INTRODUCTION Primary care is complex due to multiple health problems being addressed in each patient visit. Little is known about the effect of the number of problems per encounter (NPPE) on the resulting clinician workload (CWL), as measured using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). METHODS We evaluated the relationship between NPPE and CWL across 608 adult patient visits, conducted by 31 clinicians, using hierarchical linear regression. Clinicians were interviewed about outlier visits to identify reasons for higher or lower than expected CWL. RESULTS Mean NPPE was 3.30 ± 2.0 (sd) and CWL was 47.6 ± 18.4 from a maximum of 100. Mental demand, time demand and effort accounted for 71.5% of CWL. After adjustment for confounders, each additional problem increased CWL by 3.9 points (P < 0.001). Patient, problem, environmental and patient-physician relationship factors were qualitatively identified from interviews as moderators of this effect. CONCLUSION CWL is positively related to NPPE. Several modifiable factors may enhance or mitigate this effect. Our findings have implications for using a Human Factors (HF) approach to managing CWL.

中文翻译：

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初级保健患者就诊期间解决的健康问题数量与临床医生工作量之间的关系。

引言由于每次患者就诊均涉及多个健康问题，因此初级保健很复杂。使用美国国家航空航天局任务负荷指数（NASA-TLX）进行测量，每次遇到的问题数量（NPPE）对最终临床医生工作量（CWL）的影响知之甚少。方法我们采用分层线性回归方法，评估了31位临床医生对608名成年患者进行的NPPE和CWL之间的关系。对临床医生进行了离群访诊，以查明CWL高于或低于预期的原因。结果平均NPPE为3.30±2.0（sd），而CWL为47.6±18.4（最大值为100）。精神需求，时间需求和精力占CWL的71.5％。调整混杂因素后，每增加一个问题，CWL就会增加3.9点（P <0.001）。患者，从访谈中定性地确定了问题，环境和患者与医师之间的关系因素是造成这种影响的原因。结论CWL与NPPE呈正相关。几个可修改的因素可能会增强或减轻这种影响。我们的发现对使用人为因素（HF）方法管理CWL有影响。