醫療產業中職業壓力對醫療用藥的影響—以更年期醫療人員施行荷爾蒙療法為例

Effect of Occupational Stress in Medical Practice on Prescription of Hormone Therapy among Menopause Health Personnel in Medical Industry

陳瑞堅(Ruey-Jien Chen)

指導教授 ： 陸洛

國立臺灣大學/管理學院/商學組/碩士(2009年)

https://doi.org/10.6342/NTU.2009.10428

摘要

背景與目的：醫療人員有職業壓力。荷爾蒙療法可以緩解更年期症狀，但具有可能的副作用。即令荷爾蒙療法對更年期有許多好處，近年來更年期藥物的使用不多。本研究想瞭解更年期醫療人員的職業壓力，是否對更年期藥物的使用之荷爾蒙療法有所影響。

方法：研究方法為以問卷調查為之。問卷由研究對象自填，以分析職業壓力與開藥情況的相關性。研究對象為更年期醫學會會員共178人 (回收率54.5%)。
研究主要衡量指標項目包括三大類：職業壓力指數類，荷爾蒙療法類，以及研究對象之的特徵類。職業壓力指數類採用的是 Occupational Stress Indicator –II (OSI-2)之問題，包括工作滿意度、心理健康、身體健康、行為風格、工作掌控感、工作壓力、因應努力等職業壓力指數變項類別。荷爾蒙療法類之問題則包括開給藥物作荷爾蒙治療 (hormone replacement therapy，HRT)的可能性、副作用考量、其它適應症考量、以及服務對象年齡考量等之影響度等四個類別。研究對象之的特徵類則為16項背景資料。

結果：研究對象平均年齡為51.7歲 (SD 7.8，Range 33-76)。38.1%為開業醫師， 32.0%為區域或地區醫院醫師，29.9%為醫學中心醫師。每週工作時數平均為44.9 (SD 16.7) 小時。研究結果顯示有工作壓力感受者佔74.2%，但工作滿意度有些滿意以上者為82.5%。面對更年期症狀不會開給處方者，則只占26.8%。結果也顯示研究對象工作壓力感與其它行業高相同，並不會比較高(p>0.05)。但是工作滿意度 (p =0.0002)、心理健康 (p<0.0001)、身體健康 (p<0.0001)、因應努力 (p=0.0399)等，都比其它行業好。OSI-2變項中，開藥可能性與研究對象對付職業壓力的因應努力(coping)呈正相關 (p= 0.006)，開藥也與服務對象之年齡 (p<0.001)、也與其它適應症呈現有意義相關 (p< 0.001)。但是，藥物的開給則與工作壓力程度、工作滿意度、心理健康、 身體健康、行為風格、掌控感、以及副作用的考量等均無相關 (all p>0.05)。Multiple regression分析則顯示，因應努力 (p= 0.003)可能是在OSI-2項目中影響開藥的最主要因素。

結論： 本研究澄清有關更年期醫療人員職業壓力之存在情況及職業壓力影響HRT開藥的因素之觀點。研究結果且顯示醫療人員之開藥主要考慮之因素除了藥物作用觀點以外，因應努力是OSI-2中影響開藥的主因，而非工作壓力。此發現可能對未來醫療照護之推行有具有意義。

關鍵字

職業壓力 ； 工作滿意度 ； 心理健康 ； 工作壓力 ； 因應努力 ； 荷爾蒙療法 ； 更年期

並列摘要

BACKGROUND and OBJECTIVE: Occupational pressure exists in medical personnel. Hormone replacement therapy (HRT) may produce adverse effects. Despise benefits of HRT, its use rate is not high. The risk does not sufficiently explain why medical professionals avoid prescribing HRT to treat menopausal symptoms. The presence of stress among medical personnel may be a factor that contributes to a physician’s decision to prescribe HRT. This survey clarifies the relationship between physicians' levels of occupational stress and the likelihood of their prescribing HRT for treatment of menopausal syndrome.
METHODS: A cross-sectional, mailed, self-administered survey was sent to 178 physicians belonging to a menopausal society nationwide (response rate 54.5%). Main outcome measures were items from Occupational Stress Indicator 2 (OSI-2), which included career satisfaction, mental well-being, physical well-being, type of behavior, job control, job pressure and coping with pressure; HRT items included the possibility of recommending HRT to treat menopausal syndrome, consideration of adverse drug effects, another indications for prescription of HRT, and patient age. The relationship between occupational stress and physicians’ attitudes toward prescribing HRT was evaluated.
RESULTS: Mean respondent age was 51.7 (SD 7.8, Range 33-76): 38.1% were local practitioners, 32.0% worked at a regional hospital, and 29.9% worked at a medical center. Mean work hours were 44.9/week (SD 16.7). Data indicates that 74.2% experienced job-related stress, 82.5% were at least somewhat satisfied with their careers, and only 26.8% would not recommend HRT. Respondents did not have a higher level of job-related stress than professionals in the other fields (p>0.05). However, career satisfaction (p=0.0002), mental well-being (p<0.0001), physical well-being (p<0.0001), and coping (p=0.0399) were significantly higher. The likelihood of prescribing HRT positively correlated with the coping variable in the OSI-2 (p= 0.006); it also significantly correlated with patients’ age (p<0.001) and other indications (p< 0.001). However, the likelihood of prescribing HRT doesn’t seem to be linked with job pressure, career satisfaction, mental well-being, physical well-being, type-A behavior, or drug side-effects (all p>0.05). Multiple regression analysis indicates that, among the OSI-2 variables, the measure of coping is the most useful predictor for the likelihood of prescribing HRT (p=0.003).
CONCLUSIONS: This study collected and analyzed data about the occupational stress of healthcare workers who treat menopausal symptoms and the relationship between stress and the possibility of prescribing HRT. Besides medical considerations, the measure of coping rather than occupational pressure was found to be the main factor affecting the likelihood of prescribing HRT. Higher levels of job-related stress do not seem to result in fewer prescriptions. These results may have some implications for improving the treatment of menopausal syndrome.

並列關鍵字

occupational stress ； job satisfaction ； mental health ； job stressor ； coping ； hormone replacement therapy ； menopause

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陸洛、李惠美、謝天渝：牙醫師職業壓力與身心健康、職業倦怠之關係：以高雄市牙醫師為例。應用心理研究 2005; 27:59-80。