作者:Laurie Barclay, MD
出處:WebMD醫學新聞
November 18, 2008 — 一項線上發表於11月12日英國醫學期刊的研究結果,短期的諮詢介入可能降低一群挪威裔醫師的疲倦與壓力。
挪威Vikersund Modum Bad研究機構的Karin E. Isaksson Ro醫師與其同事表示,針對醫師精神健康的研究,喚起了降低疲倦風險與精神壓力之預防措施的注意。早期介入計畫可以確保那些遇到困難的執業醫師,在他們的問題干擾到病患照護或是造成醫療疏失之前,及時提供他們協助;但是一直沒有這些介入計劃的相關研究。
在挪威人資源中心,227位醫師於2003年到2005年之間參與一項諮詢介入計劃,並於一年後完成一份自我評估;該介入計劃包括維持一天的個人諮詢,或是持續一週以團體為基礎的諮詢,目標是鼓勵反應與承認醫師之狀況以及個人需求,主要的試驗終點是疲倦的程度,以Maslach疲倦紀錄,與根據線性迴歸找出降低情緒倦怠的預測因子。
185位(81%)醫師完成一年的後續追蹤,其中88位為男性,97位為女性。以1~5分,情緒倦怠的程度顯著地從3.00 ± 0.94降低到2.53 ± 0.76(t = 6.76;P < .001),這與於390位挪威醫師代表樣本中發現的結果相同。除此之外,參與者的工作時數每週降低1.6 ± 11.4小時。
請病假的醫師比例從試驗前的35%(182位中有63位)降低到後續追蹤的6%(182位中有10位),接受精神治療的比例從20%(182位中有36位)增加到53%(182位中有97位)。在校正年齡、性別與個性特點後,整體族群情緒倦怠的降低獨立地與每週工作時數(β = 0.17; P = .03)下降有關。在男性中,對介入的滿意是降低情緒倦怠一個獨立的預測因子(β = 0.25; P = .04)。
研究作者寫到,短期的諮詢介入與醫師情緒倦怠減少有關。也與整體族群工作時數減少有關,在男性,這可以由介入滿意度來預測。
研究的限制包括無法確定因果關係,缺乏可能造成偽陽性發現(第二型誤差)的進一步次組分析,個別性別的迴歸分析也可能造成第二型誤差,以及可能的回憶誤差。
考慮到醫師即使面對高度壓力也不願尋求協助,必要時提供他們加速接觸、以及可以增加重新考慮個人與專業優先動機的介入是很重要的。此外,造成情緒倦怠的指標因子,應以控制性研究設計進一步研究。
挪威女姓公衛組織與Modum bad精神醫院贊助這項研究。Ro醫師任職於Villa Sana資源中心且於挪威醫學會的內部會議中發表初期研究結果。
BMJ,線上發表於2008年11月12日。
Counseling May Reduce Clinician Burnout and Stress
By Laurie Barclay, MD
Medscape Medical News
November 18, 2008 — A short-term counseling intervention was effective in reducing burnout and stress in a cohort of Norwegian clinicians, according to the results of a study published online November 12 in the British Medical Journal.
"Research on the mental health of doctors has led to a call for preventive interventions to lower the risk of burnout and mental distress," write Karin E. Isaksson Ro, MDr, from the Research Institute, Modum Bad, in Vikersund, Norway, and colleagues. "Early intervention programmes could ensure that practising doctors in trouble get help in time, before their problems interfere with care of patients and give rise to medical errors, but such programmes have been poorly investigated."
At a Norwegian resource center, 227 physicians participated in a counseling intervention during 2003 to 2005 and completed a self-reported assessment at 1 year. The intervention consisted of individual counseling lasting 1 day or group-based counseling lasting 1 week, aimed at motivating reflection on and acknowledgement of the physicians' situation and personal needs. Primary endpoints were levels of burnout, measured with the Maslach burnout inventory, and predictors of reduced emotional exhaustion, based on linear regression.
Of 185 physicians (81%) who completed 1-year follow-up, 88 were men and 97 were women. On a scale of 1 to 5, the mean level of emotional exhaustion significantly decreased from 3.00 ± 0.94 to 2.53 ± 0.76 (t = 6.76; P < .001), which was similar to the level found in a representative sample of 390 Norwegian physicians. In addition, participants had decreased their working hours by 1.6 ± 11.4 hours/week.
The proportion of physicians on full-time sick leave decreased from 35% (63 of 182 physicians) at baseline to 6% (10 of 182 physicians) at follow-up, and the proportion that had undergone psychotherapy increased from 20% (36 of 182 physicians) to 53% (97 of 182 physicians). After adjustment for sex, age, and personality dimensions, reduction in emotional exhaustion in the overall cohort was independently associated with reduced number of work hours per week (β = 0.17; P = .03). Among men, "satisfaction with the intervention" was an independent predictor of reduced emotional exhaustion (β = 0.25; P = .04).
"A short term counselling intervention could contribute to reduction in emotional exhaustion in doctors," the study authors write. "This was associated with reduced working hours for the whole cohort and, in men, was predicted by satisfaction with the intervention."
Study limitations include an inability to determine causality, lack of further analyses of subgroups possibly causing a false negative finding (type 2 error), regression analyses for each sex also subject to possible type 2 errors, and possible recall bias.
"Considering doctors' reluctance to seek help, despite high levels of distress, it is important to offer interventions that facilitate access and that can enhance motivation to reconsider personal and professional priorities when necessary," the study authors write. "The indications of factors possibly contributing to reduction in emotional exhaustion need to be further investigated with a more controlled design."
The Norwegian Women's Public Health Association and Modum Bad psychiatric hospital supported this study. Dr. Ro has been employed at the resource center, Villa Sana, and was reimbursed for a presentation of preliminary results at an internal meeting of the Norwegian Medical Association.
BMJ. Published online November 12, 2008.
[ 本帖最後由 goodcat1111 於 2008-11-28 20:36 編輯 ] |
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