Identifying factors that contribute to burnout and resilience among hospital-based addiction medicine providers: A qualitative study

"Every Time I Go in There, It Gives Me Time to Reflect": A Qualitative Study of Patient Perspectives on Substance Use, Medications for Opioid Use Disorder, and Harm Reduction Following Hospitalization for Serious Injection-Related Infection

Background

Serious injection-related infections (SIRIs) have high morbidity and mortality, in part from incomplete antibiotic treatment, ongoing substance use and reinfection. Understanding how hospitalizations for SIRIs affect patient perspectives on substance use, harm reduction, and medications for opioid use disorder (MOUD) in the era of hospital-based addiction services will inform efforts to improve care.

Methods

We conducted qualitative interviews at Boston Medical Center with individuals hospitalized with SIRIs between 2020 and 2024. To ensure diverse experiences, we recruited qualifying participants based on record of SIRI International Classification of Diseases, 10th Revision, codes, presence on the outpatient parenteral antibiotic program list, during hospitalizations, and from a drop-in harm reduction program. Interviews were transcribed, coded inductively, and analyzed for key themes.

Results

Participants with SIRIs (n = 30) had the following characteristics: Most had endocarditis (n = 10) or osteomyelitis (n = 9) and had completed the recommended antibiotics (n = 24); the mean age was 39; most were male (n = 19), White (n = 21), and housed (n = 18). Three key themes emerged after SIRI hospitalization: (1) reduced substance use and adoption of harm reduction practices were common; (2) perspectives on MOUD varied, but negative experiences and medication stigma persisted; and (3) SIRI hospitalizations were viewed as an opportunity for reflection on substance use and health.

Conclusions

SIRI hospitalizations and the postdischarge period are opportunities to engage patients in addiction and infectious disease care. Participants expressed ambivalence about MOUD despite access to robust hospital-based addiction medicine services. Longitudinal support that explicitly includes harm reduction and MOUD, both linkage and retention, is needed to improve care for people with SIRIs.

Resident encounters with disruptive workplace behaviours in Japan: findings from a national cross-sectional study

IMPORTANCE

Disruptive workplace behaviours (DWBs) between healthcare professionals compromise patient care quality and organisational culture, impacting staff morale, communication and teamwork. Residents are particularly vulnerable to it from nurses and supervisors.

OBJECTIVE

Elucidate factors associated with DWBs experienced by residents.

DESIGN

Nationwide cross-sectional study using a web-based survey.

SETTING

Japanese postgraduate clinical training hospitals.

PARTICIPANTS

First- and second-year postgraduate residents were surveyed between 15 and 31 January 2023, immediately after participating in the nationally administered computer-based residency exam.

EXPOSURE

None.

MAIN OUTCOMES AND MEASURES

Primary outcomes include previously published eight types of DWBs experienced by residents. Resident characteristics at the time of the study were used. Hospital data (location of the training hospital, number of beds, number of emergency transports, average length of hospital stays, number of outpatients per day and the actual number of residents, full-time physicians and nurses) were obtained from Japan's largest hospital information database.

RESULTS

Of 5403 residents analysed, 68.3% were males, and 84.9% were under 28 years of age. Residents reported encountering DWBs from physicians and nurses approximately 35% of the time, a roughly equivalent percentage from both groups. After multivariate logistic regression analysis, the likelihood of encountering DWBs from nurses increased with hospital size (>700 beds; adjusted OR (aOR) 2.19; 501-700 beds; aOR 1.45 and 301-500 beds; aOR 1.26, all statistically significant). Furthermore, DWBs from nurses were significantly more prevalent in settings with higher admissions per nurse (aOR 1.70). DWBs from physicians were significantly more prevalent towards male (vs female) residents (aOR 1.60) and less likely among the second-year postgraduate (vs first-year postgraduate) residents (aOR 0.87).

CONCLUSIONS

DWBs from nurses are significantly more common with increasing hospital bed numbers and increase with the number of admissions per nurse. No such correlation was observed with DWBs from physicians. Male residents experience more DWBs than female residents.

Factors affecting healthcare workers burnout and their conceptual models: scoping review

BACKGROUND

The occupational stress that contributes to the development of burnout syndrome remains one of the greatest scientific challenges. Despite years of research into burnout and its determinants, burnout continues to attract the attention of researchers, and healthcare workers (HCWs) continue to experience burnout in large numbers. Burnout has a significant impact on both the mental and physical well-being of HCWs and reduces patient-centered healthcare. This review aims to identify the factors affecting healthcare workers' burnout (FAHCWB) and their conceptual models.

METHODS

The review was conducted according to Arksey and O'Malley's framework using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Searches were conducted in PubMed, Scopus, Wiley, ProQuest, Sage, Science Direct, and EBSCO using the following keywords: healthcare professionals, burnout, and internal/external factors. Empirical, qualitative, quantitative, and mixed-design research articles published in English with full-text access in peer-reviewed journals that investigated the FAHCWB were included. For an in-depth analysis of the included articles, the authors developed a data synthesis table, and thematic analysis was applied to the analysis.

RESULTS

According to the inclusion criteria, 38 articles were selected for further data analysis. Six main themes were identified: (1) FAHCWB; (2) conceptual models of FAHCWB; (3) research tools for studying FAHCWB; (4) findings on FAHCWB in the context of different models; (5) differences between findings from different models; (6) what is known and not known about FAHCWB. The results of the review show that most researchers conduct research on factors affecting burnout (FAB) based on factors related to the work environment, with fewer studies based on individual factors, including personality factors. Most of the research is based on the model developed by Maslach et al. The Maslach Burnout Inventory (MBI) has been used in most studies.

CONCLUSIONS

Despite years of research, burnout continues to evolve rapidly, indicating that scientific research needs to be re-focused. Research should be conducted using different conceptual models and new research tools that allow the syndrome to be studied from a multidimensional perspective, including both the work environment and individual factors.

"Moving beyond silos": focus groups to understand the impact of an adapted project ECHO model for a multidisciplinary statewide forum of substance use disorder care leaders manuscript authors

BACKGROUND

Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes.

METHODS

Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network's SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes.

RESULTS

16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps.

CONCLUSIONS

The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

Unintended consequences of methadone regulation for opioid use disorder treatment among hospitalized patients

BACKGROUND

In the United States, there are no federal restrictions on the use of methadone to manage opioid withdrawal symptoms when patients are hospitalized with a medical or surgical condition other than addiction. In contrast, in an outpatient setting, methadone for opioid use disorder (OUD) is highly regulated by federal and state governments and can only be dispensed from an opioid treatment program (OTP). Discrepancies in regulatory requirements across these settings may lead to barriers in care for patients with OUD.

OBJECTIVE

Identify how methadone regulation impacts the care of patients with OUD during hospitalization, care transitions, and in the OTP setting.

METHODS

We completed 26 interviews with clinicians and social workers working on hospital-based addiction consultation services across the United States. Study findings are the result of a secondary content analysis of interviews to identifying the word "methadone" and construct themes resulting from the data.

RESULTS

We identified three major themes related to "methadone" for OUD treatment, all of which impacted patient care: (1) limited OTP hours leads to tenuous or delayed hospital discharges; (2) inadequate information-sharing between hospitals and OTPs leads to delays in care; and (3) methadone regulations create treatment barriers for the most vulnerable patients.

CONCLUSION

Strict methadone regulations have resulted in unintended consequences for patients with OUD in the hospital setting, during care transitions, and in the OTP setting. Recent and ongoing federal efforts to reform methadone provision may improve some of the reported challenges, but significant hurdles remain in providing safe, equitable care to hospitalized patients with OUD.

In-Hospital Methadone Enrollment: a Novel Program to Facilitate Linkage from the Hospital to the Opioid Treatment Program for Vulnerable Patients with Opioid Use Disorder

INTRODUCTION

Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP.

AIM

Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage.

SETTING

Seven hundred-bed university hospital in Aurora, CO.

PROGRAM DESCRIPTION

A physician dually affiliated with a hospital's addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins.

PROGRAM EVALUATION METRICS

IN-MEET enrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments.

RESULTS

Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients (n = 1687), a higher percentage of IN-MEET patients were older (39.7 years, standard deviation [SD] 11.2 years vs. 36.1 years, SD 10.6 years) and were unhoused (n = 43, 58.9% vs. n = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance (n = 53, 72.6% vs. n = 677, 40.1%), reported methamphetamine as their secondary substance (n = 27, 37.0% vs. n = 380, 22.5%), and reported they injected their primary substance (n = 46, 63.0% vs. n = 478, 28.3%).

CONCLUSION

IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.

The prevalence of occupational burnout and its individual and situational predictors among addiction therapists

This study assesses the prevalence and individual and organizational predictors of occupational burnout among addiction therapists. A total of 452 addiction therapists from a representative sample of 184 Polish alcohol treatment facilities (outpatient and inpatient) participated in the study (facility response rate = 42%). The Oldenburg Burnout Inventory was used to measure occupational burnout, and 15 subscales of the Copenhagen Psychosocial Questionnaire II were administered to assess psychosocial work conditions. In addition, the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale and the abbreviated six-item De Jong Gierveld Loneliness Scale measured other important dimensions of addiction therapists' psychosocial functioning. Logistic regression was used for the analysis of the data. Occupational burnout was noticeably prevalent in the study group: 62% of respondents experienced exhaustion and 50% experienced disengagement from work, both to at least a moderate degree. Situational (organizational) variables were the most important predictors, explaining much more of the variance in both dimensions of burnout than the individual factors, of which only depression was significantly related to higher levels of exhaustion. Coronavirus anxiety played a marginal role in explaining the severity of burnout. The current study is one of the first attempts to assess the level of occupational burnout among addiction therapists and to comprehensively investigate the factors contributing to it. The findings provide useful information for the development of interventions aimed at preventing or reducing burnout in this professional group.

Barriers to initiate buprenorphine and methadone for opioid use disorder treatment with postdischarge treatment linkage

BACKGROUND

Hospitals are an essential site of care for people with opioid use disorder (OUD). Buprenorphine and methadone are underutilized in the hospital.

OBJECTIVES

Characterize barriers to in-hospital buprenorphine or methadone initiation to inform implementation strategies to increase OUD treatment provision.

DESIGN, SETTINGS, AND PARTICIPANTS

Survey of hospital-based clinicians' perceptions of OUD treatment from 12 hospitals conducted between June 2022 and August 2022.

MEASURES

Survey questions were grouped into six domains: (1) evidence to treat OUD, (2) hospital processes to treat OUD, (3) buprenorphine or methadone initiation, (4) clinical practices to treat OUD, (5) leadership prioritization of OUD treatment, and (6) job satisfaction. Likert responses were dichotomized and associations between "readiness" to initiate buprenorphine or methadone and each domain were assessed.

RESULTS

Of 160 respondents (60% response rate), 72 (45%) reported higher readiness to initiate buprenorphine compared to methadone, 55 (34%). Respondents with higher readiness to initiate medications for OUD were more likely to perceive that evidence supports the use of buprenorphine and methadone to treat OUD (p < .001), to perceive fewer barriers to treat OUD (p < .001), to incorporate OUD treatment into their clinical practice (p < .001), to perceive leadership support for OUD treatment (p < .007), and to have great job satisfaction (p < .04). Clinicians reported that OUD treatment protocols with treatment linkage, increased education, and addiction specialist support would facilitate OUD treatment provision.

CONCLUSION

Interventions that incorporate protocols to initiate medications for OUD, include addiction specialist support and education, and ensure postdischarge OUD treatment linkage could facilitate hospital-based OUD treatment provision.