Is Burnout in Family Physicians in Croatia Related to Interpersonal Quality of Care?

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The impact of physician burnout on the quality of patient care is unclear. This cross-sectional study aimed to investigate the prevalence of burnout in family physicians in Croatia and its association with physician and practice characteristics, and patient enablement as a consultation outcome measure.

Hundred and twenty-five out of 350 family physicians responded to our invitation to participate in the study. They were asked to collect data from 50 consecutive consultations with their adult patients who had to provide information on patient enablement (Patient Enablement Instrument). Physicians themselves provided their demographic and professional data, including workload, job satisfaction, consultation length, and burnout [Maslach Burnout Inventory - Human Services Survey (MBI-HSS )]. MBI-HSS scores were analysed in three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA).

Of the responding physicians, 42.4 % scored high for EE burnout, 16.0 % for DP, and 15.2 % for PA. Multiple regression analysis showed that low job satisfaction and more patients per day predicted high EE scores. Low job satisfaction, working more years at a current workplace, and younger age predicted high DP scores. Lack of engagement in education and academic work, shorter consultations, and working more years at current workplace predicted low PA scores, respectively (P<0.05 for each).

Burnout is common among family physicians in Croatia yet burnout in our physicians was not associated with patient enablement, suggesting that it did not affect the quality of interpersonal care. Job satisfaction, participation in educational or academic activities and sufficient consultation time seem to reduce the likelihood of burnout.

1 Maslach C, Jackson SE, Leiter MP. Maslach Bunout Inventory Manual. 3rd ed. Mountain View (CA): Consulting Psychologists Press; 1996.

2 Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psych 2001;52:397-422.

3 Leiter MP, Frank E, Matheson TJ. Demands, values and burnout: relevance for physicians. Can Fam Physician 2009;55:1224-5.

4 Klemenc-Ketiš Z, Kersnik J, Ojsteršek J. Perceived difficulties in managing ethical problems in family practice in Slovenia: cross-sectional study. Croat Med J 2008;49:799-806. doi: 10.3325/cmj.2008.49.799

5 Goehring C, Bouvier Gallacchi M, Kuenzi B, Bovier P. Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross sectional survey. Swiss Med Wkly 2005;135:101-8.

6 Grassi L, Magnani K. Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians. Psychother Psychosom 2000;69:329-34. doi: 10.1159/000012416

7 Cathebras P, Begon A, Laporte S, Bois C, Truchot D. [Burnout among French general practitioners, in French]. Presse Med 2004;33:1569-74.

8 Kirwan M, Armstrong D. Investigation of burnout in a sample of British general practitioners. Br J Gen Pract 1995;45:259-60.

9 Marcelino G, Cerveira JM, Carvahalo I, Costa I, Lopes JA, Calado M, Pedro M-VNE. Burnout levels among Portugese family doctors: a nationwide survey. BMJ Open 2012;2: e001050. doi:10.1136/bmjopen-2012-001050

10 Selič P, Stegne-Ignjatović T, Klemenc-Ketiš Z. Burnout among Slovenian family medicine trainees: a cross sectional study. Zdrav Vestn 2012;81:218-24.

11 Soler JK, Yaman H, Esteva M, Dobbs F, Asenova RS, Katic M, Ozvacic Z, Desgranges JP, Moreau A, Lionis C, Kotanyi P, Carelli F, Nowak PR, de Aguiar Sa Azeredo Z, Marklund E, Churchill D, Ungan M; European General Practice Research Network.Burnout Study Group. Burnout in European family doctors: the EGPRN study. Fam Pract 2008;25:245-65. doi:10.1093/fampra/cmn038

12 West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, Shanafelt TD. Association of perceived medical errors with resident distress and empathy. A prospective longitudinal study. JAMA 2006;296:1071-8.

13 Shanafelt TD, Bradely KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67.

14 Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP. Rates of medication errors among depressed and burned-out residents: prospective cohort study. BMJ 2008;336:488-91. doi: 10.1136/bmj.39469.763218

15 Campbell SM, Roland MO, Buetow SA. Defining quality of care. Soc Sci Med 2000;51:1611-25. doi: 10.1016/S0277-9536(00)00057-5

16 Howie JGR, Heaney DJ, Maxwell M. Quality, core values and the general practice consultation: issues of definition, measurment and delivery. Fam Pract 2004;21:458-68. doi: 10.1093/fampra/cmh419

17 Orton P, Orton C, Pereira Gray D. Depersonalised doctors: a cross sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice. BMJ Open 2012;2:e000274. doi: 10.1136/bmjopen-2011-000274

18 Ratanawongsa N, Roter D, Beach MC, Laird SL, Larson SM, Carson KA, Cooper LA. Physician burnout and patientphysician communication during primary care encounters. J Gen Intern Med 2008;23:1581-8. doi: 10.1007/s11606-008-0702-1

19 Croatian National Institute of Public Health. [Croatian Health Service Yearbook 2002, in Croatian]. Zagreb: Hrvatski zavod za javno zdravstvo; 2003.

20 Ožvačić Adžić Z, Katić M, Kern J, Lazić D, Cerovečki Nekić V, Soldo D. Patient, physician, and practice characteristics related to patient enablement in general practice in Croatia: cross-sectional survey study. Croat Med J 2008;49:813-23.

21 Yaman H, Soler JK. The job related burnout questionnaire. A multinational pilot study. Austral Fam Physician 2002;31:1055-6.

22 Howie JGR, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H. Quality at general practice conultations: crosssectional survey. BMJ 1999;319:738-43. doi: 10.1136/ bmj.319.7212.738

23 Howie JGR, Hopton JL, Heaney DJ, Porter AMD. Attitudes to medical care, the organization of work, and stress among general practitioners. Br J Gen Pract 1992;42:181-5.

24 Zantinge EM, Verhaak PFM, de Bakker DH, van der Meer K, Bensing JM. Does burnout among doctors afect their involvement in patients’ mental health problems? A study of videotaped consultations. BMC Fam Pract 2009;10:60. doi:10.1186/1471-2296-10-60

25 Zantinge EM, Verhaak PFM, de Bakker DH, Kerssens J, van der Meer K, Bensing JM. The workload of general practitioners does not affect their awareness of patients’ psychological problems. Patient Educ Couns 2007;67:93-9. doi: 10.1016/j.pec.2007.02.006

26 Mercer SW, Reilly D, Watt GC. The importance of empathy in the enablement of patients attending the Glasgow Homoeopathic Hospital. Br J Gen Pract 2002;52:901-5.

27 Freeman GK, Horder JP, Howie JGR, Hungin AP, Hill AP, Shah NC, Wilson A. Evolving general practice consultation in Britain: issues of length and context. BMJ 2002;324: 880-2. doi: 10.1136/bmj.324.7342.880

28 Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract 2002;52:1012-20.

29 Howie JGR, Porter AMD, Heaney DJ, Hopton JL. Long to short consultation ratio: a proxy measure of quality of care for general practice. Br J Gen Pract 1991;41:48-54.

30 Wilson A, McDonald P, Hayes L, Cooney J. Longer booking intervals in general practice: effects on docotrs’ stress and arousal. Br J Gen Pract 1991;41:184-7.

31 Howie JGR, Hopton JL, Heaney DJ, Porter AMD. Attitudes to medical care, the organization of work, and stress among general practitioners. Br J Gen Pract 1992;42:181-5.

32 Lee FJ, Stewart M, Brown JB. Stress, burnout and strategies for reducing them. Can Fam Physician 2008;54:234-5.

33 Visser MRM, Smets EMA, Oort FJ, de Haes HCJM. Stress, sastisfaction and burnout among Dutch medical specialists. CMAJ 2003;168:271-5.

34 Brondt A, Sokolowski I, Olesen F, Vedsted P. Continuing medical education and burnout among Danish GPs. Br J Gen Pract 2008;58:15-9. doi: 10.3399/bjgp08X263767

35 Kushnir T, Cohen AH, Kitai E. Continuing medical education and primary physician’s job stress, burnout and dissatisfaction. Med Educ 2000;34:430-6.

36 Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Aust J Rural Health 2005;13:149-55. doi: 10.1111/j.1440-1854.2005.00677.x

37 Hays R, Wynd S, Veitch C, Crossland L. Getting the balance right? GPs who chose to stay in rural practice. Aust J Rural Health 2003;11:193-8.

38 Bovier PA, Arigoni F, Schneider M, Gallacchi MB. Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians. Eur J Public Health 2009:19:611-7. doi: 10.1093/ eurpub/ckp056

39 Al-Dubai SA, Rampal KG. Prevalence and associated factors of burnout among doctors in Yemen. J Occup Health 2010;52:58-65.

40 Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbel KK, Greenfield JG. Burnout among American surgeons. Surgery 2001;130:696-702

41 Saultz JW. Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med 2005;3:159-66. doi: 10.1370/afm.285

42 Schers H, van den Hoogen H, Bor H, Grol R, van den Bosch R. Familiarity with a GP and patients’ evaluations of care. A cross-sectional study. Fam Pract 2005;22:15-9. doi: 10.1093/ fampra/cmh721

43 Schultz K, Delva D, Kerr J. Emotional effects of continuity of care on family physicians and the therapeutic relationship. Can Fam Physician 2012;58:178-85.

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