Effects of individual and organizational factors on job tenure of primary care physicians: A multilevel analysis from Brazil.
Effects of individual and organizational factors on job tenure of primary care physicians: A multilevel analysis from Brazil.
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DOI：
10.1371/journal.pone.0271655
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Loerbroks, Adrian
中科院分区：
文献类型：
--
作者：
Dias, Ivan Wilson Hossni;Matijasevich, Alicia;Russo, Giuliano;Scheffer, Mario Cesar;Loerbroks, Adrian
初级保健医生任期短破坏了护理的连续性，损害了低收入、中等收入和高收入国家的健康结果。这项研究的目的是调查与初级卫生保健(PHC)服务的内科医生任期相关的背景因素和个人因素。我们考虑了个人层面的社会人口变量，如教育和与工作相关的变量，以及雇主和服务的特征。这项研究是一项从2016年到2020年对巴西S圣保罗公共卫生保健系统284个初级卫生保健单位的2,335名医生进行的回顾性队列研究。选择多变量分层模型，采用多水平分析的校正COX回归方法。用《加强流行病学观察性研究报告》(STROBE)核对表来报告研究结果。平均内科年限为14.54±12.89个月，中位数为10.94个月。初级卫生保健单位之间的差异解释了结果中观察到的差异的10.83%，而雇用组织只对2.30%负责。在PHC任职年限较高的医生特征为受聘年龄，即30-60岁，[HR：0.84，95%CI：(0.75-0.95)]和五年以上的专业经验[HR：0.76，95%CI：(0.59-0.96)]。与PHC实践无关的专业与短期相关[HR：1.25，95%CI：(1.02-1.54)]。初级卫生保健单位和个人特点的不同，如专业化和经验，与专业人员的任期较低有关，但这种特点可以通过对初级保健中心基础设施的投资以及工作条件、政策、培训和人力资源政策的改变来改变。找到医生任期短的补救措施对于确保一个强大的PHC系统至关重要，该系统可以为普遍、有弹性和积极主动的医疗保健做出贡献。
The short tenure of primary care physicians undermines the continuity of care, compromising health outcomes in low-, middle and in high-income countries. The purpose of this study was to investigate the contextual and individual factors associated with the tenure of physician in Primary Health Care (PHC) services. We consider individual-level sociodemographic variables such as education and work-related variables, as well as the characteristics of employers and services. This study is a retrospective cohort study of 2,335 physicians in 284 Primary Health Care Units across the São Paulo, Brazil, public health care system from 2016 to 2020. A multivariate hierarchical model was selected, and an adjusted Cox regression with multilevel analysis was employed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to report the findings from the study. The average physician tenure was 14.54 ± 12.89 months, and the median was 10.94 months. Differences between Primary Health Care Units accounted for 10.83% of the variance observed in the outcome, while the employing organizations were responsible for only 2.30%. The physician characteristics associated with higher tenure in PHC were age at hire, i.e., being between 30 and 60 years old, [HR: 0.84, 95% CI: (0.75–0.95)] and professional experience over five years [HR: 0.76, 95% CI: (0.59–0.96)]. Specialties not related to PHC practices were associated with a short tenure [HR: 1.25, 95% CI: (1.02–1.54)]. Differences between Primary Health Care Units and in the individual characteristics, such as specializations and experience, are related to the low tenure of professionals, but such characteristics can be changed through investments in PHC infrastructure and changes in work conditions, policies, training, and human resource policies. Finding a remedy for the short tenure of physicians is essential for guaranteeing a robust PHC system that can contribute to universal, resilient, and proactive health care.
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影响因子：
1.4
作者：
Baron, Andrea N.;Hemler, Jennifer R.;Cohen, Deborah J.
通讯作者：
Cohen, Deborah J.
影响因子：
2.8
作者：
Hone, Thomas;Powell-Jackson, Timothy;Millett, Christopher
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影响因子：
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Chung, Christopher;Maisonneuve, Hubert;Haller, Dagmar M.
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DOI：
10.1590/1413-81232021265.04432021
发表时间：
2021-05-01
期刊：
Ciência & Saúde Coletiva
影响因子：
--
作者：
Lima Júnior, Antonio Leonel de;Barreto, Ivana Cristina de Holanda Cunha;Vieira-Meyer, Anya Pimentel Gomes Fernandes
通讯作者：
Vieira-Meyer, Anya Pimentel Gomes Fernandes
影响因子：
3.6
作者：
Hall, Charles B.;Brazil, Kevin;Tennen, Howard
通讯作者：
Tennen, Howard