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Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany.

Loerbroks A, Weigl M, Li J, Angerer P - BMC Public Health (2016)

Bottom Line: Physicians' depressive symptoms did not affect these associations substantially.The level of overcommitment did not modify associations between the ERI ratio and quality of care.Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.

View Article: PubMed Central - PubMed

Affiliation: Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany. Adrian.Loerbroks@uni-duesseldorf.de.

ABSTRACT

Background: Work stress may impair physicians' ability to provide high quality patient care. Prior research remains however sparse and has insufficiently explored explanations for this relationship. It has been suggested that physicians' poor mental health is one potential explanatory factor. We drew on a well-established model to measure work stress (the effort-reward imbalance [ERI] model) in order to test this hypothesis. Further, to address another research gap and to potentially inform the development of better-targeted interventions, we aimed to examine associations of individual ERI constructs with the quality of care.

Methods: We used cross-sectional data, which had been collected in 2014 among 416 physicians in Germany. ERI constructs (i.e. effort, reward, the ERI ratio, and overcommitment) were measured by the established 23-item questionnaire. Physicians' perceptions of quality of care were assessed by a six-item instrument inquiring after poor care practices or attitudes. Physicians' mental health was operationalized by the state scale of the Spielberger's State-Trait Depression Scales. We used both continuous and categorized dependent and independent variables in multivariable linear and logistic regression analyses.

Results: Both an increasing ERI ratio and increasing effort were associated with poorer quality of care while increasing rewards were related to better care. Physicians' depressive symptoms did not affect these associations substantially. Associations with overcommitment were weak and attenuated to non-significant levels by correction for depressive symptoms. The level of overcommitment did not modify associations between the ERI ratio and quality of care.

Conclusions: Our study suggests that high work-related efforts and low rewards are associated with reports of poorer patient care among physicians, irrespectively of physicians' depressive symptoms. Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.

No MeSH data available.


Related in: MedlinePlus

Mediation analyses of effort reward imbalance constructs (z scores) and quality of care (continuous variable), adjusted for age, sex, working environment and leadership position; * p <0.05, ** p < 0.01, *** p < 0.001
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Fig1: Mediation analyses of effort reward imbalance constructs (z scores) and quality of care (continuous variable), adjusted for age, sex, working environment and leadership position; * p <0.05, ** p < 0.01, *** p < 0.001

Mentions: Figure 1 depicts the results from the multivariable linear regression mediation analyses. All ERI components showed a significant relationship with depressive symptoms, which in turn, were associated with poorer quality of care. In analyses unadjusted for depressive symptoms, increasing scores for effort, ERI ratio, and overcommitent were associated with poorer care while higher rewards were related to better patient care. Correction for depression partly attenuated all those associations. Notably, associations of effort, reward, and the ERI ratio with quality of care persisted after additional adjustment for depressive symptoms. By contrast, the overcommitment-care relationship was weak and was attenuated to non-significant levels after adjustment for depressive symptoms.Fig. 1


Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany.

Loerbroks A, Weigl M, Li J, Angerer P - BMC Public Health (2016)

Mediation analyses of effort reward imbalance constructs (z scores) and quality of care (continuous variable), adjusted for age, sex, working environment and leadership position; * p <0.05, ** p < 0.01, *** p < 0.001
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835931&req=5

Fig1: Mediation analyses of effort reward imbalance constructs (z scores) and quality of care (continuous variable), adjusted for age, sex, working environment and leadership position; * p <0.05, ** p < 0.01, *** p < 0.001
Mentions: Figure 1 depicts the results from the multivariable linear regression mediation analyses. All ERI components showed a significant relationship with depressive symptoms, which in turn, were associated with poorer quality of care. In analyses unadjusted for depressive symptoms, increasing scores for effort, ERI ratio, and overcommitent were associated with poorer care while higher rewards were related to better patient care. Correction for depression partly attenuated all those associations. Notably, associations of effort, reward, and the ERI ratio with quality of care persisted after additional adjustment for depressive symptoms. By contrast, the overcommitment-care relationship was weak and was attenuated to non-significant levels after adjustment for depressive symptoms.Fig. 1

Bottom Line: Physicians' depressive symptoms did not affect these associations substantially.The level of overcommitment did not modify associations between the ERI ratio and quality of care.Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.

View Article: PubMed Central - PubMed

Affiliation: Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany. Adrian.Loerbroks@uni-duesseldorf.de.

ABSTRACT

Background: Work stress may impair physicians' ability to provide high quality patient care. Prior research remains however sparse and has insufficiently explored explanations for this relationship. It has been suggested that physicians' poor mental health is one potential explanatory factor. We drew on a well-established model to measure work stress (the effort-reward imbalance [ERI] model) in order to test this hypothesis. Further, to address another research gap and to potentially inform the development of better-targeted interventions, we aimed to examine associations of individual ERI constructs with the quality of care.

Methods: We used cross-sectional data, which had been collected in 2014 among 416 physicians in Germany. ERI constructs (i.e. effort, reward, the ERI ratio, and overcommitment) were measured by the established 23-item questionnaire. Physicians' perceptions of quality of care were assessed by a six-item instrument inquiring after poor care practices or attitudes. Physicians' mental health was operationalized by the state scale of the Spielberger's State-Trait Depression Scales. We used both continuous and categorized dependent and independent variables in multivariable linear and logistic regression analyses.

Results: Both an increasing ERI ratio and increasing effort were associated with poorer quality of care while increasing rewards were related to better care. Physicians' depressive symptoms did not affect these associations substantially. Associations with overcommitment were weak and attenuated to non-significant levels by correction for depressive symptoms. The level of overcommitment did not modify associations between the ERI ratio and quality of care.

Conclusions: Our study suggests that high work-related efforts and low rewards are associated with reports of poorer patient care among physicians, irrespectively of physicians' depressive symptoms. Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.

No MeSH data available.


Related in: MedlinePlus