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1.
Artigo em Inglês | MEDLINE | ID: mdl-33298803

RESUMO

BACKGROUND: The Minnesota Hospital Association (MHA) recognized the impact that burnout and disengagement had on the clinician population. A clinician task force developed a conceptual framework, followed by annual surveys and a series of interventions. Features of the job demands-resources model were used as the conceptual underpinning to this analysis. PURPOSE: The aim of this study was to assess the applicability of a clinician-driven conceptual model in understanding burnout and work engagement in the state of Minnesota. METHODOLOGY: Four thousand nine hundred ninety clinicians from 94 MHA member hospitals/systems responded to a 2018 survey using a brief instrument adapted, in part, from previously validated measures. RESULTS: As hypothesized, job demands were strongly related to burnout, whereas resources were most related to work engagement. Variables from the MHA model explained 40% of variability in burnout and 24% of variability in work engagement. Variables related to burnout with the highest beta weights included having sufficient time for work (-0.266), values alignment with leaders (-0.176), and teamwork efficiency (-0.123), all ps < .001. Variables most associated with engagement included values alignment (0.196), feeling appreciated (0.163), and autonomy (0.093), ps < .001. CONCLUSION: Findings support the basic premises of the proposed conceptual model. Remediable work-life conditions, such as having sufficient time to do the job, values alignment with leadership, teamwork efficiency, feeling appreciated, and clinician autonomy, manifested the strongest associations with burnout and work engagement. PRACTICE IMPLICATIONS: Interventions reducing job demands and strengthening resources such as values alignment, teamwork efficiency, and clinician autonomy are seen as having the greatest potential efficacy.

4.
BMC Fam Pract ; 21(1): 221, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115421

RESUMO

BACKGROUND: In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. METHODS: Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. RESULTS: Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P < .05; rho magnitude range: 0.16-0.66). Furthermore, Brief PETS scores differentiated groups based on marital and education status, presence/absence of a self-management routine, and optimal/suboptimal medication adherence (P < .05; ES range: 0.25-1.00). Declines in patient-reported physical or mental health status over time were associated with worsening PETS burden scores, while improvements were associated with improving PETS burden scores (P < .05; ES range: 0.04-0.44). Among clinic patients, 91% were willing to complete the Brief PETS as part of their clinic visits. CONCLUSIONS: The Brief PETS (final version: 32 items) is a reliable and valid tool for assessing person-centered care quality related to treatment burden. It holds promise as a means of giving voice to patient concerns about the complexity of disease management.

5.
J Gen Intern Med ; 35(2): 465-472, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31797160

RESUMO

BACKGROUND: The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear. OBJECTIVE: To quantify associations between time pressure, workplace characteristics ,and clinician outcomes. DESIGN: Prospective analysis of data from the Healthy Work Place randomized trial. PARTICIPANTS: 168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast. MAIN MEASURES AND METHODS: Time pressure was present when clinicians needed more time than allotted to provide quality care. Other metrics included work control, work pace (calm to chaotic), organizational culture and clinician satisfaction, stress, burnout, and intent to leave the practice. Hierarchical analysis assessed relationships between time pressure, organizational characteristics, and clinician outcomes. Adjusted differences between clinicians with and without time pressure were expressed as effect sizes (ESs). KEY RESULTS: Sixty-seven percent of clinicians needed more time for new patients and 53% needed additional time for follow-up appointments. Time pressure in new patient visits was more prevalent in general internists than in family physicians (74% vs 55%, p < 0.05), women versus men (78% vs 55%, p < 0.01), and clinicians with larger numbers of complex psychosocial (81% vs 59%, p < 0.01) and Limited English Proficiency patients (95% vs 57%, p < 0.001). Time pressure in new patient visits was associated with lack of control, clinician stress, and intent to leave (ESs small to moderate, p < 0.05). Time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate ESs, p's < 0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality. CONCLUSIONS: Time pressure, more common in women and general internists, was related to chaos, control and culture, and stress, burnout, and intent to leave. Future studies should evaluate these findings in larger and more geographically diverse samples.

6.
Crit Care Explor ; 1(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31872192

RESUMO

Objective: Burnout tends to be high in Intensive Care Unit (ICU) settings. Stressors include serious patient illness, round-the-clock acute events, and end of life (non-beneficial) care. We report on an ICU with very low burnout scores. We sought to understand factors that might be responsible for these favorable outcomes. Design: We compared ICU scores on burnout and its predictors with scores in non ICU providers, merging scores in four ICUs (burn, medical, surgical and pediatrics). Analyses included descriptive statistics, as well as general estimating equations to assess odds of burnout in ICU vs non ICU clinicians. Setting: Annual wellness survey performed in October 2017 at Hennepin Healthcare System (HHS), an integrated system of care that includes an urban safety net hospital in Minneapolis, Minnesota. Participants: Six hundred seventy-nine providers (physicians and advanced practice providers). Interventions: None. Measurements and Main Results: Annual surveys are performed using the validated Mini-Z 10 item wellness instrument. The Mini-Z assesses stress, satisfaction, and burnout, as well as known predictors including work control, chaos, teamwork, values alignment, and electronic medical record-related stress. Response rate in ICUs was 70% (64% elsewhere). Ten percent of ICU clinicians reported burnout, vs 37% of other providers (p = 0.015). ICUs were characterized as having lower chaos, less stress, and very high teamwork and values alignment between clinicians and leaders. Odds of burnout were four times lower in ICU clinicians (Odds Ratio 0.24, 95% CI 0.06, 0.96, p = 0.043). Of all HHS providers, those with values not aligned with leaders had 3.28 times the odds of burnout (CIs 1.92, 5.59, p < 0.001). Conclusions: Low burnout can be present in a busy, safety net ICU. Explicitly aligning values between clinicians and leaders may hold promise as a remediable worklife factor for producing these favorable results.

7.
JAMA Netw Open ; 2(8): e199609, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31418810

RESUMO

Importance: Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). Objectives: To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Design, Setting, and Participants: This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. Main Outcomes and Measures: Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. Results: Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (ß̂ = 1.26; P < .001), control of workload (for optimal control: ß̂ = -7.86; P < .001), and physical symptoms attributed to EHR use (ß̂ = 1.29; P < .001). Work conditions accounted for 36.2% of variance in burnout, where challenges included chaos (adjusted odds ratio, 1.39; 95% CI, 1.10-1.75; P = .006) and physical symptoms perceived to be from EHR use (adjusted odds ratio, 2.01; 95% CI, 1.48-2.74; P < .001). Coping strategies were associated with only 2.4% of the variability in stress and 1.7% of the variability in burnout. Conclusions and Relevance: Although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde/organização & administração , Profissionais de Enfermagem/psicologia , Assistentes Médicos/psicologia , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Adaptação Psicológica , Adulto , Assistência Ambulatorial/organização & administração , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Grupos Focais , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Médicos de Atenção Primária/organização & administração , Fatores de Risco , Carga de Trabalho
8.
JAMA Netw Open ; 2(6): e196201, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31225894

RESUMO

Importance: There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention. Objective: To examine organizational characteristics associated with trust. Design, Setting, and Participants: This prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016. Main Outcomes and Measures: Clinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach α = 0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more. Results: The study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P < .001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P < .001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P < .001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P < .001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P < .001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P = .02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P = .04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P < .001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P < .001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P = .02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P = .04). Conclusions and Relevance: Addressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.


Assuntos
Pessoal de Saúde/psicologia , Organizações/normas , Atenção Primária à Saúde/normas , Confiança , Local de Trabalho/normas , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Comunicação , Eficiência Organizacional/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Saúde do Trabalhador/normas , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/etiologia , Cultura Organizacional , Organizações/estatística & dados numéricos , Lealdade ao Trabalho , Assistentes Médicos/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional , Estudos Prospectivos , Responsabilidade Social , Estados Unidos , Carga de Trabalho/estatística & dados numéricos
11.
J Am Med Inform Assoc ; 26(2): 106-114, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517663

RESUMO

Objective: To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians. Methods: All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor/marginal time for documentation, moderately high/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures. Results: Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0-4.1; P < .0001), compared to those reporting sufficient time. Physicians reporting moderately high/excessive time on EHRs at home had 1.9 times the odds of burnout (95% CI: 1.4-2.8; P < .0001), compared to those with minimal/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout (95% CI: 1.6-3.7; P < .0001), compared to those who disagreed. Conclusion: HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Satisfação no Emprego , Masculino , Medicina , Pessoa de Meia-Idade , Estresse Ocupacional , Rhode Island , Inquéritos e Questionários , Carga de Trabalho
12.
Int J Health Care Qual Assur ; 31(8): 888-895, 2018 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-30415613

RESUMO

PURPOSE: The Healthy Work Place (HWP) study investigated methods to improve clinicians' dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice. DESIGN/METHODOLOGY/APPROACH: In total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed. FINDINGS: In total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418). SOCIAL IMPLICATIONS: More providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout. ORIGINALITY/VALUE: There is limited research on clinicians' workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.


Assuntos
Esgotamento Profissional/epidemiologia , Satisfação no Emprego , Atenção Primária à Saúde , Inquéritos e Questionários/estatística & dados numéricos , Local de Trabalho/psicologia , Ética Médica , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Melhoria de Qualidade/organização & administração , Fatores Sexuais
13.
Jt Comm J Qual Patient Saf ; 44(5): 238-249, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29759257

RESUMO

BACKGROUND: Medical scribes are frequently incorporated into the patient care model to improve provider efficiency and enable providers to refocus their attention to the patient rather than the electronic health record (EHR). The medical scribe program was based on four pillars (objectives): (1) provider satisfaction, (2) standardized documentation, (3) documentation components for risk adjustment, and (4) revenue enhancement. METHODS: The medical scribe program was deployed in nine non-resident-supported clinics (internal medicine, ophthalmology, orthopedics, hematology/oncology, urology), with the medical scribes (who have no clinical duties) supporting both physicians and advanced practice providers (nurse practitioners and physician assistants). This paper describes a prospective quasi-experimental study conducted at an academic, inner-city, hospital-based clinic system, RESULTS: A pre-post analysis showed positive results; of the 51 providers, 44 responded to the survey pre and 41 responded post. Respondents in the post-scribe group felt that a scribe was valuable (90.2%), that documentation time at the office improved (75.0% poor or marginal pre-scribe, vs. 24% post; p <0.0001), and that time spent on the EHR at home declined (63.6% with excessive or moderately high home EHR time pre vs. 31.7% post; p = 0.003). More providers felt satisfied with their role in clinic with the use of scribes, and more providers felt that with scribes they could listen sufficiently to patients (p <0.05). CONCLUSION: Scribe support was well received across the institution in multiple clinical settings. Benefits for providers were seen in documentation time and ability to listen to patients. Scribes appear to be an effective intervention for improving clinician work life.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Documentação/métodos , Documentação/normas , Pessoal de Saúde/organização & administração , Centros Médicos Acadêmicos/normas , Registros Eletrônicos de Saúde , Humanos , Satisfação no Emprego , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Médicos/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos
14.
JAMIA Open ; 1(1): 49-56, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093606

RESUMO

Objectives: Determine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies. Materials and methods: We performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians-each at 3 different health care institutions with 3 different EHRs. Results: Of the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted "a great deal of stress" because of their job. Forty-two percent reported "poor" or "marginal" control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was "excessive" or "moderately high." Focus group themes included HICT "successes" where all patients' information is accessible from multiple locations. HICT "stressors" included inefficient user interfaces, unpredictable system response times, poor interoperability between systems and excessive data entry. "Adverse outcomes" included ergonomic problems (eg, eye strain and hand, wrist, and back pain) and decreased attractiveness of primary care. Suggested "organizational changes" included EHR training, improved HICT usability, and scribes. "Personal/resilience" strategies focused on self-care (eg, exercise, maintaining work-life boundaries, and positive thinking). Discussion and conclusion: HICT use, while beneficial in many ways for patients and providers, has also increased the burden of ambulatory practice with personal and professional consequences. HICT and clinic architectural and process redesign are likely necessary to make significant overall improvements.

15.
Patient Relat Outcome Meas ; 8: 143-156, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29184456

RESUMO

Aims: To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS), in people with diabetes. Methods: We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management. Internal reliability of PETS scales was determined using Cronbach's alpha. Construct validity was determined through correlation of PETS scores with established measures (measures of chronic condition distress, medication satisfaction, self-efficacy, and global well-being), and known-groups validity through comparisons of PETS scores across clinically distinct groups. In an exploratory test of predictive validity, step-wise regressions were used to determine which PETS scales were most associated with outcomes of chronic condition distress, overall physical and mental health, and medication adherence. Results: Respondents were 37-88 years old, 59% female, 29% non-white, and 67% college-educated. PETS scales showed good reliability (Cronbach's alphas ≥0.74). Higher PETS scale scores (greater treatment burden) were correlated with more chronic condition distress, less medication convenience, lower self-efficacy, and worse general physical and mental health. Participants less (versus more) adherent to medications and those with more (versus fewer) health care financial difficulties had higher mean PETS scores. Medication burden was the scale that was most consistently associated with well-being and patient-reported adherence. Conclusion: The PETS is a reliable and valid measure for assessing perceived treatment burden in people coping with diabetes.

16.
Health Aff (Millwood) ; 36(10): 1808-1814, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-28971927

RESUMO

To better understand how clinicians' job satisfaction relates to work conditions and outcomes for clinicians and patients, we examined data from the Healthy Work Place trial. Data were collected from physicians and advanced practice providers at baseline and approximately one year later. At baseline, 74 percent of respondents indicated job satisfaction. Satisfaction was associated with less chaos, more cohesion, better communication, and closer values alignment at work, but not with higher-quality care or fewer medical errors. At follow-up, the respondents with satisfaction data then and at baseline who indicated increased satisfaction (16 percent of these respondents) were almost three times more likely to report improved burnout scores and over eight times as likely to indicate reduced intention to leave their practices, compared to the clinicians whose satisfaction did not increase. These findings confirm that clinicians' job satisfaction is related to remediable work conditions and suggest that it may be an important metric for clinical practices and practice organizations.


Assuntos
Satisfação no Emprego , Médicos/psicologia , Local de Trabalho/psicologia , Esgotamento Profissional/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Inquéritos e Questionários
17.
Patient Prefer Adherence ; 11: 1635-1646, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29033551

RESUMO

PURPOSE: Having multiple chronic conditions (MCCs) can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ) - the communicative and interpersonal skill of the provider - may mitigate treatment burden and promote self-management. The objectives of this study were to 1) identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2) determine if certain indicators of HPRQ are more strongly associated than others with these outcomes. PATIENTS AND METHODS: This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples t-tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes. RESULTS: Most respondents (69%) were diagnosed with ≥3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes (P<0.001), even after controlling for physical and mental health. Those reporting 100% adherence to prescribed medications had higher HPRQ scores than those reporting less than perfect adherence (P<0.001). HPRQ items showing the strongest associations with outcomes were "my healthcare provider spends enough time with me", "my healthcare provider listens carefully to me", and "I have trust in my healthcare provider". CONCLUSION: Good communication and interpersonal skills of healthcare providers may lessen feelings of treatment burden and empower patients to feel confident in their self-management. Patient trust in the provider is an important element of HPRQ. Educating healthcare providers about the importance of interpersonal and relational skills could lead to more patient-centered care.

18.
J Am Board Fam Med ; 30(2): 127-129, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28379818

RESUMO

The article by Puffer et al in this month's JABFM confirms a high burnout rate (25%) among family physicians renewing their credentials, with a higher rate among young and female doctors. Recent reports confirm high burnout rates among general internists. Thus, mechanisms to monitor and improve worklife in primary care are urgently needed. We describe the Mini Z (for "zero burnout program") measure, designed for these purposes, and suggest interventions that might improve satisfaction and sustainability in primary care, including longer visits, clinician control of work schedules, scribe support for electronic medical record work, team-based care, and an explicit emphasis on work-home balance.


Assuntos
Esgotamento Profissional , Esgotamento Psicológico , Feminino , Humanos , Médicos , Médicos de Família , Prevalência , Atenção Primária à Saúde , Recursos Humanos
19.
Qual Life Res ; 26(2): 489-503, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27566732

RESUMO

PURPOSE: The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS). METHODS: A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. RESULTS: A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps < 0.001). Patients with lower health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01). CONCLUSION: A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Autocuidado/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
J Gen Intern Med ; 32(1): 56-61, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27612486

RESUMO

BACKGROUND: While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety. DESIGN: A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City. PARTICIPANTS: Primary care clinicians and their diabetic and hypertensive patients. INTERVENTIONS: Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline. MAIN MEASURES: We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category. KEY RESULTS: There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09). LIMITATIONS: Few quality metrics, short time span, fewer clinicians recruited than anticipated. CONCLUSIONS: Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov # NCT02542995.


Assuntos
Erros Médicos/prevenção & controle , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Local de Trabalho/organização & administração , Idoso , Esgotamento Profissional/prevenção & controle , Análise por Conglomerados , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Análise de Regressão
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