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Tong M, Hurtado A, Deshpande R, Pietrzak RH, He C, Kaplan C, Kaplan S, Akhtar S, Feder A, Feingold JH, Ripp JA, Peccoralo LA. Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:450-459. [PMID: 37845586 PMCID: PMC10897117 DOI: 10.1007/s11606-023-08422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). OBJECTIVE To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. DESIGN A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. PARTICIPANTS Frontline HCWs at an urban tertiary care hospital in New York City. MAIN MEASURES Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. KEY RESULTS Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). CONCLUSIONS Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.
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Affiliation(s)
- Michelle Tong
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Richa Deshpande
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Sabrina Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Saadia Akhtar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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DePierro JM, Chan CC, Mohamed N, Starkweather S, Ripp J, Peccoralo LA. Determinants of Staff Intent to Leave Health Care During the COVID-19 Pandemic. Am J Public Health 2024; 114:200-203. [PMID: 38354356 PMCID: PMC10916731 DOI: 10.2105/ajph.2024.307574] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
Objectives. To identify potential drivers of health care worker attrition. Methods. We conducted a survey of 1083 nonphysician health care workers in a large urban health system in New York City from September to October 2022. Results. The results of a multivariable logistic regression analysis revealed that higher odds of intending to leave health care were significantly associated with male gender, registered nurse profession, burnout, self-perceived mental health service need, and verbal abuse from patients or visitors, whereas lower odds were seen among those reporting greater emotional well-being and a better workplace culture. A relative importance analysis indicated that burnout was the strongest correlate of intention to leave (22.5% relative variance explained [RVE]), followed by subjective emotional well-being (16.7% RVE), being a registered nurse (12.3% RVE), poorer perceived workplace culture (9.5% RVE), and male gender (5.9% RVE). Conclusions. Overall, our findings suggest the need for well-coordinated interventions that address both individual- and system-level factors in an effort to improve retention. Public Health Implications. Our results indicate a need for interventions targeting workplace culture, staff burnout, and mental health service provision. (Am J Public Health. 2024;114(S2):S200-S203. https://doi.org/10.2105/AJPH.2024.307574).
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Affiliation(s)
- Jonathan M DePierro
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chi C Chan
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nihal Mohamed
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sydney Starkweather
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan Ripp
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lauren A Peccoralo
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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Hennein R, Lowe SR, Feingold JH, Feder A, Peccoralo LA, Ripp JA, Mazure CM, Pietrzak RH. Pre- and peri-traumatic event stressors drive gender differences in chronic stress-related psychological sequelae: A prospective cohort study of COVID-19 frontline healthcare providers. J Psychiatr Res 2023; 162:88-94. [PMID: 37105023 DOI: 10.1016/j.jpsychires.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Women are at heightened risk for chronic stress-related psychological sequelae (SRPS), including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in response to potentially traumatic events, including the COVID-19 pandemic. However, few studies have examined pre- and peri-event stressors that could account for gender differences in chronic SRPS. To address this gap, we conducted a prospective cohort study of healthcare providers (HCPs) caring for patients with COVID-19 at a large tertiary care hospital in New York City, and measured mental health risk factors and symptoms of MDD, GAD, and PTSD at baseline (April 2020) and at a 7-month follow-up (December 2020). We defined chronic SRPS as the presence of probable MDD, GAD, and/or PTSD at both timepoints. We conducted a mediation analysis to evaluate whether pre- and peri-event stressors explained women's increased risk for chronic SRPS. Among our sample of 786 HCPs, 571 (72.6%) were women. Compared with men, women were twice as likely to have chronic SRPS (18.7% vs. 8.8%, χ2[1] = 11.38, p < 0.001). However, after accounting for pre- and peri-event stressors, being a woman was no longer associated with chronic SRPS (p = 0.58). The pre- and peri-event stressors that accounted for this heightened risk among women included being in a woman-prevalent profession (specifically nursing; estimate = 0.08, SE = 0.04, p = 0.05), pre-pandemic burnout (estimate = 0.11, SE = 0.05, p = 0.04), greater family-related (estimate = 0.09, SE = 0.03, p = 0.004), infection-related (estimate = 0.06, SE = 0.02, p = 0.007), and work-related concerns (estimate = 0.11, SE = 0.03, p < 0.001), and lower leadership support (estimate = 0.07, SE = 0.03, p = 0.005). These findings can inform institutional interventions to mitigate the risk of chronic SRPS among women HCPs.
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Affiliation(s)
- Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn M Mazure
- Yale School of Medicine, New Haven, CT, USA; Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pietrzak RH, Feder A, Feingold JH, Peccoralo LA, Ripp JA. Resilience in the Face of the COVID-19 Crisis. Prim Care Companion CNS Disord 2022; 24. [DOI: 10.4088/pcc.22br03342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Peccoralo LA, Pietrzak RH, Feingold JH, Syed S, Chan CC, Murrough JW, Kaplan C, Verity J, Feder A, Charney DS, Southwick SM, Ripp JA. A prospective cohort study of the psychological consequences of the COVID-19 pandemic on frontline healthcare workers in New York City. Int Arch Occup Environ Health 2022; 95:1279-1291. [PMID: 35064838 PMCID: PMC8783588 DOI: 10.1007/s00420-022-01832-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
Abstract
Objectives We sought to describe the course and correlates of psychological distress in frontline healthcare workers (FHCWs) during the COVID-19 pandemic in New York City (NYC). Methods A prospective cohort study of FHCWs at the Mount Sinai Hospital was conducted during the initial 2020 surge (T1) and 7 months later (T2). Psychological distress [i.e., positive screen for pandemic-related post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and/or generalized anxiety disorder (GAD)], occupational and personal exposures to COVID-19, coping strategies, and psychosocial characteristics were assessed. Four courses of psychological distress response were identified: no/minimal, remitted, persistent, and new-onset. Multinomial logistic regression and relative importance analyses were conducted to identify factors associated with courses of distress. Results Of 786 FHCWs, 126 (16.0%) FHCWs had persistent distress; 150 (19.1%) remitted distress; 35 (4.5%) new-onset distress; and 475 (60.4%) no/minimal distress. Relative to FHCWs with no/minimal distress, those with persistent distress reported greater relationship worries [19.8% relative variance explained (RVE)], pre-pandemic burnout (18.7% RVE), lower dispositional optimism (9.8% RVE), less emotional support (8.6% RVE), and feeling less valued by hospital leadership (8.4% RVE). Relative to FHCWs with remitted symptoms, those with persistent distress reported less emotional support (29.7% RVE), fewer years in practice (28.3% RVE), and psychiatric history (23.6% RVE). Conclusions One-fifth of FHCWs in our study experienced psychological distress 7 months following the COVID-19 surge in NYC. Pandemic-related worries, pre-pandemic burnout, emotional support, and feeling valued by leaders were linked to persistent distress. Implications for prevention, treatment, and organizational efforts to mitigate distress in FHCWs are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01832-0.
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Affiliation(s)
- Lauren A Peccoralo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shumayl Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Depression and Anxiety Center for Discovery and Treatment, New York, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn Verity
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lowe SR, Hennein R, Feingold JH, Peccoralo LA, Ripp JA, Mazure CM, Pietrzak RH. Are Women Less Psychologically Resilient Than Men? Background Stressors Underlying Gender Differences in Reports of Stress-Related Psychological Sequelae. J Clin Psychiatry 2021; 83. [PMID: 34936244 DOI: 10.4088/jcp.21br14098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Corresponding author: Sarah R. Lowe, PhD, Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510
| | - Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| | - Robert H Pietrzak
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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Peccoralo LA, Kaplan CA, Pietrzak RH, Charney DS, Ripp JA. The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty. J Am Med Inform Assoc 2021; 28:938-947. [PMID: 33550392 DOI: 10.1093/jamia/ocaa349] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify specific thresholds of daily electronic health record (EHR) time after work and daily clerical time burden associated with burnout in clinical faculty. MATERIALS AND METHODS We administered an institution-wide survey to faculty in all departments at Mount Sinai Health System from November 2018 to February 2019. The Maslach Burnout Inventory and Mayo Well-Being Index assessed burnout. Demographics, possible confounding variables, and time spent on EHR work/clerical burden were assessed. RESULTS Of 4156 eligible faculty members, 1781(42.9%) participated in the survey. After adjustment for background factors, EHR frustration (odds ratio [OR]=1.64-1.66), spending >90 minutes on EHR-outside the workday by self-report (OR = 1.41-1.90) and >1 hour of self-reported clerical work/day (OR = 1.39) were associated with burnout. Reporting that one's practice unloads clerical burden (OR = 0.50-0.66) and higher resilience scores (OR = 0.77-0.84) were negatively associated with burnout.Spending >90 minutes/day on EHR-outside work (OR = 0.66-0.67) and >60 minutes/day on clerical work (OR = 0.54-0.58) was associated with decreased likelihood of satisfactory work-life integration (WLI) and professional satisfaction (PS). Greater meaning in work was associated with an increased. LIKELIHOOD of achieving WLI (OR = 2.51) and PS (OR = 21.67). CONCLUSION Results suggest there are thresholds of excessive time on the EHR-outside the workday (>90 minutes) and overall clerical tasks (>60 minutes), above which clinical faculty may be at increased risk for burnout, as well as reduced WLI and PS, independent of demographic characteristics and clinical work hours. These thresholds of EHR and clerical burden may inform interventions aimed at mitigating this burden to reduce physician burnout.
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Affiliation(s)
- Lauren A Peccoralo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Office of Well-being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carly A Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Office of Well-being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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McNeely J, Kumar PC, Rieckmann T, Sedlander E, Farkas S, Chollak C, Kannry JL, Vega A, Waite EA, Peccoralo LA, Rosenthal RN, McCarty D, Rotrosen J. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addict Sci Clin Pract 2018; 13:8. [PMID: 29628018 PMCID: PMC5890352 DOI: 10.1186/s13722-018-0110-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background
Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Methods Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13–24, 2006). Results Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient’s substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual’s own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial.
Conclusions Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers. Electronic supplementary material The online version of this article (10.1186/s13722-018-0110-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA. .,Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Pritika C Kumar
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Traci Rieckmann
- Greenfield Health and Department of Psychiatry, Oregon Health and Science University, 9450 SW Barnes Suite 100, Portland, OR, 97225, USA
| | - Erica Sedlander
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Sarah Farkas
- Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Christine Chollak
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Joseph L Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Aida Vega
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Eva A Waite
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Lauren A Peccoralo
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Richard N Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, 1090 Amsterdam Avenue, New York, NY, 10025, USA
| | - Dennis McCarty
- OHSU-PSU School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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Peccoralo LA, Tackett S, Ward L, Federman A, Helenius I, Christmas C, Thomas DC. Resident satisfaction with continuity clinic and career choice in general internal medicine. J Gen Intern Med 2013; 28:1020-7. [PMID: 23595920 PMCID: PMC3710375 DOI: 10.1007/s11606-012-2280-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis. OBJECTIVE To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers. DESIGN Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM. PARTICIPANTS IM residents at three urban medical centers. MAIN MEASURES Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career. KEY RESULTS Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0-34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50-6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic. CONCLUSIONS Resident satisfaction with most aspects of continuity clinic was high; yet, continuity clinic had an overall negative influence on residents' attitudes toward GIM careers. Targeting resources toward improving ambulatory patient continuity, workflow efficiency and increasing pre-residency interest in primary care may help build the primary care workforce.
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Affiliation(s)
- Lauren A Peccoralo
- Division of General Internal Medicine, Samuel M. Bronfman Department of Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029, USA.
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Peccoralo LA, Callahan K, Stark R, DeCherrie LV. Primary Care Training and the Evolving Healthcare System. ACTA ACUST UNITED AC 2012; 79:451-63. [DOI: 10.1002/msj.21329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Pizzagalli DA, Peccoralo LA, Davidson RJ, Cohen JD. Resting anterior cingulate activity and abnormal responses to errors in subjects with elevated depressive symptoms: a 128-channel EEG study. Hum Brain Mapp 2006; 27:185-201. [PMID: 16035102 PMCID: PMC6871316 DOI: 10.1002/hbm.20172] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Depression has been associated with dysfunctional executive functions and abnormal activity within the anterior cingulate cortex (ACC), a region critically involved in action regulation. Prior research invites the possibility that executive deficits in depression may arise from abnormal responses to negative feedback or errors, but the underlying neural substrates remain unknown. We hypothesized that abnormal reactions to error would be associated with dysfunctional rostral ACC activity, a region previously implicated in error detection and evaluation of the emotional significance of events. To test this hypothesis, subjects with low and high Beck Depression Inventory (BDI) scores performed an Eriksen Flanker task. To assess whether tonic activity within the rostral ACC predicted post-error adjustments, 128-channel resting EEG data were collected before the task and analyzed with low-resolution electromagnetic tomography (LORETA) using a region-of-interest approach. High BDI subjects were uniquely characterized by significantly lower accuracy after incorrect than correct trials. Mirroring the behavioral findings, high BDI subjects had significantly reduced pretask gamma (36.5-44 Hz) current density within the affective (rostral; BA24, BA25, BA32) but not cognitive (dorsal; BA24', BA32') ACC subdivision. For low, but not high, BDI subjects pretask gamma within the affective ACC subdivision predicted post-error adjustments even after controlling for activity within the cognitive ACC subdivision. Abnormal responses to errors may thus arise due to lower activity within regions subserving affective and/or motivational responses to salient cues. Because rostral ACC regions have been implicated in treatment response in depression, our findings provide initial insight into putative mechanisms fostering treatment response.
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Affiliation(s)
- Diego A Pizzagalli
- Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA.
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