to be quality improvement exempt from full review by a KP Institutional Review Board.