Emergency Medical Services Personnel Compliance with Escalating Airway Algorithm Protocol.

Introduction. When emergency medical services (EMS) personnel respond to emergencies, the decisions they make often can mean life or death for the patient. This is especially true in the case of advanced airway management. Protocols are set in place to ensure that the least invasive airway management techniques are used initially before more invasive techniques. The purpose of this study was to determine how often EMS personnel followed this protocol, while adequately achieving the goals of appropriate oxygenation and ventilation. Methods. This retrospective chart review was approved by the Institutional Review Board of the University of Kansas Medical Center. The authors reviewed the Wichita/Sedgewick County EMS system for cases during 2017 in which patients required airway support. We examined de-identified data to determine if invasive methods were applied in sequence. Cohen's kappa coefficient (κ) and immersioncrystallization approach were used to analyze the data. Results. A total of 279 cases were identified in which EMS personnel used advanced airway management techniques. In 90% (n = 251) of cases, less invasive techniques were not used prior to more invasive techniques and in 80% (n = 222) of cases, the more invasive technique was used alone. A dirty airway was the most common reason for the EMS personnel's choice of using more invasive approaches in achieving the goals of appropriate oxygenation and ventilation. Conclusions. Our data showed that EMS personnel in Sedgwick County/Wichita, Kansas often deviated from the advanced airway management protocols when caring for patients in need of respiratory intervention. Dirty airway was the main reason for using a more invasive approach in achieving the goals of appropriate oxygenation and ventilation. It is important to understand reasons why deviations in protocol were occurring to ensure that current protocols, documentation, and training practices are effective in producing the best possible patient outcomes.

Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies.

Introduction. Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary; however, the final decision of which medication to administer to a patient is made independently by paramedics. This study sought to describe the clinical decision-making process of prehospital behavioral emergencies when paramedics consider chemical restraints, and determine the factors associated with choosing specific medications to administer. Methods. Paramedics from a Midwest County in the United States were surveyed in November of 2019. The survey consisted of two open-ended questions, measuring paramedics' clinical decision-making process and factors that they considered when selecting a medication. An immersion-crystallization approach was used to analyze the interviews. Results. There was a 53% (79/149) response rate. Six themes emerged regarding the paramedics' decisions to use medication for cases involving patients with behavioral emergencies: safety of the patients and paramedics; inability to use calming techniques; severity of the behavioral emergency; inability to assess the patient due to presentation; etiology of the behavioral episode; and other factors, such as age, size, and weight of the patient. Six themes emerged regarding factors paramedics considered when choosing which medication to use in behavioral emergencies: etiology of the behavioral emergency, patient presentation, the patient's history, the patient's age, desired effect and intended outcome of the medication, and other factors. Conclusion. This study suggests there are several factors, such as safety and the etiology of the behavioral emergency, that contributed to paramedics' decision-making. The results of this study could help Emergency Medical Services administrators in revising behavioral emergency protocols.

Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies.

Introduction: Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary for prehospital behavioral emergency. However, the final decision of which medication to administer to a patient is made independently by paramedics. The authors evaluated circumstances in a prehospital behavioral emergency when paramedics considered chemical restraints, and factors that go into choosing which medications to administer. Methods: A qualitative research design was used involving paramedics from a Midwestern County in the United States, between November 18 and 26, 2019. A total of 149 paramedics were asked to complete a survey consisting of two open-ended questions to measure their clinical decision-making process and factors considered when selecting a medication from a behavioral emergencies protocol. An immersion-crystallization approach was used to analyze the content of the interviews. Results: There was a 53% (n = 79) response rate. Six major themes emerged regarding the paramedics' decisions to use medication for behavioral emergencies: safety of the patients and paramedics, inability to use calming techniques, severity of the behavioral emergency, inability to assess the patient due to presentation, etiology of the behavioral episode, and other factors, such as age, size, and weight of the patient. Six major themes emerged regarding factors considered when choosing medication for behavioral emergency: etiology of the behavioral emergency, patient presentation, the patients' history and age, desired effect and intended outcome of the medication, and other factors. Conclusions: Emergency medical services (EMS) paramedics relied on several factors, such as safety of all parties involved and etiology of the behavioral emergency in deciding when, and which medication to use in a behavioral emergency. The findings could help EMS administrators to develop protocols, such as how paramedics respond and treat patients with behavioral health emergencies.

Evaluation of 340B prescription assistance program on healthcare use in chronic obstructive pulmonary disease.

Background: The federal 340B drug program was designed to stretch scarce federal resources to provide more comprehensive services for more eligible patients. To help satisfy community needs, 340B Prescription Assistance Programs (PAPs) allow eligible patients to access medications at significantly reduced costs. Objectives: To measure the impact of reduced-cost medications for chronic obstructive pulmonary disease (COPD) through a 340B PAP on all-cause hospitalizations and emergency department visits. Methods: This multi-site, retrospective, single-sample, pre-post cohort study involved patients with COPD who used a 340B PAP to fill prescriptions for an inhaler or nebulizer between April 1, 2018, and June 30, 2019. Data from included subjects were evaluated and compared in the year before and after each individual patient's respective prescription fill in the 340B PAP. The primary outcome evaluated the impact of 340B PAP on all-cause hospitalizations and emergency department visits. Secondary outcomes evaluated the financial impact associated with program use. Wilcoxon signed-rank test was utilized to assess changes in the outcome measures. Results: Data for 115 patients were included in the study. Use of the 340B PAP resulted in a significant reduction in the composite mean number of all-cause hospitalizations and emergency department visits (2.42 vs 1.66, Z = -3.12, p = 0.002). There was an estimated $1012.82 mean cost avoidance per patient due to reduction in healthcare utilization. Annual program-wide prescription cost savings for patients totaled $178,050.21. Conclusions: This study suggested that access to reduced-cost medications through the federal 340B Drug Pricing Program was associated with a significant reduction in hospitalizations and emergency department visits for patients with COPD, decreasing patients' utilization of healthcare resources.

Improving Chronic Pain Management in a Family Medicine Residency.

BACKGROUND AND OBJECTIVE: Although the opioid epidemic continues to affect millions of Americans, many family physicians feel underprepared to perform chronic pain management (CPM) and treat opioid use disorder (OUD). To address this gap, we created organizational policy changes and implemented a didactic curriculum to help improve patient care, including medication-assisted treatment (MAT) into our residency. We investigated whether the educational program improved the comfort and ability of family physicians to prescribe opioids and utilize MAT. METHOD: Clinic policies and protocols were updated to align with the 2016 Centers for Disease Control and Prevention Guidelines for Prescribing Opioids. A didactic curriculum was created to improve resident and faculty comfort with CPM and introduce MAT. An online survey was completed pre- and postintervention between December 2019 and February 2020, utilizing paired sample t test and percentage effective (z test) to assess for change in provider comfort with opioid prescribing. Assessments were made using clinical metrics to monitor compliance with the new policy. RESULTS: Following the interventions, providers reported improved comfort with CPM (P=.001) and perception of MAT (P<.0001). Within the clinical setting there was significant improvement in the number of CPM patients who had a pain management agreement on file (P<.001) and completed a urine drug screen within the past year (P<.001). CONCLUSION: Provider comfort with CPM and OUD increased over the course of the intervention. We were also able to introduce MAT, adding a tool to the toolbox to help our residents and graduates treat OUD.

Assessment of Emergency Medical Services Personnel Compliance with Escalating Airway Algorithm Protocol.

Introduction: When emergency medical services (EMS) personnel respond to emergencies, the decisions they make often can mean life or death for the patient. This is especially true in the case of advanced airway management. Protocols are set in place to ensure that the least invasive airway management techniques are used initially before more invasive techniques. The purpose of this study was to determine how often EMS personnel followed this protocol, while adequately achieving the goals of appropriate oxygenation and ventilation. Methods: This retrospective chart review was approved by the Institutional Review Board of the University of Kansas Medical Center. The authors reviewed the Wichita/Sedgewick County EMS system for cases during 2017 in which patients required airway support. We examined de-identified data to determine if invasive methods were applied in sequence. Cohen's kappa coefficient (κ) and immersion-crystallization approach were used to analyze the data. Results: A total of 279 cases were identified in which EMS personnel used advanced airway management techniques. In 90% (n = 251) of cases, less invasive techniques were not used prior to more invasive techniques and in 80% (n = 222) of cases, the more invasive technique was used alone. A dirty airway was the most common reason for the EMS personnel's choice of using more invasive approaches in achieving the goals of appropriate oxygenation and ventilation. Conclusions: Our data showed that EMS personnel in Sedgwick County/Wichita, Kansas often deviated from the advanced airway management protocols when caring for patients in need of respiratory intervention. Dirty airway was the main reason for using a more invasive approach in achieving the goals of appropriate oxygenation and ventilation. It is important to understand reasons why deviations in protocol were occurring to ensure that current protocols, documentation, and training practices are effective in producing the best possible patient outcomes.

Nicotine Dependence from Electronic Cigarettes Use and Depressive Symptoms Among Adolescents.

Introduction: The use of electronic cigarettes (e-cigarettes) has been increasing among adolescents in the United States since they were first introduced to the U.S. market in 2007. With depression as a major risk factor for suicide in adolescents, this study examined nicotine dependence from the use of e-cigarettes and depressive symptoms among adolescents. Methods: The authors conducted a retrospective patient chart review at a pediatric clinic in the Midwestern United States, from May 2021 to September 2021. As a standard practice, the clinic uses the adapted Penn State Nicotine Dependency Index to evaluate its patients' nicotine dependence from the use of e-cigarettes, and the PHQ-9 modified for teens to screen for depressive symptoms of its patients. Data on 69 patients were included in the study. The authors used standard descriptive statistics and an adjusted odds ratio (aOR) to analyze the data on the 69 adolescents. Results: The mean age of the adolescents was 17.6 (SD = 2.3), 46.4% (n = 32) were female, and 53.6% (n = 37) were male. More than 88% (n = 61) of the adolescents met criteria for high nicotine dependence from e-cigarette use and 30.4% (21 of 69) of them screened positive for depression. Findings of the analyses indicated that there was not a statistically significant association between nicotine dependence from e-cigarette use and depressive symptoms (aOR = 1.07; 95% confidence interval, 0.93-1.23; p = 0.297). Conclusions: The results showed that while a third of the adolescents screened positive for depression and the majority (88%) depended on nicotine from e-cigarettes, there was no association between the outcomes. Future larger multicenter studies are needed to better understand the association between nicotine dependence from e-cigarettes and depressive symptoms as reported in the literature.

Improving First-Year Family Medicine Residents' Confidence in Safe Opioid Prescribing Through a Multiactivity Educational Program.

BACKGROUND AND OBJECTIVE: It is documented that some of the opioids prescribed to manage chronic pain are diverted and used for nonmedical purposes. We investigated whether a skill-based, chronic pain management (CPM) educational program could improve first-year family medicine residents' comfort, knowledge, and concerns in assessing and managing patients who use opioids for chronic noncancer pain. METHODS: A total of 72 first-year residents (four cohorts of 18) participated in a 3-month CPM training intervention that consisted of didactic lectures, objective structured clinical examination (OSCE) activities, and post-OSCE debriefing with faculty, one being a behavioral health specialist, between 2017 and 2020. We used a single-sample, pre/post design. At three points in time (baseline, 3-months, and 6-months postintervention), participants completed a set of measures assessing comfort, knowledge, and concern. We used repeated measures analyses to assess changes in outcome measures. RESULTS: Participants reported improvements compared with baseline at both follow-up time points. At 6 months postintervention, the participants had significantly better scores on measures of comfort (F[1, 71]=65.22; P<.001), knowledge (F[1, 71]=22.38, P<.001), and concern (F[1, 71]=37.89, P<.001) in prescribing opioids for chronic noncancer pain. CONCLUSION: A multiactivity CPM educational program for first-year residents was associated with improvement in perceived sense of comfort, knowledge, and concerns in assessing and managing patients who use opioids for chronic noncancer pain. CPM training interventions may be an effective tool to educate first-year residents to implement best practices for pain management with the goal of reducing the chances of inappropriately prescribing controlled substances or denying analgesia.

Burnout, Depression, Anxiety, and Stress Among Resident Physicians 18 Months Into the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Burnout among resident physicians has been an area of concern that predates the COVID-19 pandemic. With the significant turmoil during the pandemic, this study examined resident physicians' burnout, depression, anxiety, and stress as well as the benefits of engaging in activities related to wellness, mindfulness, or mental wellbeing. Methods: A cross-sectional survey of 298 residents from 13 residency programs sponsored by the University of Kansas School of Medicine-Wichita was conducted in October and November 2021. A 31-item questionnaire measured levels of burnout, depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, one-way ANOVA/Kruskal-Wallis tests, adjusted odds ratios (aOR), and immersion-crystallization methods were used to analyze the data. Results: There was a 52% response rate, with 65.8% (n = 102) of the respondents reporting manifestations of burnout. Those who reported at least one manifestation of burnout experienced a higher level of emotional exhaustion (aOR = 6.73; 95% CI, 2.66-16.99; p < 0.01), depression (aOR = 1.21; 95% CI, 1.04-1.41; p = 0.01), anxiety (aOR = 1.14; 95% CI, 1.00-1.30; p = 0.04), and stress (aOR = 1.36; 95% CI, 1.13-1.64; p < 0.01). Some wellness activities that respondents engaged in included regular physical activities, meditation and yoga, support from family and friends, religious activities, time away from work, and counseling sessions. Conclusions: The findings suggested that the COVID-19 pandemic poses a significant rate of burnout and other negative mental health effects on resident physicians. Appropriate wellness and mental health support initiatives are needed to help resident physicians thrive in the health care environment.

Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas: 18 Months into the COVID-19 Pandemic.

INTRODUCTION: Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted 3 months into the pandemic. METHODS: A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians' levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t-test, χ2, adjusted odds ratio, and immersion-crystallization methods were used to analyze the data. RESULTS: The response rate was 48.9% (n = 133). In aggregate, 69.2% of respondents reported at least 1 manifestation of professional burnout in 2021 compared with 50.4% in 2020; P ≤ .01). The 2021 respondents were at higher odds of experiencing burnout compared with 2020 respondents (aOR = 1.86; 95% CI, 1.00 to 3.57; P = .046). The respondents who reported at least 1 manifestation of professional burnout were more likely to screen positive for depression (aOR = 1.87; 95% CI, 1.31-2.66; P ≤ .01), report higher levels of anxiety (aOR = 1.53; 95% CI, 1.04-2.24; P = .013), and higher levels of stress (aOR = 1.39; 95% CI, 1.17-1.66; P ≤ .001). CONCLUSION: As the COVID-19 pandemic continued, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest timely need for appropriate psychological supports.

Using the Residency Matched Method and Intent to Practice Method to Estimate Primary Care Workforce Production.

Introduction: Many medical schools overestimate the percentage of their graduates who enter the primary care workforce based on the "first-certificate" residency their graduates enter. To rectify this problem, Deutchman and colleagues proposed a new method of estimation. The objective of this study was to compare results from the traditional residency match and Deutchman methods to the actual percentage of University of Kansas School of Medicine (KUSM) graduates who practice primary care after completing medical school and all residency and subspeciality fellowship training. Methods: A retrospective study was conducted using a convenience sample of KUSM graduates from 2003-2014. Percentages of graduates classified as primary care by the traditional Residency Match Primary Care Method (RMPCM) and the percentages of graduates identified as primary care by Deutchman's Intent to Practice Primary Care Method (IPPCM) were compared with the actual percentage of graduates who eventually entered the primary care workforce. Results: Of the 1,944 KUSM graduates identified during the study period, the RMPCM predicted a 48.1% primary care output rate. The Deutchman's IPPCM predicted a 22.8% primary care output rate. The actual known percentage of graduates practicing primary care was 34.2%. Conclusions: Neither the RMPCM nor the Deutchman's IPPCM performed well in predicting the percentage or number of KUSM graduates who eventually practiced primary care. Due to predictions for the shortage of primary care physicians, there is a need to identify a method that more accurately predicts the medical schools' contribution to the primary care workforce.

My Experiences with the North American Primary Care Research Group: A Reflection from an Emerging Primary Care Researcher.

As an early career medical educator and a relatively new member of the North American Primary Care Research Group, and as an emerging researcher, author would like to share his experiences with NAPCRG using the 5 Ws to mark the organization's 50th Anniversary.

Assessing Family Medicine Physicians' Perceptions of Integrated Behavioral Health in a Primary Care Residency.

BACKGROUND AND OBJECTIVES: Physicians are increasingly confronted with patients' interrelated psychosocial and physiological issues. To assist physicians in managing the psychosocial needs of patients, integrated behavioral health (IBH) has become increasingly common. This study was completed in a large, Midwestern family medicine residency program where the authors sought to (1) identify physicians' perceptions of IBH implementation and areas of needed IBH improvement, and (2) recognize educational needs to be addressed when providing behavioral health training to resident physicians. METHODS: The authors utilized a pre/post design to measure physician perception of access and quality of an integrated behavioral health program. For quantitative data, we performed standard descriptive statistics, likelihood ratio χ2 tests, independent sample t test, and linear mixed-model analysis. For qualitative data, we completed phenomenological analysis, derived from a focus group. RESULTS: Physician satisfaction with access and quality of behavioral health services significantly improved after the implementation of the IBH (P<.01). Perception of behavioral health management also improved, including the commitment of the residency program to mental health well-being, benefit from consultations with BHPs, and physician ownership of managing patients' mental health needs. Themes from the focus group indicated a desire for increased communication with BHPs, as well as additional assessment and intervention skills to manage psychiatric disorders. CONCLUSIONS: Family physicians value IBH in supporting patients' behavioral health treatment, and resident physicians hone behavioral health management skills through collaborating with BHPs and completing behavioral health training. Residencies should increase focus on teaching essential skills in behavioral health management.

Brief Mindfulness Intervention for Emotional Distress, Resilience, and Compassion in Family Physicians During COVID-19: A Pilot Study.

Background and Objective: There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program. Methods: A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures. Results: Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21. Conclusion: This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.

Academic Impact of COVID-19 in Collegiate Athletes.

Introduction: The COVID-19 pandemic caused a pause to nearly all sporting activities in the spring of 2020, and collegiate athletes at the National Collegiate Athletic Association (NCAA)-affiliated universities whose sporting seasons were affected by the pandemic were granted an extra year of athletic eligibility. This study was conducted to determine how collegiate athletes planned to use an additional year of eligibility granted by the NCAA. Methods: The authors conducted a cross-sectional survey of 632 athletes from two universities in the Midwestern United States, between August and September 2021. The athletes completed an anonymous, nine-item survey to assess the effect of the pandemic on the athletic season, athletic eligibility, and potential change in an academic or professional career. Chi-square tests, generalized linear mixed models, and adjusted odds ratio were used for the analyses. Results: The participation rate was 74.5% (471 of 632). Nearly 63% (290 of 461) of the athletes received an additional year of eligibility because of the pandemic, with 193 (66.6%) planned to use their extra year for scholastic development. Male athletes (65.3% vs. 34.7%; χ2[1, n = 290] = 11.66, p < 0.001, Φ = 0.20), Division II athletes (59.6% vs. 40.4%; χ2[1, n = 290] = 13.93, p < 0.001, Φ = 0.22), and athletes who had not previously used redshirt (73.1% vs. 26.9%; χ2[1, n = 290] = 4.79, p = 0.029, Φ = 0.32) where more likely to use their extra year of eligibility academically. Conclusions: Our findings suggested that most of the athletes planned to use their extra year of eligibility to pursue further scholastic or professional development, highlighting the positive part of the COVID-19 pandemic. Future studies should investigate how these findings relate to athletes from universities in different geographical locations and intra-division schools.

Family physicians in kansas response to the COVID-19 pandemic.

Introduction The novel coronavirus infectious disease (COVID-19) has spread rapidly with vast global implications. This study assessed how family physicians in Kansas responded to COVID-19 and the effects of the pandemic on the physicians' well-being. Methods. The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 18-item survey assessing family physicians' concerns about being exposed to COVID-19, levels of personal depression, anxiety, stress, and burnout in addition to demographic information. Results. There was a 45.6% response rate, with 50.4% (n=57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared to those who did not, were more likely to report at least one manifestation of burnout (odds ratio[OR]=3.96; 95% confidence interval [CI], 1.38-11.36; P = .011), experience emotional exhaustion (OR=3.21; 95% CI, 1.01-10.10; P<.05), and feel a higher level of personal stress (OR=1.13; 95% CI, 1.01-1.27; P=.011). Conclusion. Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes such as burnout, depression, anxiety, and stress, to determine the need for interventions, and influence the implementation of programs to support physician wellness. These data can help drive wellness and mental health support initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.

Family Physicians' Perception of the New mRNA COVID-19 Vaccines.

INTRODUCTION: This study was conducted to assess family physicians' perception of the US Food and Drug Administration-approved mRNA Coronavirus disease 2019 (COVID-19) vaccines, their plans to be vaccinated with an approved mRNA COVID-19 vaccine, and their support for vaccination of patients and family members. METHODS: The authors conducted a cross-sectional survey of 307 practicing family physicians, full-time faculty physicians, and resident physicians in Kansas from December 14, 2020, to December 31, 2020. The study participants completed an anonymous, 20-item survey assessing family physicians' concerns about exposure to COVID-19 and their perceptions of the mRNA COVID-19 vaccines to control SARS-CoV-2. A mixed-method approach was used to collect, analyze, and interpret the data. RESULTS: There was a 51.1% response rate. The proportion of family physicians who reported their intentions to be vaccinated for COVID-19 was significantly higher than those who were hesitant to receive the mRNA vaccines (90.6% vs 9.4%; χ2 [1, n = 307] = 201.9.1; P < .0001). Among those who were willing to be vaccinated with an approved mRNA COVID-19 vaccine, the main reasons were to prevent COVID-19 infection; protect self, family, and community; contribute to herd immunity; inspire confidence that the vaccines are safe and end the pandemic and bring life back to normal. CONCLUSION: Our findings suggest a significantly positive association between a physician's concerns and their willingness to be vaccinated with an approved mRNA COVID-19 vaccine. With the authorization of 2 new mRNA COVID-19 vaccines, future studies should investigate the number of physicians in our study who received the vaccine.

Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas Responding to the COVID-19 Pandemic.

INTRODUCTION: COVID-19 has spread rapidly, with vast global implications. This study assessed how family physicians in Kansas were responding to COVID-19 and the effects of the pandemic on their well-being. METHODS: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 36-item survey assessing their concerns about being exposed to COVID-19 and levels of personal depression, anxiety, stress, and burnout in addition to demographic information. RESULTS: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared with those who did not, were more likely to report at least 1 manifestation of burnout, experience emotional exhaustion, and feel a higher level of personal stress. CONCLUSION: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes. Data can help drive initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.

Loneliness, Burnout, and Other Types of Emotional Distress Among Family Medicine Physicians: Results From a National Survey.

PURPOSE: This study assessed the prevalence of loneliness, burnout, and depressive symptoms from a national sample of family medicine physicians. DISCUSSION: We conducted a cross-sectional survey of 401 physicians who were members of the American Academy of Family Physicians (AAFP) and AAFP National Research Network between December 7, 2019, and January 20, 2020. The study participants completed an anonymous, 30-item survey measuring loneliness, burnout, symptoms of depression, fatigue, in addition to providing demographic information. RESULTS: The response rates were 16.3% (401 of 2456) for all the physicians, 7.0% (113 of 1606) for the AAFP NRN member physicians, and 33.9% (288 of 850) for the AAFP member insight physicians. The prevalence of loneliness, burnout, and depressive symptoms was 44.9% (165 of 367), 45.1% (181 of 401), and 44.3% (163 of 368) respectively. The physicians who experienced a greater feeling of loneliness compared with those who experienced a lesser feeling of loneliness were more likely to report at least 1 manifestation of burnout (69.1% vs 27.4%, P < .01), screen positive for depression (66.0% vs 27.6%, P < .01), and experience a higher degree of fatigue (59.5% vs 32.4%, P < .01). Depressive symptoms (odds ratio [OR] = 5.08; 95% confidence interval [CI], 4.64-7.94; P < .001), overwhelming exhaustion (OR = 7.19; 95% CI, 4.03 to 12.02; P < .001), and burnout (OR = 4.61; 95% CI, 2.96-7.19; P < .001) were associated with loneliness status. CONCLUSION: Our findings demonstrate that loneliness is common in practicing family medicine physicians and is significantly associated with burnout and depression. Future work is needed to understand the various interactions and relationships among loneliness, burnout, and depression to help inform effective interventions.