Page 65 - 中国全科医学2022-07

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University，Jinan 250012，China
2.Shandong University Center for Health Economics Experiment and Public Policy Research，Jinan 250012，China
3.NHC Key Lab of Health Economics and Policy Research（Shandong University），Jinan 250012，China
*
Corresponding author：XU Lingzhong，Professor，Doctoral supervisor；E-mail：lzxu@sdu.edu.cn
【Abstract】 Background Burnout has become a prominent issue as the increase of workload in family doctor team members
in primary healthcare institutions during the promotion of contracted family doctor services. There is still a lack of research comparing the
differences in burnout among family doctor team members in different types of primary healthcare institutions. Objective To compare
burnout prevalence and associated factors between family doctors in community/township health centers，and those in community health
stations/village clinics，providing a basis for improving the mental health status and team stability of family doctors，as well as the
quality of services provided by them. Methods From August 1 to 21，2020，a multistage cluster random sampling method was used to
select 760 family doctor team members〔201（26.4%） working at community/township health centers，and 559（73.6%） working at
community health stations/village clinics〕 as the participants from primary healthcare institutions in 6 counties/county-level cities /districts
of Taian City，Shandong Province. They were invited to attend a survey to complete Demographic Questionnaire and the Chinese version
of Maslach Burnout Inventory-General Survey（MBI-GS）. Results Overall，the prevalence of burnout among the participants
was 68.9%（524/760）. Overall，the prevalence of burnout among the participants was 68.9%（524/760），and the prevalence of
burnoutof family doctor team members in community/township health centers and community health stations/village clinics was 63.7%
（128/201） and 70.8%（396/559），respectively. The levels of burnout of family doctor team members in community health stations/
village clinics was higher than that of those in community/township health centers，with a statistically significant difference（P<0.05）.
Family doctor team members in community health stations/village clinics had higher total score of MBI-GS and higher subscale score
of reduction of professional efficacy than did those in community /township health centers，with a statistically significant difference
（P<0.05）. Multivariate Logistic regression analysis showed that：for family doctor team members in community/township health
centers，the risk of burnout of those aged 41-50 years is higher than that aged ≤ 30 years〔OR（95%CI）=7.119（1.770，
28.638）〕，the risk of burnout of those with monthly income >4 000 yuan is lower than that with monthly income <2 000 yuan〔OR（95%CI）
=0.194（0.040，0.941）〕，the risk of burnout of those with high/very high self-rated work pressure is higher than that of those
without/little self-rated work pressure〔OR（95%CI）=3.629（1.475，8.929）〕，the risk of job burnout of those who evaluated
the incentive mechanism as ordinary and relative effective/very effective was lower than that evaluated the incentive mechanism as very
ineffective/less effective〔OR（95%CI） were 0.196（0.052，0.739） and 0.235（0.066，0.834）〕. For the family doctor team
members in community health stations/village clinics，the risk of burnout in women is lower than that in men〔OR（95%CI）=0.603（0.396，
0.920）〕，the risk of job burnout of those with general and relatively high/very high self-assessment residents' recognition is lower than
that with very low/relatively low self-assessment residents' recognition〔OR（95%CI） were 0.258（0.113，0.590） and 0.428（0.199，
0.918）〕，the risk of burnout of those with high/very high self-rated job stress is higher than that without/little self-rated job stress
〔OR（95%CI）=2.320（1.368，3.935）〕. Conclusion Family doctor team members in community health stations/village clinics
demonstrated higher burnout prevalence，and lower professional efficacy. To reduce the burnout prevalence and improve professional
efficacy in family doctor team members，it is suggested to strengthen trainings，increase salary and further improve incentive mechanism
for those in community/township health centers，and to increase the number of officially budgeted posts，and promotion opportunities as
well as the propaganda of contracted family doctor services for those in community health stations/village clinics. Moreover，the workflow
of contracting family doctor services should be simplified in all these institutions.
【Key words】 Primary health care institutions；Family doctors；Contracted family doctor services；Burnout，
professional；Root cause analysis

职业倦怠是个体长期处于工作压力状态而产生的一 于推进家庭医生签约服务的指导意见》，指出要加快推
种身心消耗过度、精力衰竭的综合症状 ［1］ ，目前学者 进家庭医生签约服务 ［5］ 。家庭医生团队需为居民提供
常采用 MASLACH 等 ［2］ 构建的情感耗竭、去个性化、 除基本医疗以外的预防、保健、康复等服务，工作量大
个人成就感降低三维度结构模型进行研究。医务人员作 且繁杂，容易产生职业倦怠 ［6-8］ 。作为居民健康的“守
为特殊的服务人群，每日面临着高强度的诊疗工作、沉 门人”，家庭医生团队成员的工作状态对签约服务的推
重的工作压力及复杂的医患关系，是职业倦怠的高发群 进具有重要意义。因此，亟须开展基层医疗卫生机构家
体 ［3］ 。既往研究表明，医护人员的职业倦怠不仅会影 庭医生团队成员职业倦怠的相关研究。现阶段，家庭医
响其身心健康，也会对医疗服务质量和服务水平产生不 生签约服务主要由基层医疗卫生机构承担，包括社区卫
利影响 ［4］ 。2016 年，国务院医改办等七部委发布《关 生服务中心/乡镇卫生院和社区卫生服务站/村卫生室。