Background Physicians’ work conditions and mental well-being may affect healthcare quality and efficacy. Yet the effects on objective measures of healthcare performance remain understudied. This study examined mental well-being, job satisfaction and self-rated workability in general practitioners (GPs) in relation to hospitalisations for ambulatory care sensitive conditions (ACSC-Hs), a register-based quality indicator affected by referral threshold and prevention efforts in primary care.
Methods This is an observational study combining data from national registers and a nationwide questionnaire survey among Danish GPs. To ensure precise linkage of each patient with a specific GP, partnership practices were not included. Study cases were 461 376 adult patients listed with 392 GPs. Associations between hospitalisations in the 6-month study period and selected well-being indicators were estimated at the individual patient level and adjusted for GP gender and seniority, list size, and patient factors (comorbidity, sociodemographic characteristics).
Results The median number of ACSC-Hs per 1000 listed patients was 10.2 (interquartile interval: 7.0–13.7). All well-being indicators were inversely associated with ACSC-Hs, except for perceived stress (not associated). The adjusted incidence rate ratio was 1.26 (95% CI 1.13 to 1.42) for patients listed with GPs in the least favourable category of self-rated workability, and 1.19 (95% CI 1.05 to 1.35), 1.15 (95% CI 1.04 to 1.27) and 1.14 (95% CI 1.03 to 1.27) for patients listed with GPs in the least favourable categories of burn-out, job satisfaction and general well-being (the most favourable categories used as reference). Hospitalisations for conditions not classified as ambulatory care sensitive were not equally associated.
Conclusions ACSC-H frequency increased with decreasing levels of GP mental well-being, job satisfaction and self-rated workability. These findings imply that GPs’ work conditions and mental well-being may have important implications for individual patients and for healthcare expenditures.
- general practice
- human factors
- quality improvement
- ambulatory care
- primary care
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Contributors All authors contributed substantially to the design of the study. KBN performed the statistical analyses in consultation with AHC. KBN wrote the first draft of the article. AFP, FB, AHC and PV assisted in writing and revising the manuscript. All authors read and approved the final manuscript.
Funding This study is funded by the Danish National Research Foundation for Primary Care and by the Danish Health Foundation.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The project was approved by the Danish Data Protection Agency (J.no. 2016–41-4648). According to Danish law, approval by the Danish National Committee on Health Research Ethics was not required for this study as no biomedical intervention was performed. Respondents gave their consent to participate by responding to the questionnaire. Personally identifiable information on GPs and patients were recoded and anonymised at Statistics Denmark prior to data analysis.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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