Relationship between number of health problems addressed during a primary care patient visit and clinician workload

Temte, Jonathan L.; Beasley, John W.; Holden, Richard J.; Karsh, Ben‐Tzion; Potter, Beth; Smith, Paul D.; O'Halloran, Peggy

doi:10.1016/j.apergo.2019.103035

Cited by 11 publications

(12 citation statements)

References 29 publications

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“…Despite the importance and widely recognized need to measure the perceived mental workload of workers, there are still few studies that have applied techniques such as Nasa-TLX in actual work settings (16).…”

Section: Nasa-tlx As a Workload Measurementioning

confidence: 99%

Has COVID-19 changed the workload for primary care physicians? The case of Spain

Fernández-Aguilar¹,

Casado‐Aranda

Fernández³

et al. 2021

Family Practice

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Background The COVID-19 pandemic has led to a massive over-exertion of doctors, multiplying their work intensity, overload and stress. Yet no studies have been conducted on the changes in primary care physician overload during the pandemic. Objective To address this research gap, the aim of this article is to document the subjective dimensions of physicians’ work during the peak of the pandemic for comparison with a pre-COVID-19 situation. In addition, the relationship between workload and the individual characteristics of the physician or the percentage of tele-assistance is examined. Methods This study performs a subjective measurement procedure for the analysis of work overload through the NASA-TLX questionnaire, with a total of 102 records from 16 doctors from a Primary Health Centers of the Granada-Metropolitan Health district (Andalusia, Spain). Results The results reflect a significantly higher workload during COVID-19 in relation to a previous situation (66.1% versus 48.6% before COVID-19). All the dimensions of the NASA-TLX test suffered an increase during the COVID-19, this increase being higher in the physical, temporal and frustration levels. Interestingly, the findings reflect the higher the percentage of telematic consultations, the lower workload. Conclusions Work overload and the emotional state of health workers is one of the many repercussions of the COVID-19 pandemic. The results derived from this study may be useful in formulating policies and practices related to the workforce development, funding streams to prepare for the next wave of COVID-19 infections as well as for future public health emergencies.

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Section: Nasa-tlx As a Workload Measurementioning

confidence: 99%

Has COVID-19 changed the workload for primary care physicians? The case of Spain

Fernández-Aguilar¹,

Casado‐Aranda

Fernández³

et al. 2021

Family Practice

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“…Workload is generally considered to comprise the following two large aspects: objective workload that is simply reflected by the quantity of work tasks, and mental workload that reflects the mental strains resulting from a human operator performing a work task under a specific environmental or operational condition as well as the capability of the human operator to respond to task demands ( 16 ). Currently, the onset of modern technology and automation has greatly shifted the workload paradigm from the physical domain to the mental domain ( 16 , 17 ), and some researchers thereby used mental workload as the measure of an individual's workload ( 18 ). Mental workload is also a term referring to the cost of completing a work task, and it can be defined as the amount of brain or cognitive resources used/consumed per unit time to reach the acceptable performance required by the work task ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have investigated the physician workload in various working settings [e.g., emergency department ( 16 , 23 ), clinical care ( 18 , 25 )] using single methods noted in the literature review or a combination of these methods ( 16 ); however, most of them might have failed to comprehensively assess physician workload, since they either only focused on the objective workload ( 4 ) or mental workload using single or multiple metrics, or just simply measured both objective workload and mental workload to obtain a more comprehensive assessment of physician workload ( 16 ). It is obvious that such a single or non-integrated evaluation framework will not effectively solve comprehensive assessments of physician workload.…”

Section: Introductionmentioning

confidence: 99%

“…Workload is also influenced in part by the nature of the work task in question ( 28 ). Research indicated that physician workload is increased with complexity of medical cases or medical care ( 16 , 18 , 23 , 26 , 30 , 31 ), and the well-known RBRVS (resource-based relative value scale, RBRVS) model, widely used for medical workers' performance appraisal, revealed that these patient factors such as complexity, and severity of the patient's disease had a positive impact on the physician workload. Thus, patient complexity should be considered into the comprehensive assessment framework of physician workload.…”

Section: Introductionmentioning

confidence: 99%

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Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China

et al. 2022

Front. Public Health

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BackgroundPrevious studies, often simply using either objective workload or mental workload as a measure of physician workload in various healthcare settings might have failed to comprehensively reflect the real workload among physicians. Despite this, there is little research that further explores a comprehensive workload evaluation framework with the integration of objective workload and mental workload to describe their comprehensive workload.MethodsA comprehensive evaluation framework for physician workload was proposed based on the combination of objective workload and task-level mental workload also with the consideration of quality of provided medical services and served patient complexity; and accordingly, an integrated evaluation model for physician comprehensive workload (PCW) tethered to outpatient practice was developed and further applied to perform a PCW analysis using cross-sectional data on outpatient workload of 1,934 physicians mainly from 24 hospitals in 6 provinces in Eastern, Central, and Western China. Multiple linear regression and multinomial logistic regression analyses were established to identify significant factors influencing the PCW.ResultsOverall, the average score of PCW tethered to outpatient practice Chinese physicians experienced was 811.30 (SD=494.98) with concentrating on between 200 and 1,200. Physicians who were female, from Eastern or Western China, and those who worked >60 h per week and longer outpatient hours per week were more likely to experience a higher PCW. 11.2% of participating physicians were identified as very high PCW physicians, compared with 11.6% as low PCW physicians, 45.5% as medium PCW physicians and 30.7% as high PCW physicians. Those who were female, older, from Western China, those who had lower educational levels, lower professional titles and longer working years in the current institution, and those who worked in tertiary A hospitals and Internal or Surgical, and worked >60 h per week and longer outpatient hours per week were more likely to be very high PCW physicians.ConclusionsOur work has a potential application for comprehensively assessing physician workload tethered to outpatient practice and could provide a solid foundation for hospital managers to further accurately determine and identify physicians with high workload, who would otherwise be missed in either objective workload or mental workload.

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“…Furthermore, the number of problems addressed affects the GP’s perceived workload due to the strict time constraints. 13 This suggests that time pressure is a common working condition in primary care. Nevertheless, only few studies have explored the significance of strategies used to cope with lack of time and the association with burnout.…”

Section: Introductionmentioning

confidence: 99%

Burnout, coping strategies and help-seeking in general practitioners: a two-wave survey study in Denmark

Pedersen

Vedsted

2022

BMJ Open

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ObjectiveWork pressure remains an issue among general practitioners (GPs). Nevertheless, GPs rarely seek help for symptoms of burnout. The aim of this study was to examine whether burnout level was associated with coping strategies and help-seeking behaviour during time pressure.DesignA two-wave nationwide survey (2016 and 2019) based on questionnaire data from 1059 GPs.SettingPrimary care in Denmark.MethodsBurnout was measured by the Maslach Burnout Inventory (MBI), whereas coping strategies and help-seeking behaviour were measured by questions developed for the study. A composite score of quartile points was calculated for the three subscales of the MBI subscales. A score ≥9 was categorised as high level of burnout, and the composite score of 2019 was used as outcome. Data were analysed with logistic regression adjusted for sex, age and composite burnout score in 2016.ResultsHigh scores in 2016 on four key factors were associated with increased risk of high composite burnout score in 2019. These factors were compromising work (ORadjusted=2.27, 95% CI=1.45 to 3.56), postponing decisions (ORadjusted=1.53, 95% CI=1.04 to 2.24), delaying tasks (ORadjusted=1.61, 95% CI=1.16 to 2.25) and reducing breaks (ORadjusted=1.46, 95% CI=1.01 to 2.11) during time pressure. A lower risk of high composite burnout score was seen in 2019 in GPs who had sought help compared with GPs who did not seek help despite a perceived need (ORadjusted=0.59, 95% CI=0.35 to 0.97).ConclusionCertain coping strategies used in 2016 were associated with increased risk of high burnout score in 2019, whereas lower risk of high burnout was seen in the GPs seeking help. These findings are relevant to reduce burnout rates among GPs.

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Relationship between number of health problems addressed during a primary care patient visit and clinician workload

Cited by 11 publications

References 29 publications

Has COVID-19 changed the workload for primary care physicians? The case of Spain

Has COVID-19 changed the workload for primary care physicians? The case of Spain

Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China

Burnout, coping strategies and help-seeking in general practitioners: a two-wave survey study in Denmark

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