■临床医生倦怠与临床医生的结果有关,但与患者预后的关联仍不清楚.
■评估临床医生倦怠与接受指南推荐的创伤后应激障碍(PTSD)心理治疗患者预后之间的关系。
这项队列研究是在美国退伍军人事务医疗保健系统中进行的,其中包括在2019年5月2日至10月8日期间提供以创伤为重点的心理治疗并对在线调查做出回应的持牌治疗师,以及在第二年开始以创伤为重点的治疗的患者。患者数据收集至2020年12月31日。数据从2023年5月至9月进行了分析。
■完成调查的治疗师报告了职业倦怠,并从医师工作生活研究中获得了5点验证措施。倦怠被定义为3分或更多。
■主要结果是根据《精神障碍诊断和统计手册》(第五版)PTSD检查表,患者PTSD症状有临床意义的改善。患者退出,治疗师依从性,会议间隔通过电子健康记录进行评估.多变量随机效应逻辑回归检查了治疗师倦怠和临床意义改善的关联,针对案例组合进行了调整。
■在这项研究中,180名治疗师中有165名(91.7%)(89[53.9%]女性)完成了倦怠措施,并为1268名患者(961名[75.8%]男性)提供了以创伤为重点的心理治疗,并提供了结果数据。58(35.2%)的治疗师认可倦怠。三分之一的患者(431[34.0%])符合临床上有意义的改善标准。在治疗师报告倦怠的424例患者中,有120例(28.3%)经历了PTSD症状的临床意义改善,在治疗师没有倦怠的844例患者中,有311例(36.8%)经历了创伤后应激障碍症状的改善。倦怠与临床上有意义的改善的几率较低相关(调整后的优势比[OR],0.63;95%CI,0.48-0.85)。对于退出的患者,临床上有意义的改善的几率降低了(OR,0.15;95%CI,0.11-0.20),并且具有更大的会话间隔(OR,0.80;95%CI,0.70-0.92)。治疗师的依从性与治疗效果无关。调整退出或会话间隔并没有显着改变倦怠与临床上有意义的改善之间的关联程度。
■在这项前瞻性队列研究中,治疗师职业倦怠与创伤集中心理治疗的有效性降低相关.研究倦怠何时以及如何影响患者的结果可能会为工作场所的干预提供信息。
UNASSIGNED: Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear.
UNASSIGNED: To evaluate the association between clinician burnout and the outcomes of patients receiving of
guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD).
UNASSIGNED: This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023.
UNASSIGNED: Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more.
UNASSIGNED: The primary outcome was patients\' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix.
UNASSIGNED: In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement.
UNASSIGNED: In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.