Análisis de la violencia del paciente en atención primaria

Abstract

Main aim: to determine the frequency of violence in primary care. Secondary aims: to analyse its causes, consequences and connection with professional burnout and reduced motivation. Transversal, descriptive study. Primary care. 68 primary care doctors from 4 districts in the province of Jaén (350, 19%). Self-administered questionnaire with an ad hoc design, sent out by mail and including personal and job details and doctors' views on the causes and consequences of burnout and violence, and the attitudes of the Andalusian Health Service (SAS) and professional bodies (overall reliability, Cronbach's alpha =.7898). 58% had suffered aggression (85% verbal abuse, 67.5% threats, 12.5% physical aggression). Being attacked was linked with attributing the responsibility to the patients (odds ratio [OR]=7.6, 95% confidence interval [CI], 2.5-23), with doing extra shifts (OR=6.3; 95% CI, 1.2-33), rigidity (OR=3.5; 95% CI, 1.2-10.7), inadequate handling of emotive situations (OR=3.2; 95% CI, 1.1-9.2,) and incompetence (OR=5.2; 95% CI, 1.6-17). Violence scored the lowest as cause of burnout and was linked to the job being less rewarding (OR=2.9; 95% CI, 1.0-7.8). It was linked to irritation with the SAS (OR=2.8; 95% CI, 1.0-7.5) and fear of reduced motivation (OR=2.8; 95% CI, 1.0-7.5), with this latter being linked to loss of social prestige (P<.01), feeling low self-esteem (P<.01), and depression (P<.01). Violence is more common than in the figures given by the International Labour Organisation. It is associated with distrust, lack of communication in health care delivery and incompetence. It is the cause of burnout that is least appreciated and it is linked to the job being less rewarding and to greater fear of reduced motivation.