Job satisfaction of staff and the team environment in Australian general practice

OBJECTIVE: To study the work satisfaction of general practice staff, the differences between types of staff, and the individual and organisational factors associated with work satisfaction. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional multipractice study based on a self-completed job satisfaction survey of 626 practice staff in 96 general practices in Australia between 16 December 2003 and 8 October 2004. MAIN OUTCOME MEASURES: Job satisfaction scores for all staff and for general practitioners alone; relationship between job satisfaction and the team climate, practice size, particular jobs within practices, demographic characteristics of participants, and geographical location of practices. RESULTS: The response rate was 65%. Job satisfaction was high, with a mean score of 5.66 (95% CI, 5.60-5.72). Multilevel analysis showed that all general practice staff were highly satisfied if they worked in a practice with a good team climate. Practice managers reported the highest satisfaction with their work. Practice size and individual characteristics such as the sex of the participant were unrelated to job satisfaction. GPs tended to have lower satisfaction than other staff in relation to income, recognition for good work and hours of work. Rural GPs were more satisfied. CONCLUSIONS: Most general practice staff are satisfied with their work. Facilitating teamwork may be a key strategy for both recruitment and retention of the general practice workforce, especially staff who are not GPs.     

Job sharing in general practice

A questionnaire survey of 500 consecutive patients consulting their general practitioners was undertaken to compare job sharing part time partners and full time partners in respect of patients' perception of and satisfaction with the availability of the doctor they wished to consult. Comparison of linear analogue scales of patients' satisfaction with the availability of their chosen doctor showed no significant difference between job sharing partners and full time partners. Nevertheless, significantly fewer patients were able to see the full time partner of their choice within two days than were able to see the job sharing partner of their choice within the same period. In this study patients were as satisfied with the availability of job sharing partners as they were with that of full time partners; the findings highlight important considerations for practices wishing to appoint partners with a limited commitment.     

安徽省全科医生对执业方式改革及执业满意度的调查研究

目的:了解安徽省全科医生对执业方式改革及执业现状的满意度,并探讨影响因素。方法:采用自填式问卷调查,抽取安徽省基层医疗卫生机构（包括社区卫生服务中心及乡镇卫生院）50所,选取调查当日50所基层医疗卫生机构在岗的全科医生为问卷调查对象。调查内容包括卫生技术人员的基本情况、对执业方式改革的认知情况、与居民签约服务情况、对执业现状的满意度。结果:在387名全科医生中,有178人（46.00%）知晓医生可多点执业,有199人（51.42%）支持医生多点执业,有128人（33.07%）认为所在单位支持医生多点执业;有219人（56.59%）所在单位已经开展了与居民的签约服务;有228人（58.92%）支持居民签约服务;有244人（63.05%）赞成病人自由选择医生;有142人（36.68%）赞成医生自由选择病人。对目前执业状况,5个具体方面评价选择不满意的比例由高到低依次是奖金分配（37.98%）、工作负荷（36.69%）、医患关系（33.07%）、工作环境（27.91%）和工作内容（27.39%）。认为制约全科医生多点执业的主要因素依次是相关设施服务不健全（33.67%）、单位制度制约（32.81%）、工作压力大（12.51%）以及基层医生数量不足（17.29%）。结论:安徽省全科医生对执业方式改革的积极性较高,执业满意度不高,并存在各种制约全科医生多点执业的因素。应加大全科医生多点执业的相关设施服务建设,设置多点执业准入标准,引导全科医生多点执业;完善单位制度,合理制定绩效工资分配制度,提高全科医生的执业满意度。     

Job satisfaction of doctors in Negeri Sembilan

A cross sectional study was carried out in Negeri Sembilan to identify factors associated with job satisfaction of doctors serving in Ministry of Health and their intentions to resign. All Ministry of Health doctors currently working in Negeri Sembilan were included in the study and data collection was done via a self-administered postal questionnaire. The response rate was 69.4%. Out of those who responded, only 31.3% had global job satisfaction, with the majority dissatisfied. Intention to resign was high among 32.7% of the respondents. Factors found to be significantly associated with job satisfaction were age, job designation, income, duration of service and intention to resign. Intention to resign was found to be significantly associated with ethnicity and income. From logistic regression, predictors of job satisfaction identified were age, place of first graduation, and satisfaction with status and autonomy, satisfaction with career development, satisfaction with workload and satisfaction with transfers. Predictors of intention to resign were race, income and global job satisfaction.     

Disability as identified from general practice records

Thirty eight doctors who attended a postgraduate educational course provided information about disabled patients identified in a search of 7000 records. Disablement was defined as a major disruption to the normal lifestyle of patients in appropriate age and sex groups. Altogether 242 people were identified as disabled, equivalent to 32 per 1000 population, which is closely similar to that published by Harris, who identified patients by postal questionnaire. Among adults aged 15 to 64 more men were identified than women, and we suggest that a higher rate of disablement might be expected in men. Disablement among women may be underestimated because of underrecognition by doctors of disability in housewives. Fifty two per cent of all disabled people were able to attend the doctor's surgery, and 72% were receiving regular medication; 79% were dependent on relatives, but only 30% were dependent on statutory services. In the opinion of the recording doctors medical and nursing needs were well met, though not the social needs, where the importance of living alone is noteworthy.     

Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs

OBJECTIVE: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. MAIN OUTCOME MEASURES: Occupational violence towards general practitioners during the previous 12 months. RESULTS: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug- and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. CONCLUSION: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.     

功能社区中青年人群对全科医疗服务内容需求及影响因素分析

目的为制定适宜功能社区中青年人群的全科医疗服务内容和政策提供参考依据,引导其就诊社区、签约社区。方法2021年7月采用分层随机抽样法向上海市黄浦区功能社区中青年发放自制问卷703份,回收有效问卷670份,运用SPSS 20.0统计学软件进行数据分析。结果中青年人群医保享有率高（94.2%）,未签约家庭医生占比大（79%）;中青年人群除中医推拿针灸、急救服务2项外,其他6项服务内容签约者的需求评分均高于未签约者（P<0.05）;居住时长、是否签约全科医生是中青年人群对服务内容总体需求度的显著影响因素。结论功能社区中青年人群的需求呈现出优先自我诊疗、非社区首诊、对中医认可度高的特点,建议参考其需求特点和影响需求的主要因素,制定适宜其人群的个性化服务内容和政策。     

全科医疗评估问卷在社区卫生服务患者满意度调查中的应用与评价

目的探讨全科医疗评估问卷（GPAQ）2,0就诊咨询版在社区卫生服务中对患者满意度评价的应用。方法由3名全科医学领域专家翻译和反翻译GPAQ2．0就诊咨询版,形成GPAQ2．0就诊咨询中文版。从北京大兴、南菜园、永宁、韩村河4个社区卫生服务中心,分别随机抽取在2008年4月25日出诊的10名全科医生作为患者对全科医疗服务满意度评价的对象,由此40名医生在该日内各自所诊治的前30例患者（共1200例,年龄≥16岁）用GPAQ2．0就诊咨询中文版调查问卷进行患者满意度调查,评价其信度与效度。结果GPAQ2．0就诊咨询中文版5个评价方面信度分析的克朗巴赫（cronbach）α系数为0．734-0．813,特征值〉1的公因子有3个,累积贡献率为58．722％。接诊人员的帮助、可及性、持续性、医生的交流能力和自我照顾能力等5方面的得分,均比英国国家基准分低（t值分别为-6．397,-11．729,-6．328,-59．871,-2．210,均P〈0．05）。结论GPAQ2．0中文版具有较好的信度,效度尚可,可在适当修订后作为我国社区卫生服务质量患者满意度的评价工具。     

全科门诊接诊桌和带教方式的改进及其在全科规培医师带教中的应用

目的 观察一种改进的全科门诊接诊桌及带教方法及其在全科规培医师门诊带教中的应用效果。 方法 接诊桌的改进包括桌面加长60 cm,键盘托加长50 cm,使之适合学员及教师并列相座同时接诊,电脑显示器、键盘及鼠标等可在学员及教师之间移动。选择嘉兴市第一医院规培第2年的全科住院医师60名,采用随机数字表法分为A、B两组(各30名),分别采用改进法、传统教学法进行门诊带教。2组学员在接受门诊带教前及1个月的门诊带教后分别进行3个不同病种3个考站的Mini-CEX评估,规培医师和带教教师对2次评估进行满意度的评分。 结果 门诊带教后,2组学员Mini-CEX各项评分比带教前均有明显提高,差异有统计学意义(均P<0.05)。A组学员在医学面谈技能、沟通技巧、条理性/效率、临床综合能力的评分上均高于B组(均P<0.05);在查体技能、人文素质/专业精神、临床判断的比较上,2组差异无统计学意义(均P>0.05)。规培医师及带教教师对2次Mini-CEX评价满意度的比较,差异均无统计学意义(均P>0.05)。 结论 通过对全科诊室接诊桌及门诊带教方法的改进,能提高全科规培医师在人文关怀、沟通表达、问诊技巧、病历书写、组织效能等方面的技能水平,达到更好的门诊带教效果。      

综合性医院中全科医学专科的建立与职能

论述了全科医学作为一个独立临床医学专科的理由,根据综合性医院中全科医学专科建立的实践,提出了综合性医院中全科医学专科的职能：带动全科医学科研发展,确立全科医学学术地位;开展全科医学教学工作,推动全科医学教育的发展：开展全科诊室、家庭病房、全科病房业务,提供人性化、综合性服务;作为连接社区与综合医院的桥梁,畅通双向转诊的通道。