Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care
Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care
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DOI：
10.1007/s11606-018-4434-6
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发表时间：
2018-07-01
影响因子：
5.7
通讯作者：
Lee, Wei Wei
中科院分区：
文献类型：
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作者：
Pozdnyakova, Anastasia;Laiteerapong, Neda;Lee, Wei Wei
电子健康记录（EHRs）的使用与医生的压力和倦怠有关。虽然急诊科和专科医生已经使用抄写员来解决这个问题，但人们对抄写员在学术初级保健中的影响知之甚少。评估在学术综合内科（GIM）诊所的抄写员对医生和病人满意度的影响。前瞻性，预-后试点研究。在3个月的试点期间，医生们在有抄写员和没有抄写员的情况下进行了门诊。我们评估了以下方面的变化：(1)医生工作场所满意度和职业倦怠；(2)电子病历记录时间；(3)患者满意度。六名GIM教师和他们在学术GIM诊所的病人的方便样本（N = 325）。一项包含21个项目的试点前调查和44个项目的试点后调查评估了医生的工作场所满意度和职业倦怠。医生使用日志记录门诊时间以外在电子病历文件上花费的时间。一项27项的访后调查评估了患者在使用和不使用抄写器期间的满意度。6名医生中，100%的人对试点后的临床工作流程满意（试点前为33%），83%的人对试点后的电子病历使用满意（试点前为17%）。医生的倦怠在基线时很低，并且在试验后没有改变。门诊后电子病历记录的平均时间从每次就诊1.65小时减少到0.76小时（p = 0.02）。患者满意度在有抄写员和没有抄写员的患者之间没有总体差异，也没有年龄、性别和种族的差异。与65岁或65岁以上的患者相比，年轻患者更有可能报告说，在抄写员在场的情况下，医生更细心，提供了更多的教育（p分别= 0.03和0.02）。男性患者更有可能报告他们不喜欢抄写员（p = 0.03）。在学术GIM设置中，雇用抄写员与提高医生满意度相关，而不影响患者满意度。
Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care.Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic.Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction.Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic.A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe.Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03).In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.