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Sullivan EE, McKinstry D, Adamson J, Hunt L, Phillips RS, Linzer M. Burnout Among Missouri Primary Care Clinicians in 2021: Roadmap for Recovery? Mo Med 2022; 119:397-400. [PMID: 36118800 PMCID: PMC9462904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Rates of burnout among clinicians have been exacerbated by the COVID-19 (COVID)pandemic. A survey of Missouri primary care professionals at federally qualified health centers was conducted during a COVID surge in August 2021 to assess burnout, stress, and job satisfaction as well as if respondents had sought assistance for burnout or attended resiliency training. Despite respondents reporting rates of burnout (56%) that exceed those reported nationally (48%), only 17% sought help for burnout. Most (81%) had not attended resiliency training; of those who did, 16% said sessions "make me feel less alone," while an equivalent number found sessions not useful, identifying an absence of resources within their organization. Comments focused on the need for dedicated time to receive support, including time to seek assistance during working hours, time to take breaks, and time for self-care. The data suggest one path forward to remediate burnout: provide the workforce with time to access support.
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Affiliation(s)
- Erin E Sullivan
- Sawyer School of Business, Suffolk University, Boston, Massachusetts, and Harvard Medical School, Center for Primary Care, Harvard University, Boston, Massachusetts
| | | | - Joni Adamson
- Missouri Primary Care Association, Jefferson City, Missouri
| | - Lindsay Hunt
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, Massachusetts
| | - Russell S Phillips
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, Massachusetts and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Linzer
- Department of Medicine and Institute for Professional Worklife, Hennepin Healthcare System, Minneapolis, Minnesota
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DePuccio MJ, Sullivan EE, Breton M, McKinstry D, Gaughan AA, McAlearney AS. The Impact of COVID-19 on Primary Care Teamwork: a Qualitative Study in Two States. J Gen Intern Med 2022; 37:2003-2008. [PMID: 35412178 PMCID: PMC9002024 DOI: 10.1007/s11606-022-07559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The emergence of coronavirus disease 2019 (COVID-19) disrupted how primary care physicians (PCPs) and their staff delivered team-based care. OBJECTIVE To explore PCPs' perspectives about the impact of stay-at-home orders and the increased use of telemedicine on interactions and working relationships with their practice staff during the first 9 months of the pandemic. DESIGN Qualitative research. PARTICIPANTS Participants included PCPs from family and community medicine, general internal medicine, and pediatrics. APPROACH One-on-one, semi-structured video interviews with 42 PCPs were conducted between July and December 2020. Physicians were recruited from 30 primary care practices in Massachusetts and Ohio using a combination of purposeful, convenience, and snowball sampling. Interview questions focused on work changes and work relationships with other staff members during the pandemic as well as their experiences delivering telemedicine. All interviews were audio-recorded, transcribed verbatim, and coded using deductive and inductive approaches. KEY RESULTS Across respondents and states, the context of the pandemic was reported to have four major impacts on primary care teamwork: (1) staff members' roles were repurposed to support telemedicine; (2) PCPs felt disconnected from staff; (3) PCPs had difficulty communicating with staff; and (4) many PCPs were demoralized during the pandemic. CONCLUSIONS The lack of in-person contact, and less synchronous communication, negatively impacted PCP-staff teamwork and morale during the pandemic. These challenges further highlight the importance for practice leaders to recognize and attend to clinicians' relational and work-related needs as the pandemic continues.
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Affiliation(s)
- Matthew J DePuccio
- Department of Health Systems Management, College of Health Sciences, Rush University, Chicago, IL, USA.
| | - Erin E Sullivan
- Sawyer School of Business, Suffolk University, Boston, MA, USA.,Center for Primary Care, Harvard Medical School, Boston, MA, USA
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | | | - Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Breton M, Sullivan EE, Deville-Stoetzel N, McKinstry D, DePuccio M, Sriharan A, Deslauriers V, Dong A, McAlearney AS. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Fam Pract 2021; 22:192. [PMID: 34563113 PMCID: PMC8467009 DOI: 10.1186/s12875-021-01543-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has driven primary healthcare (PHC) providers to use telehealth as an alternative to traditional face-to-face consultations. Providing telehealth that meets the needs of patients in a pandemic has presented many challenges for PHC providers. The aim of this study was to describe the positive and negative implications of using telehealth in one Canadian (Quebec) and one American (Massachusetts) PHC setting during the COVID-19 pandemic as reported by physicians. METHODS We conducted 42 individual semi-structured video interviews with physicians in Quebec (N = 20) and Massachusetts (N = 22) in 2020. Topics covered included their practice history, changes brought by the COVID-19 pandemic, and the advantages and challenges of telehealth. An inductive and deductive thematic analysis was carried out to identify implications of delivering care via telehealth. RESULTS Four key themes were identified, each with positive and negative implications: 1) access for patients; 2) efficiency of care delivery; 3) professional impacts; and 4) relational dimensions of care. For patients' access, positive implications referred to increased availability of services; negative implications involved barriers due to difficulties with access to and use of technologies. Positive implications for efficiency were related to improved follow-up care; negative implications involved difficulties in diagnosing in the absence of direct physical examination and non-verbal cues. For professional impacts, positive implications were related to flexibility (teleworking, more availability for patients) and reimbursement, while negative implications were related to technological limitations experienced by both patients and practitioners. For relational dimensions, positive implications included improved communication, as patients were more at ease at home, and the possibility of gathering information from what could be seen of the patient's environment; negative implications were related to concerns around maintaining the therapeutic relationship and changes in patients' engagement and expectations. CONCLUSION Ensuring that health services provision meets patients' needs at all times calls for flexibility in care delivery modalities, role shifting to adapt to virtual care, sustained relationships with patients, and interprofessional collaboration. To succeed, these efforts require guidelines and training, as well as careful attention to technological barriers and interpersonal relationship needs.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, 150, place Charles-LeMoyne, Room 200, Longueuil, QC, J4K 0A8, Canada.
| | - Erin E Sullivan
- Healthcare Management, Sawyer School of Business, Suffolk University, Boston, USA
- Department of Global Health and Social Medicine/Center for Primary Care, Harvard Medical School, Boston, USA
| | - Nadia Deville-Stoetzel
- Department of Community Health Sciences, Université de Sherbrooke, 150, place Charles-LeMoyne, Room 200, Longueuil, QC, J4K 0A8, Canada
| | - Danielle McKinstry
- Healthcare Management, Sawyer School of Business, Suffolk University, Boston, USA
| | - Matthew DePuccio
- Department of Health Systems Management, Rush University, College of Health Sciences, Chicago, USA
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Véronique Deslauriers
- Department of Community Health Sciences, Université de Sherbrooke, 150, place Charles-LeMoyne, Room 200, Longueuil, QC, J4K 0A8, Canada
| | - Anson Dong
- Mount Sinai Hospital Academic Family Health Team, Toronto, Canada
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine and Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University, Columbus, USA
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Larochelle P, Genest J, Kuchel O, Boucher R, Gutkowska Y, McKinstry D. Effect of captopril (SQ 14225) on blood pressure, plasma renin activity and angiotensin I converting enzyme activity. Can Med Assoc J 1979; 121:309-16. [PMID: 223756 PMCID: PMC1704340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Seven patients with essential hypertension and seven patients with hypertension associated with renal artery stenosis received captopril (SQ 14225), an inhibitor of angiotensin I converting enzyme. There was a significant reduction in mean blood pressure, from 176/113 +/- 4/3 mm Hg during the control period to 140/90 +/- 5/3 mm Hg during captopril administration. Five patients received captopril alone and nine patients needed hydrochlorothiazide in addition to control their blood pressure. Captopril produced a significant increase in peripheral plasma renin activity. When measured 12 hours after the administration of captopril the angiotensin I converting enzyme activity was found to be similar to that during the control period even though the blood pressure was at or near normal. These findings indicate that although captopril is an effective antihypertensive agent, its action does not depend only on inhibition of plasma angiotensin I converting enzyme activity.
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Brunner HR, Waeber B, Wauters JP, Turin G, McKinstry D, Gavras H. Innappropriate renin secretion unmasked by captopril (SQ 14 225) in hypertension of chronic renal failure. Lancet 1978; 2:704-7. [PMID: 80634 DOI: 10.1016/s0140-6736(78)92703-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Captopril (SQ 14 225), an orally active inhibitor of angiotensin-converting enzyme, was given to 7 hypertensive patients with chronic renal failure whose plasma-creatinine ranged from 1.5--7.4 mg/dl; whose plasma-renin activity was normal; whose hypertension was not controlled by previous therapy consisting in 5 patients of three or more antihypertensive drugs; and whose blood-pressures averaged 176/111 +/- 11/3 mm Hg. Inhibition of converting enzyme by oral captopril, 200 mg twice daily, reduced blood-pressure to 156/100 +/- 9/5 mm Hg. 5 patients needed additional treatment by frusemide 40--250 mg/day orally. With this combined regimen the blood-pressure of all patients averaged 126/85 +/- 4/3 mm Hg after 8 +/- 2 weeks of captopril. The drug was well tolerated. These results suggest that inhibition of angiotensin-converting enzyme with or without sodium depletion is an efficient treatment for hypertension associated with chronic renal failure. It appears that although renin levels in patients with this condition may be "normal", they are inappropriate in relation to the subtle degree of sodium retention that occurs with this disorder.
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