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Ortmeyer HK, Giffuni J, Etchberger D, Katzel L. The Role of Companion Dogs in the VA Maryland Health Care System Whole Health(y) GeroFit Program. Animals (Basel) 2023; 13:3047. [PMID: 37835653 PMCID: PMC10571922 DOI: 10.3390/ani13193047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
GeroFit is a gym-based exercise program that promotes health and wellness among older sedentary veterans. The aims of the current study were to determine whether providing a companion dog as an alternative to gym-based exercise would similarly affect whole health outcomes. A total of 15 (n = 15) veterans (62 ± 11 years of age; 13 of 15 >54 years of age) underwent physical function testing, completed global and whole health questionnaires, and wore an accelerometer for 7 days before (baseline) and 3 months after a dog came into their home. The participants completed the Pet Attachment Scale (PAS), Dog Owner-Specific Quality of Life (DOQOL), and Canine Behavioral Assessment and Research questionnaires at 3 months. Cardiorespiratory endurance, lower body strength, daily steps, and time spent engaging in moderate physical activity all increased compared to the baseline levels. Body weight decreased among veterans whose body mass index was ≥30 (n = 11). The PAS and DOQOL scores indicated high attachment and positive effects on quality of life after having a dog in the home, with all veterans agreeing that having a dog improved the number of social activities they performed. We conclude that providing a companion dog to veterans not inclined to participate in gym-based exercise is an effective alternative method of promoting health and wellness in this population.
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Affiliation(s)
- Heidi K. Ortmeyer
- Geriatric Research Education Clinical Center, VA Maryland Health Care System, Baltimore, MD 21201, USA; (J.G.); (D.E.); (L.K.)
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Jamie Giffuni
- Geriatric Research Education Clinical Center, VA Maryland Health Care System, Baltimore, MD 21201, USA; (J.G.); (D.E.); (L.K.)
| | - Danielle Etchberger
- Geriatric Research Education Clinical Center, VA Maryland Health Care System, Baltimore, MD 21201, USA; (J.G.); (D.E.); (L.K.)
| | - Leslie Katzel
- Geriatric Research Education Clinical Center, VA Maryland Health Care System, Baltimore, MD 21201, USA; (J.G.); (D.E.); (L.K.)
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Thomas HR, Best M, Chua D, King D, Lynch J. Whole person assessment for family medicine: a systematic review. BMJ Open 2023; 13:e065961. [PMID: 37080631 PMCID: PMC10124221 DOI: 10.1136/bmjopen-2022-065961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES To identify and evaluate clinical approaches to whole person assessment (WPA) that are translatable to family medicine regarding feasibility, quality and alignment with theoretical models of whole person care (WPC). DESIGN Systematic literature review. DATA SOURCES MEDLINE, CINAHL, PsycINFO and ATLA Religion databases were searched through 9 March 2020, with additional handsearches. ELIGIBILITY CRITERIA English language clinical assessments of multiple domains; which involve patient-clinician interaction and are translatable to general practice (GP); from the fields of medicine, allied health, nursing, mental health and pastoral care. Tools designed for single diseases or symptoms, for outcome rather than clinical assessment or with outdated classification systems were excluded. DATA EXTRACTION AND SYNTHESIS We appraised the quality of included papers using Johanna Briggs' Institute Checklists and Terwee's criteria for validation studies. Clinical assessments' alignment with theoretical WPC, feasibility for adaptation to GP and quality were examined. We analysed extracted data using framework synthesis. RESULTS Searches retrieved 7535 non-duplicate items. Fifty-nine were included after screening, describing 42 WPA methods and representing multiple disciplines, purposes and formats. All included assessments aligned partially with models of WPC, but most did not adequately encompass all aspects of WPC. Robustness varied significantly and was often inadequately described. We judged none of the identified assessments to be ideal as a multipurpose WPA in GP. Some could be used for specific purposes, such as elicitation of patient perspectives or complexity assessment. CONCLUSIONS While no WPAs were found that were sufficient for broad implementation in GP, some approaches may be suitable with adaptation and evaluation. Strengths of existing approaches could inform WPA development in future. PROSPERO REGISTRATION NUMBER CRD42020164417.
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Affiliation(s)
- Hayley Robyn Thomas
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan Best
- Institute for Ethics and Society, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - David Chua
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David King
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Johanna Lynch
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Findley PA, Wiener RC, Mitra S, Wang H, Shen C, Sambamoorthi U. Whole Health in Parts: Omissions from National Data Sets. Popul Health Manag 2023; 26:22-28. [PMID: 36799933 PMCID: PMC10081708 DOI: 10.1089/pop.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.
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Affiliation(s)
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, USA
| | - Sophie Mitra
- Department of Economics, Research Consortium on Disability, Fordham University, Bronx, New York, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, Texas, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, “Vashisht” Professor for Health Disparities, HEARD Scholar, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Neba RA, Warner M, Manning SE, Wiener RC, Sambamoorthi U. The Association of Multimorbidity With Whole Health Activities Among Adults in the United States: Evidence From the NHIS and BRFSS. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231156857. [PMID: 37151572 PMCID: PMC10161296 DOI: 10.1177/27536130231156857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 05/09/2023]
Abstract
Background Whole health is a holistic approach encompassing integrative medicine, emotional, and spiritual health and is critical to improving health outcomes among individuals with multimorbidity. Objective To examine the prevalence of Whole Health activities and the association of multimorbidity and Whole Health activities using nationally representative datasets. Methods As no single dataset has information on Whole Health self-care activities, data from the 2017 National Health Interview Survey (n = 25 134) was used to measure participants' mind-body therapy usage, sleep, mental health, and physical activity. We used the 2017 Behavioral Risk Factor Surveillance System (n = 347 029) to assess regular vegetable and/or fruit consumption. Results A significantly lower percentage of adults with multimorbidity had adequate sleep (58.2%vs.67.1%), no psychological distress (71.8%vs.82.1%), adequate physical activity (48.2%vs.62.1%), and regular vegetable and/or fruit consumption (54.2%vs.56.6%) compared to those without multimorbidity. Although lower percentages of adults with multimorbidity utilized mind-body therapies (22.9%vs.25.2%), the association was reversed when adjusted for socioeconomic factors. In the fully adjusted models, adults with multimorbidity were more likely to use mind-body therapies (AOR = 1.19, 95%CI = 1.09, 1.31). Furthermore, when adjusting for other independent variables, the associations of multimorbidity with sleep, psychological distress, and diet were exacerbated, and the association of multimorbidity with physical activity was attenuated. Conclusion Adults with multimorbidity were less likely to engage in most of the Whole Health activities except mind-body therapies compared to the no multimorbidity group. Findings suggest that adjustment for other factors such as age and socioeconomic status changed the magnitude and direction of the association of multimorbidity with Whole Health activities.
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Affiliation(s)
- Rolake A. Neba
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Mayela Warner
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sydney E. Manning
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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Marchand WR, Zhang C, Hamilton C, Presson AP, Nelson R, Yoo M, Garland EL, Nazarenko E, Herrmann T. Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness. Complement Ther Med 2022; 71:102884. [PMID: 36096414 DOI: 10.1016/j.ctim.2022.102884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders. DESIGN This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes. SETTING The study was conducted at a large VHA medical center. INTERVENTIONS Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated. MAIN OUTCOME MEASURES Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures. RESULTS There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables. CONCLUSIONS WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.
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Affiliation(s)
- W R Marchand
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah School of Medicine Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, the United States of America; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, the United States of America.
| | - Chong Zhang
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Clayton Hamilton
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Angela P Presson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Richard Nelson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Minkyoung Yoo
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Eric L Garland
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, College of Social Work, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America; University of Utah Center on Mindfulness and Integrative Health Intervention Development, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Tracy Herrmann
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, Health Sciences Center, Department of Nutrition and Integrative Physiology, Salt Lake City, UT 84108, the United States of America
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Khanna A, Dryden EM, Bolton RE, Wu J, Taylor SL, Clayman ML, Anwar C, Kasom D, McGowan M, Mullur RS, Bokhour BG, Hyde J. Promoting Whole Health and Well-Being at Home: Veteran and Provider Perspectives on the Impact of Tele-Whole Health Services. Glob Adv Health Med 2022; 11:2164957X221142608. [PMID: 36452292 PMCID: PMC9703484 DOI: 10.1177/2164957x221142608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background The Veterans Health Administration (VA) is undergoing a transformation in how healthcare is organized and provided. This transformation to a Whole Health System of Care encompasses the integration of complementary and integrative health services, education, and Whole Health coaching to develop Veterans' self-care skills. During the COVID-19 pandemic, these services were provided via telehealth (tele-WH). Objective We sought to understand Veteran and provider perspectives on how tele-WH impacts Veteran engagement in Whole Health-aligned services and the impact on their well-being. Methods Semi-structured interviews were conducted with 51 providers who delivered tele-WH at 10 VA Medical Centers (VAMCs) and 19 Veterans receiving tele-WH at 6 VAMCs. Participants were asked about their experiences with tele-WH, what they perceived to be the impact of tele-WH on Veterans, and their preferences moving forward. Interviews were transcribed, and a content analysis was performed using a rapid approach. Results We identified 3 major themes that describe the perceived impact of tele-WH on Veterans. These include: (1) increased use of Whole Health-aligned services; (2) deeper engagement with Whole-Health aligned services; and (3) improvements in social, psychological, and physical well-being. Conclusion Tele-WH is perceived to be a strong complement to in-person services and is a promising mechanism for improving engagement with Whole Health-aligned services and promoting Veteran well-being. Future research is needed to measure outcomes identified in this study and to support more equitable access to telehealth for all.
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Affiliation(s)
- Aishwarya Khanna
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Eileen M. Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E. Bolton
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Brandeis University, The Heller School for Social Policy and Management, MA, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Stephanie L. Taylor
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | - Marla L. Clayman
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Chitra Anwar
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Danna Kasom
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Michael McGowan
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Rashmi S. Mullur
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Integrative Medicine Collaborative, University of California Los Angeles Health, Los Angeles, CA, USA
| | - Barbara G. Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Justeen Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Section of General Internal Medicine, Department of Medicine, Boston, MA, USA
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Strewler A, Bellamy K. Caring for Veteran Women. Nurs Clin North Am 2022; 57:359-373. [DOI: 10.1016/j.cnur.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levis M, Ludmer DJ, Cornelius S, Scott R, Watts BV, Shiner B. An implementation and effectiveness study evaluating Conflict Analysis in VA residential substance abuse services: Whole Health informed self-guided online care. Explore (NY) 2022; 18:688-697. [DOI: 10.1016/j.explore.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
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Schwabenbauer AK, Knight CM, Downing N, Morreale-Karl M, Mlinac ME. Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:374-393. [PMID: 34410781 PMCID: PMC8406673 DOI: 10.1037/fsh0000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Cynthia M. Knight
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Nicole Downing
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Michelle Morreale-Karl
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Department of Medicine, Harvard Medical School
| | - Michelle E. Mlinac
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School
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