醫師門住診服務量對罹患感冒的影響

Effect of Service Volume on Cold Incidence among Physicians

目的：工作負荷衍生的壓力與疲勞可能威脅醫師的健康，本研究旨在探討醫師工作負荷對自身健康的影響。方法：利用國家衛生研究院發行之全民健康保險資料中所有醫學中心在1999-2010年的門診與住院資料，以廣義估計方程式進行邏輯斯迴歸分析，實證檢視醫師罹患感冒是否與前月門住診服務量有關，並檢視有無收治住院病患的醫師，其門診服務量對發生感冒的解釋能力是否不同。結果：控制醫院特性、醫師特性、季節與時間趨勢的影響後，當醫師每日看診人次、月看診人次、月看診天數或收治住院病患數增加時，都可能使醫師次月感冒的發生率提高，顯示醫師的健康與其門住診服務量有關：而以提供門診服務為主要工作的醫師，其門診服務量對罹患感冒的影響高於同時提供門住診服務的醫師。結論：避免醫師工作負荷過大，有助於降低健康危害。

Objectives. We hypothesize that the stress and burnout accompanying increases in workload could threaten physicians' health. To find out, we investigated the effect of workload on incidence of colds. Methods. We extracted insurance claims data for patients utilizing medical centersfrom the records of theBureau of National Health Insurance, including data for both outpatient and inpatient treatment records from January 1, 1999 to December 31, 2010.We examined (1) the association between the physicians' number of services and the incidence of common colds among these physicians in the subsequent month using logistic regression models and generalized estimating equations and (2) the difference in the incidences of colds between physicians who cared for inpatients and those who did not. Results. After controlling for influences of hospital characteristics, physician characteristics, season and time trend, we found that the incidence of colds increased significantly with the increase in clinical services per day, clinical services per month, clinical dates per month, and hospitalized patients per month. In addition, the effect of workload on physicians providing clinical services to outpatients only was higher than that it was on physicians seeing hospitalized patients. Conclusion. Steps should be taken to prevent overwork among physicians in order to reduce the incidence of colds in this population.