Mindfulness-based interventions for health professionals have been linked to improvements in burnout, well-being, empathy, communication, patient-centered care, and patient safety, but the optimal ...formats and intensity of training have been difficult to determine because of the paucity of studies and the heterogeneity of programs. A 4-days residential "Mindful Practice" workshop for physicians and medical educators featuring contemplative practices, personal narratives, and appreciative dialogs about challenging experiences may hold promise in improving participants' well-being while also improving compassionate care, job satisfaction, work engagement, and teamwork.
We collected baseline and 2-month follow-up data during four workshops conducted in 2018 to 2019 at conference centers in the United States and Europe. Primary outcomes were burnout, work-related distress, job satisfaction, work engagement, patient-centered compassionate care, and teamwork.
Eighty-five of 120 participants (71%) completed both surveys (mean age was 49.3 and 68.2% female). There were improvements (P < .01) in two of three burnout components (emotional exhaustion and depersonalization), work-related distress, job satisfaction, patient-centered compassionate care, work engagement and meaning, teamwork, well-being, positive emotion, mindfulness, somatic symptoms, and spirituality. Effect sizes (standardized mean difference of change) ranged from 0.25 to 0.61. With Bonferroni adjustments (P < .0031), teamwork, general well-being, and mindfulness became nonsignificant.
An intensive, multiday, mindfulness-based workshop for physicians had clinically significant positive effects on clinician well-being, quality of interpersonal care and work satisfaction, and meaning and engagement, all important indicators of improved health and sustainability of the health care workforce. Future iterations of the program should increase the focus on teamwork.
•eHealth literacy and HIV health literacy increased in the intervention group.•The greatest improvements were among those with the lowest health literacy scores.•Our findings have implications for ...broadening the function of peers/lay health workers in the health care continuum.
The goal of this study was to determine if a 6-week, peer-led intervention improves health literacy and numeracy among people living with HIV (PLWH).
We used a randomized controlled trial with repeated measurements, which included six, 90-minute, group-based training sessions. We recruited PLWH participants (n = 359) from safety-net practices in the New York City Metropolitan area and Rochester, NY. Participants were randomly assigned (1:1) to an intervention group (n = 180) or a control group (n = 179). Outcome measures were collected at baseline, eight weeks post-baseline, and at six months using the Brief Estimate of Health Knowledge and Action-HIV (BEHKA-HIV), the Electronic Health Literacy Scale (eHEALS), the Rapid Estimate of Adult Literacy (REALM), and the Newest Vital Sign (NVS).
The intervention group had statistically significant improvements in eHealth literacy and BEHKA-HIV compared to the control group. There were no statistically significant changes in general health literacy or numeracy in either group. The intervention had the greatest impact on participants with the lowest levels of eHealth literacy at baseline.
The intervention had a positive impact on participants’ HIV health literacy and eHealth literacy.
Our findings have implications for broadening the function of peer-workers in the health care continuum.
Substance use disorders, including opioid use disorder (OUD), are understood as chronic diseases with a relapsing and remitting course and no known cure. Medications for OUD (MOUD) are well ...established with decades of evidence supporting their safety and efficacy; however, treatment access remains poor and inequitable. Buprenorphine is an MOUD that can be prescribed in a primary care outpatient setting, although regulatory and administrative challenges are a barrier to prescribing it. Recent regulatory changes offer an opportunity to expand the number of family doctors who treat OUD.
We offered free, easily accessible buprenorphine "x-waiver training" led by a team of primary care clinicians. In addition, we provided wrap-around support for MOUD clinical questions and administrative needs with experienced family medicine mentors.
More than 400 clinicians attended our trainings, including medical students, residents, and attending physicians. Of the 101 attending physicians who completed our trainings, only 30 went on to apply for an x-wavier, and of those only 7 were currently prescribing when contacted 12 months later.
Our experience indicates that removing the training requirement is a necessary first step but is unlikely to result in major changes to rates of prescribing without other significant cultural changes.
Background
Little is known about strategies to improve patient activation, particularly among persons living with HIV (PLWH).
Objective
To assess the impact of a group intervention and individual ...coaching on patient activation for PLWH.
Design
Pragmatic randomized controlled trial.
Sites
Eight practices in New York and two in New Jersey serving PLWH.
Participants
Three hundred sixty PLWH who received care at participating practices and had at least limited English proficiency and basic literacy.
Intervention
Six 90-min group training sessions covering use of an ePersonal Health Record loaded onto a handheld mobile device and a single 20–30 min individual pre-visit coaching session.
Main Measures
The primary outcome was change in Patient Activation Measure (PAM). Secondary outcomes were changes in eHealth literacy (eHEALS), Decision Self-efficacy (DSES), Perceived Involvement in Care Scale (PICS), health (SF-12), receipt of HIV-related care, and change in HIV viral load (VL).
Key Results
The intervention group showed significantly greater improvement than the control group in the primary outcome, the PAM (difference 2.82: 95% confidence interval CI 0.32–5.32). Effects were largest among participants with lowest quartile PAM at baseline (
p
< 0.05). The intervention doubled the odds of improving one level on the PAM (odds ratio 1.96; 95% CI 1.16–3.31). The intervention group also had significantly greater improvement in eHEALS (difference 2.67: 95% CI 1.38–3.9) and PICS (1.27: 95% CI 0.41–2.13) than the control group. Intervention effects were similar by race/ethnicity and low education with the exception of eHealth literacy where effects were stronger for minority participants. No statistically significant effects were observed for decision self-efficacy, health status, adherence, receipt of HIV relevant care, or HIV viral load.
Conclusions
The patient activation intervention modestly improved several domains related to patient empowerment; effects on patient activation were largest among those with the lowest levels of baseline patient activation.
Trial Registration
This study is registered at Clinical Trials.Gov (NCT02165735).
Medications contribute to patients' out-of-pocket costs, yet most clinicians do not routinely screen for patients' cost-of-medication (COM) concerns.
To assess whether a single training session ...improves COM conversations.
Before-after cross-sectional surveys of patients and qualitative interviews with clinicians and staff.
7 primary care practices in 3 U.S. states.
In total, 700 patients were surveyed from May 2017 to January 2018: 50 patients per practice before the intervention and another 50 patients per practice after the intervention. Eligibility criteria included age 18 years or older and taking 1 or more long-term medications. Qualitative interviews with 45 staff members were conducted.
A single 60-minute training session for clinicians and staff from each practice on COM importance, team-based screening, and cost-saving strategies.
Patient data (demographics, number of long-term medications, total monthly out-of-pocket medication costs, and history of cost-related medication nonadherence) were obtained immediately before and 3 months after the intervention. Practice staff were interviewed 3 months after the intervention.
A total of 700 patient surveys were completed. Frequency of COM discussion improved in 6 of the 7 practices and remained unchanged in 1 practice. Overall, COM conversations with patients increased from 17% at baseline to 32% postintervention (P = 0.00). There was substantial heterogeneity among sites in before-after differences in patient-reported out-of-pocket COM. Qualitative analyses from key informant interviews showed wide variation in implementation of screening approaches, workflow, adoption of a team-based approach, and strategies for addressing COM.
It is not known whether improvements in COM conversations were sustained beyond 3 months.
A single team training to screen and address patients' medication cost concerns improved COM discussions over the short term. Further research is needed to assess sustained effects and impact on patient costs and medication adherence and to determine whether more intensive, scalable interventions are needed.
Robert Wood Johnson Foundation.
Despite decades of new policy guidelines and mandatory training modules, sexual harassment (SH) and gender bias (GB) continue in academic medicine. The hierarchical structure of medical training ...makes it challenging to act when one experiences or witnesses SH or GB. Most trainings designed to address SH and GB are driven by external mandates and do not utilize current educational techniques. Our goal was to design training that is in-person, active, and directed toward skills development.
Our academic family medicine (FM) department began by surveying our faculty and residents about their lived experiences of SH and GB. We used these data, incorporating principles of adult learning, to deliver voluntary, experiential, interactive workshops throughout 2019. The workshops took place during faculty development meetings and an annual retreat. We used interactive techniques that included case-based and Theater of the Oppressed formats.
Eighty percent of faculty and residents participated in at least one of our voluntary training sessions. In April of 2020, we administered a retrospective, pre/postsurvey on confidence in recognizing, responding to, and reporting SH and GB. We found significant improvements in all domains surveyed; many participants reported using the skills in the 6 months prior to completing the surveys.
We demonstrated that voluntary, interactive training sessions using the recommendations of the National Academies of Science Engineering and Medicine Report on the Sexual Harassment of Women improve participants' reported confidence in recognizing, responding to, and reporting SH and GB in one academic FM department. This training intervention is practical and can be disseminated and implemented in many settings.
Background
Shortening time between office visits for patients with uncontrolled hypertension represents a potential strategy for improving blood pressure (BP).
Objective
We evaluated the impact of ...multimodal strategies on time between visits and on improvement in systolic BP (SBP) among patients with uncontrolled hypertension.
Design
We used a stepped-wedge cluster randomized controlled trial with three wedges involving 12 federally qualified health centers with three study periods: pre-intervention, intervention, and post-intervention.
Participants
Adult patients with diagnosed hypertension and two BPs ≥ 140/90 pre-randomization and at least one visit during post-randomization control period (
N
= 4277).
Intervention
The core intervention included three, clinician hypertension group-based trainings, monthly clinician feedback reports, and monthly meetings with practice champions to facilitate implementation.
Main Measures
The main measures were change in time between visits when BP was not controlled and change in SBP. A secondary planned outcome was changed in BP control among all hypertension patients in the practices.
Key Results
Median follow-up times were 34, 32, and 32 days and the mean SBPs were 142.0, 139.5, and 139.8 mmHg, respectively. In adjusted analyses, the intervention did not improve time to the next visit compared with control periods, HR = 1.01 (95% CI: 0.98, 1.04). SBP was reduced by 1.13 mmHg (95% CI: −2.10, −0.16), but was not maintained during follow-up. Hypertension control (< 140/90) in the practices improved by 5% during intervention (95% CI: 2.6%, 7.3%) and was sustained post-intervention 5.4% (95% CI: 2.6%, 8.2%).
Conclusions
The intervention failed to shorten follow-up time for patients with uncontrolled BP and showed very small, statistically significant improvements in SBP that were not sustained. However, the intervention showed statistically and clinically relevant improvement in hypertension control suggesting that the intervention affected clinician decision-making regarding BP control apart from visit frequency. Future practice initiatives should consider hypertension control as a primary outcome.
Clinical Trial
www.ClinicalTrials.gov
Identifier: NCT02164331
Clinical Practice Guidelines (CPGs) represent a culmination of evidence-based recommendations for preventable conditions such as hypertension. Clinicians use CPGs to assist in making decisions about ...appropriate treatment and health care management in clinical situations. Despite clinicians’ positive regard and acceptance of CPGs to help achieve clinical goals, actual uptake of CPGs remains low. In order to improve uptake of clinical guidelines, it is important to understand factors that are drivers of clinician behavior related to achieving clinical goals. Goal motivation, as indicated by Regulatory Focus Theory (RFT), can be used to explain clinicians’ approach to achieving clinical care goals. This dissertation considers the implications of the relationship between Regulatory Focus and the uptake of hypertension clinical guidelines. Using data from a clinical trial within a practice-based research network (PBRN) of federally qualified health centers (FQHCs), this dissertation explored the relationship between clinicians’ Chronic Regulatory Focus and the uptake of hypertension clinical guidelines. Results indicated the majority of the clinicians in the sample were Prevention Dominant, and had been in practice over 5 years. Clinicians RF orientations were not jointly associated with clinician adherence to clinical practice guidelines, patients’ systolic blood pressure variation, or risk-taking in hypertension treatment. There was some evidence for an independent effect for each orientation on our outcomes of interest, however those findings will need to be confirmed in future studies. The results of this dissertation provide some evidence that RFT can be used a potential framework for understanding clinician treatment decisions in the clinical setting. Future studies should focus on including goals more closely aligned with clinician-specific behaviors.
A central premise in deployment of community health workers (CHW) is that CHWs share key characteristics with their patients. We sought to develop a scale to measure this construct called the ...Perceived Navigator Similarity (PNS) questionnaire.
We adopted items from a similarly developed scale, patient perceived similarity to their physicians, and examined its psychometric properties among 51 patients who were navigated for cancer care by a CHW.
Principal component analysis revealed two main factors: personal and ethnic. The scale was associated with greater satisfaction with navigation (p < 0.005) and cancer care (p < 0.05).
The PNS shows promise for further validation in larger samples assessing navigator-patient similarity from the patient perspective.
PDF
