负性医疗事件对医生防御性医疗的影响——来自八市医生调查的证据  

Association between Adverse Medical Events and Defensive Medicine:Evidence from A Physician Survey in 8 cities

作　　者：张莹 杜凡星 侯志远[1] Zhang Ying;Du Fanxing;Hou Zhiyuan(School of Public Health,Fudan University/NHC Key Laboratory of Health Technology Assessment,Shanghai,200032,China;不详)

机构地区：[1]复旦大学公共卫生学院·国家卫生健康委员会卫生技术评估重点实验室,上海200032

出　　处：《中国医院管理》2024年第3期68-71,共4页Chinese Hospital Management

基　　金：国家自然科学基金项目(71874034)。

摘　　要：目的分析我国公立医院医生的防御性医疗行为现状以及负性医疗事件经历所带来的影响。方法采用方便抽样收集2019年8个城市15家二级或三级医院的数据,运用描述性分析和多元线性回归模型,描述医生基本特征,分析医生的基本特征和负性医疗事件经历对防御性医疗的影响。结果男性(β_(2)=-0.59)、低收入(β_(2)=-1.47)以及急危重症科室(β_(1)=3.84,β_(2)=1.84)、儿科(β_(1)=3.01,β_(2)=2.16)和外科(β_(1)=2.64,β_(2)=1.67)的医生更易出现防御性医疗行为(P<0.05);具有负性医疗事件经历的医生更有可能实施防御性医疗行为。结论负性医疗事件经历会显著增加医生的防御性医疗行为,应通过各方努力改善医患关系,注重源头预防,完善纠纷化解机制。Objective To investigate the prevalence of defensive medicine among physicians in public hospitals in China and the impact of physicians'adverse medical events experiences.Methods Data were collected from 15secondary or tertiary public hospitals in the eight cities in 2019 using convenience sampling method.Descriptive and multiple linear regression analyses were performed to investigate physicians'characteristics and explore the associations between characteristics,adverse medical events experiences and the frequencies of defensive medicine.Results Physicians who are male(β_(2)=-0.59),low income(β_(2)=-1.47)and work in acute care units(β_(1)=3.84,β_(2)=1.84),pediatrics(β_(1)=3.01,β_(2)=2.16)and surgery(β_(1)=2.64,β_(2)=1.67)were more likely to engage in defensive medical behavior(P<0.05).Physicians who experienced adverse medical events practiced more frequent defensive medicine.Conclusion Adverse medical events experiences significantly increase physicians'defensive medicine practice.Joint efforts should be made to improve physician-patint relationship and focus on prevention at source and improving dispute resolution mechanisms.

关 键 词：防御性医疗 医患关系 负性医疗事件医生 公立医院 

分 类 号：R951[医药卫生—药学]