某公立医院临床医师对防御性医疗行为的认知调查与分析  

A survey on clinicians'perceptions of defensive medical behaviors in a public hospital

作　　者：刘军军 Liu Junjun(The Yancheng School of Clinical Medicine,Nanjing Medical University/Yancheng Third People's Hospital,Yancheng 224000,Jiangsu Province,China)

机构地区：[1]南京医科大学盐城临床医学院、盐城市第三人民医院,江苏盐城224000

出　　处：《中国医疗管理科学》2023年第4期46-51,共6页Chinese Journal Of Medical Management Sciences

基　　金：江苏医药职业学院临床学院专项科研发展基金课题(20219148)。

摘　　要：目的调查分析临床医师对防御性医疗行为的认知情况及其影响因素,为医院管理实践提供参考。方法采用便利抽样法,于2023年3月期间抽取盐城市第三人民医院临床医师作为调查对象,使用自行设计的调查问卷进行认知情况调查,采用多元线性回归分析探究防御性医疗行为的影响因素。结果对防御性医疗行为的成因表示赞同及非常赞同比例最高的是“避免医疗纠纷的忧患意识”(84.48%)和“因医患信任度下降而产生的防备心理”(79.78%);对防御性医疗行为的主要影响因素表示赞同及非常赞同比例最高的是“恐惧医疗纠纷”(91.70%)和“工作科室”(91.34%);倾向于采取的消极型防御性医疗行为中表示赞同及非常赞同比例最高的前4位是“签署更多知情同意书”(91.16%)、“增加检查项目或扩大检查范围”(86.10%)、“由患方自行决定诊疗方案”(82.85%)、“夸大病情或诊疗风险”(82.67%);“诊疗实践活动具有高风险性”(b=0.347,t=2.589)和“医疗机构风险管理的推动”(b=-0.284,t=-2.200)是消极型防御性医疗行为的影响因素(P<0.05)。结论忧患意识和防备心理是防御性医疗行为的主要成因;恐惧医疗纠纷和工作科室是防御性医疗行为的主要影响因素;医院人文教育的延续性亟待完善。提示需健全医疗风险动态评估体系及应对机制;强化内部控制管理,以推动公立医院高质量发展;弘扬医学人文精神,积极推动医学模式转变;完善顶层设计与医疗职业保障体系。Objective To investigate and analyze clinicians'perceptions of defensive medical behaviors(DMB)and their influencing factors in an attempt to provide evidence in hospital management.Methods Using the convenience sampling method,we selected clinicians from the Third People's Hospital of Yancheng City as the research subjects in March 2023 and investigated their perceptions on DMB using a self-designed questionnaire.Factors affecting DMB were analyzed using the multivariate linear regression analysis.Results The vast majority of respondents agreed or strongly agreed that the causes of DMB were"the awareness of being involved in a crisis of medical dispute"(84.48%)and"the defensive mentality due to the decreased trust between doctors and patients"(79.78%).The respondents agreed or strongly agreed that the main factors influencing DMB were"fear of medical disputes"(91.70%)and"the department I work in"(91.34%).It was agreed or strongly agreed that the top 4 negative DMBs were"signing more informed consent"(91.16%),"increasing the number of tests or expanding the scope of tests"(86.10%),"letting the patient decide on his or her own diagnosis/treatment protocol"(82.85%),"exaggerating the medical condition or the risks of treatment"(82.67%).The main influencing factors for negative DMB were"high risk of treatment practice activities"(b=0.347,t=2.589)and"promotion of risk management in medical institutions"(b=-0.284,t=-2.200)(all P<0.05).Conclusions Awareness of crisis and defensive mentality are the main causes of DMB,and fear of medical disputes and working departments are the main influencing factors of DMB.The continuity of humanistic education in hospitals needs to be improved.Possible solutions may include:improve the dynamic medical risk assessment system and response mechanisms;strengthen internal control/management to promote high-quality development of public hospitals;enrich the medical humanism and promote the transformation of medical models;and improve top-level design and protection systems.

关 键 词：公立医院 临床医师 防御性医疗行为 认知调查 

分 类 号：R197[医药卫生—卫生事业管理]