Psychosocial working conditions as determinants of concerns to have made important medical errors and possible intermediate factors of this association among medical assistants - a cohort study.

We sought to examine the association of psychosocial working conditions with concerns to have made important medical errors and to identify possible intermediate factors in this relationship. We used data from 408 medical assistants (MAs) in Germany who participated in a 4-year prospective cohort study (follow-up period: 03-05/2021). Psychosocial working conditions were assessed at baseline by the effort-reward imbalance questionnaire and by a MA-specific questionnaire with seven subscales. MAs reported at follow-up whether they are concerned to have made an important medical error throughout the last 3 months, 12 months or since baseline (yes/no). These variables were merged into a single variable (any affirmative response vs. none) for primary analyses. Potential intermediate factors measured at baseline included work engagement (i.e., vigor and dedication, assessed by the UWES), work satisfaction (COPSOQ), depression (PHQ-2), anxiety (GAD-2) and self-rated health. We ran Poisson regression models with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). Doing so, we employed the psychosocial working condition scales as continuous variables (i.e. z-scores) in the primary analyses. Potential intermediate factors were added separately to the regression models. Poor collaboration was the only working condition, which was significantly predictive of the concern of having made an important medical error (RR = 1.26, 95%CI = 1.00-1.57, p = 0.049). Partial intermediate factors in this association were vigor, depression and anxiety. We found weak and mostly statistically non-significant associations. The only exception was poor collaboration whose association with concerns to have made an important medical error was partially explained by vigor and poor mental health.

Mambrey V ，Angerer P ，Loerbroks A 《BMC HEALTH SERVICES RESEARCH》

Psychosocial working conditions as determinants of slips and lapses, and poor social interactions with patients among medical assistants in Germany: A cohort study.

We sought to examine the relationship of unfavorable psychosocial working conditions with slips and lapses and poor patient interaction as well as potential intermediate factors among medical assistants (MAs) in Germany based on prospective data. We used data from 408 MAs from a 4-year cohort study (follow-up: 2021). At baseline, psychosocial working conditions were assessed by the established effort-reward-imbalance questionnaire and a MA-specific questionnaire with 7 subscales. Frequency of slips and lapses (e.g., pertaining to measurements and documentation) and the quality of patient interactions (e.g., unfriendliness or impatience) due to work stress were assessed at follow-up with three items each (potential score ranges = 3-15). Potential intermediate factors at baseline included work engagement (i.e., vitality and dedication (UWES)), work satisfaction (COPSOQ), anxiety (GAD-2), depressiveness (PHQ-2), and self-reported health. We ran multivariable linear regression using z-standardized exposures to estimate unstandardized coefficients (B) and 95% confidence intervals (CI). Potential intermediate factors were added separately to the regression models. Attenuation of the association between exposure and outcome toward the null value (B = 0) was interpreted as mediation. High reward and lack of resources were weakly associated with the frequency of slips and lapses (the Bs were -0.18 and 0.23, respectively; p<0.05), with little evidence of mediation. With the exception of low recognition, all unfavorable psychosocial working conditions predicted a higher frequency of poor interactions with patients (p-values<0.01). These associations were attenuated by work engagement, work satisfaction, and health outcomes. We found mostly non-significant associations between adverse psychosocial working conditions and the frequency of slips and lapses. However, unfavorable psychosocial working conditions among MAs predicted a higher frequency of poor interaction with patients due to stress.

Mambrey V ，Loerbroks A 《PLoS One》

The Gutenberg health study: a five-year prospective analysis of psychosocial working conditions using COPSOQ (Copenhagen psychosocial Questoinnaire) and ERI (effort-reward imbalance).

Psychosocial working conditions were previously analyzed using the first recruitment wave of the Gutenberg Health Study (GHS) cohort (n = 5000). We aimed to confirm the initial analysis using the entire GHS population at baseline (N = 15,010) and at the five-year follow-up. We also aimed to determine the effects of psychosocial working conditions at baseline on self-rated outcomes measured at follow-up. At baseline, working GHS participants were assessed with either the Effort-Reward-Imbalance questionnaire (ERI) (n = 4358) or with the Copenhagen Psychosocial Questionnaire (COPSOQ) (n = 4322); participants still working after five years received the same questionnaire again (ERI n = 3142; COPSOQ n = 3091). We analyzed the association between working conditions and the outcomes job satisfaction, general health, burnout, and satisfaction with life at baseline, at follow-up and also prospectively from baseline to follow-up using linear regression models. We examined the outcome variance explained by the models (R2) to estimate the predictive performance of the questionnaires. The models' R2 was comparable to the original baseline analyses at both t0 and t1 (R2 range: ERI 0.10-0.43; COPSOQ 0.10-0.56). However, selected scales of the regression models sometimes changed between assessment times. The prospective analysis showed weaker associations between baseline working conditions and outcomes after five years (R2 range: ERI 0.07-0.19; COPSOQ 0.07-0.24). This was particularly true for job satisfaction. After adjusting for the baseline levels of the outcomes, fewer scales still explained some of the variance in the distribution of the outcome variables at follow-up. The models using only data from t0 or t1 confirmed the previous baseline analysis. We observed a loss of explained variance in the prospective analysis models. This loss was greatest for job satisfaction, suggesting that this outcome is most influenced by short-term working conditions. Both the COPSOQ and ERI instruments show good criterion validity and adequately predict contemporaneously measured self-reported measurements of health and (occupational) well-being. However, the COPSOQ provides a more detailed picture of working conditions and might be preferable for improvment strategies in workplaces. Additional prospective research with shorter follow-up times would be beneficial for estimating dose-response relationships.

Nuebling M ，Hegewald J ，Starke KR ，Lincke HJ ，Jankowiak S ，Liebers F ，Latza U ，Letzel S ，Riechmann-Wolf M ，Gianicolo E ，Beutel M ，Pfeiffer N ，Lackner K ，Münzel T ，Wild PS ，Seidler A ... -  《BMC PUBLIC HEALTH》

The Relationship of Medical Assistants' Work Engagement with Their Concerns of Having Made an Important Medical Error: A Cross-Sectional Study.

Loerbroks A ，Vu-Eickmann P ，Dreher A ，Mambrey V ，Scharf J ，Angerer P ... -  《-》

Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany.

Vu-Eickmann P ，Li J ，Müller A ，Angerer P ，Loerbroks A ... -  《-》