Improving Well-Being Among Trainees: A Partnership to Reduce Barriers to Primary Care Services.
Ontology highlight
ABSTRACT: Background
Improved well-being is a focus for graduate medical education (GME) programs. Residents and fellows often express difficulty with visiting primary care physicians, and this issue has not been thoroughly investigated.Objective
We reported implementation and utilization of a primary care concierge scheduling service and a primary care video visit service for GME trainees.Methods
GME leaders collaborated with Duke Primary Care to offer trainees a concierge scheduling service and opportunity for primary care video visits. This quantitative evaluation included (1) analysis of the institutional GME survey results pre- and post-intervention, and (2) review of use of the concierge scheduling line.Results
Comparison of the 2018 and 2019 internal GME surveys showed a decrease in perceived barriers accessing primary care (58% to 31%, P < .0001), a decrease in perceived delays to access primary care (27% to 21%, P = .023), and an increase in respondents who reported needing health care services in the past year (37% to 62%, P < .0001). Although increased need for health services was reported, there was no difference in the proportion reporting use of health services (63% and 65%, P = .43). Of the 142 concierge line calls reviewed, 127 (87%) callers requested clinic appointments, and 15 (10%) callers requested video appointments. Of callers requesting clinic appointments, 99 (80%) were scheduled.Conclusions
Providing resources to connect trainees to primary care greatly reduces their perception of barriers to health care and may provide a convenient mechanism to schedule flexible primary care appointments.
SUBMITTER: Tan C
PROVIDER: S-EPMC7161318 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundThe psychological importance of subjective well-being for a healthy life has been well recognized. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. The aim of this cross-sectional, descriptive study was to assess the subjective well-being status of a group of primary healthcare patients in relation to socio-demographic characteristics, personal health and mood-status.MethodsA total of 284 patients participated in the study. The Oxford Happiness Scale, Life Satisfaction Scale, DASS-42 (Depression, Anxiety and Stress Scales-42) and a questionnaire about socio-demographic characteristics were completed by the participants.ResultsIn general, the participants were found to be moderately happy and satisfied with their lives. They had mild levels of depression, anxiety and stress. In terms of happiness, an older age (≥40 years), educated to secondary level or higher and not having depression or anxiety were found to be factors increasing happiness. In terms of life satisfaction, female gender, an older age (≥40 years), educated to secondary level or higher, being single and not having depression were found to increase life satisfaction.ConclusionPrimary healthcare providers should give more importance to the mood status of their patients. Screening for depression and anxiety should be applied at the primary healthcare level because negative mood status is more important than some socio-demographic characteristics in respect of unhappiness and dissatisfaction.
| S-EPMC4259359 | biostudies-literature
Project description:We analyze Dutch panel data to investigate whether partnership has a causal effect on subjective well-being. As in previous studies, we find that, on average, being in a partnership improves well-being. Well-being gains of marriage are larger than those of cohabitation. The well-being effects of partnership formation and disruption are symmetric. We also find that marriage improves well-being for both younger and older cohorts, whereas cohabitation benefits only the younger cohort. Our main contribution to the literature is on well-being effects of same-sex partnerships. We find that these effects are homogeneous to sexual orientation. Gender differences exist in the well-being effects of same-sex partnerships: females are happier cohabiting, whereas marriage has a stronger well-being effect on males.
| S-EPMC6290656 | biostudies-literature
Project description:ObjectiveThe well-being of primary care physicians (PCPs) has become an object of concern for governments due to staff shortages and high staff turnover. The objective of this study was to carry out a systematic review of individualised interventions aimed at improving the well-being of PCPs, which allowed us to determine (1) the type of interventions being carried out; (2) the well-being indicators being used and the instruments used to assess them; (3) the theories proposed to support the interventions and the mechanisms of action (MoA) put forward to explain the results obtained and (4) the role that individual motivation plays in the interventions to improve well-being among PCPs.DesignSystematic review.Eligibility criteriaClinical trials on interventions aimed at improving the well-being of PCPs.Information sourcesa search of studies published between 2000 and 2022 was carried out in MEDLINE/PubMed, SCOPUS and Web of Science (WOS).ResultsFrom the search, 250 articles were retrieved. The two authors each reviewed the articles independently, duplicate articles and those that did not meet the inclusion criteria were discarded. A total of 14 studies that met the criteria were included: 6 randomised clinical trials, 4 controlled clinical trials and 4 unique cohorts, with a before-and-after assessment of the intervention, involving a total of 655 individuals participating in the interventions. A meta-analysis was not possible due to the heterogeneity of the studies.ConclusionsThe information evaluated is insufficient to accurately assess which outcomes are the best indicators of PCPs well-being or what role plays in the individual motivation in the results of the interventions. More studies need to be carried out on the subject to determine the MoA of the different interventions on the results and the motivation of the participating PCPs.
| S-EPMC10952968 | biostudies-literature
Project description:This study first examines the relationship between partnership status and subjective well-being in 45 European countries by analyzing the European Values Study 2008. It was expected and empirically confirmed that married individuals have the highest level of well-being, followed by (in order) cohabiting, dating, single, and finally widowed and divorced individuals. In addition, this study examines to what extent the well-being gaps depend on the normative climate in which an individual lives. It is hypothesized that: (a) being in a non-married relationship (especially cohabitation and divorce) lowers well-being compared to being married in societies that reject non-traditional partnership statuses; and (b) not having a partner is especially detrimental for well-being levels in familialistic societies, which emphasize the importance of a strong, close-knit family. The normative climate appears to hardly affect well-being gaps between partnership statuses. Only the gap between divorced and married women is significantly wider in familialistic societies. It is concluded that the weak dependence of well-being on the normative climate may point at high autonomy in private, relationship-related decisions.
| S-EPMC3371189 | biostudies-literature
Project description:Purpose:Challenges experienced by staff in the Oncology Services Group at Queensland Children's Hospital led to issues with staff retention, well-being, and stress on team culture. Therefore, a customized program was developed through a needs analysis to improve the well-being and resilience of oncology staff, enabling them to cope with stressors and critical incidents inherent in their everyday work and to flourish. The program included education, on-site counselors, mindfulness sessions, debriefing, well-being resources, and improved engagement, support, and communication. Methods:Evaluation of the program in the first year examined program participation, staff feedback following education workshops and mindfulness sessions, staff retention rates, and the results of an annual organizational staff survey and a program outcome survey. Results:Approximately 76% of staff attended the Introduction to Well-being workshop, and 98% of responses to survey questions were positive. Staff also provided positive feedback on the other well-being workshops and sessions embedded within existing education programs. Employee Assistance Program counseling sessions had an 81% uptake, with a wide variety of presenting issues, 62% related to work. All participants in mindfulness sessions agreed that it was a valuable tool to improve clinical practice, 94% said it had an immediate positive impact on their well-being, and 70% agreed that they were applying mindfulness principles outside the sessions. Staff retention and turnover improved. Staff reported a positive effect on awareness of self-care, addressing risks to resilience, seeking support from trusted colleagues, coping with critical incidents, and the ability to interact positively with patients and families. Conclusion:The evaluation showed a positive impact on staff well-being. Although there was a wide variety of successful interventions reported in the literature, sustainability needs to be considered. Feedback on this program found that staff appreciated being listened to, valued, and supported through the strategies, and the ongoing program will continue to monitor staff needs and be responsive in building their resilience and well-being.
| S-EPMC6241860 | biostudies-other
Project description:ImportancePhysician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking.ObjectiveTo assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees.Design, setting, and participantsA randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported).InterventionA 4-month, web-based, group coaching program.Main outcomes and measuresThe primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes.ResultsAmong the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) -3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], -4.13 [0.92] points; 95% CI, -5.94 to -2.32 points; P < .001). Depersonalization decreased by a mean (SE) of -1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], -1.87 [0.53] points; 95%CI, -2.91 to -0.82 points; P < .001). Impostor syndrome decreased by a mean (SE) of -1.43 (0.14) points in the intervention group compared with -0.15 (0.11) points in the control group (absolute difference [SE], -1.28 (0.18) points; 95% CI -1.63 to -0.93 points; P < .001). Moral injury decreased by a mean (SE) of -5.60 (0.92) points in the intervention group compared with -0.92 (0.71) points in the control group (absolute difference [SE], -4.68 [1.16] points; 95% CI, -6.95 to -2.41 points; P < .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P < .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P < .001). The sensitivity analysis found similar findings.Conclusions and relevanceThe findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees.Trial registrationClinicalTrials.gov Identifier: NCT05222685.
| S-EPMC10551770 | biostudies-literature
Project description:Managing ecosystems for multiple ecosystem services and balancing the well-being of diverse stakeholders involves different kinds of trade-offs. Often trade-offs involve noneconomic and difficult-to-evaluate values, such as cultural identity, employment, the well-being of poor people, or particular species or ecosystem structures. Although trade-offs need to be considered for successful environmental management, they are often overlooked in favor of win-wins. Management and policy decisions demand approaches that can explicitly acknowledge and evaluate diverse trade-offs. We identified a diversity of apparent trade-offs in a small-scale tropical fishery when ecological simulations were integrated with participatory assessments of social-ecological system structure and stakeholders' well-being. Despite an apparent win-win between conservation and profitability at the aggregate scale, food production, employment, and well-being of marginalized stakeholders were differentially influenced by management decisions leading to trade-offs. Some of these trade-offs were suggested to be "taboo" trade-offs between morally incommensurable values, such as between profits and the well-being of marginalized women. These were not previously recognized as management issues. Stakeholders explored and deliberated over trade-offs supported by an interactive "toy model" representing key system trade-offs, alongside qualitative narrative scenarios of the future. The concept of taboo trade-offs suggests that psychological bias and social sensitivity may exclude key issues from decision making, which can result in policies that are difficult to implement. Our participatory modeling and scenarios approach has the potential to increase awareness of such trade-offs, promote discussion of what is acceptable, and potentially identify and reduce obstacles to management compliance.
| S-EPMC4460479 | biostudies-other
Project description:ObjectiveIn Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial re-orientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC.MethodsA review of World Health Organization (WHO) reports was conducted for all 47 countries in the WHO African Region. To report each country's progress, we used an a priori framework developed by the WHO regional office for Africa (AFRO). Twelve indicators were used to measure countries' progress. The proportion of countries meeting each indicator was tabulated using a heat map. Correlation between country income status and attainment of each indicator was also assessed.FindingsNo country met all the recommended indicators to integrate NCD services into PHC and seven countries met none of the indicators. Few countries (30%) had nationally approved guidelines for NCD management and very few reported availabilities of all essential NCD medicines (13%) and technologies (11%) in PHC facilities. There was no overall correlation between a country's GDP per capita and the aggregate of targets being met (rho = 0.23; P = .12). There was, however, a modestly negative correlation between out-of-pocket expenditure and overall country progress (rho = -0.58; P < .001).ConclusionProgress by AFRO Member States in integrating NCD care into PHC is variable across the region. Enhanced government commitment and judicious resource allocation to prioritize NCDs are needed. Particular areas of focus include increasing the uptake of simplified guidelines for NCDs; increasing workforce capacity to manage NCDs; and removing access barriers to essential medicines and basic diagnostic technologies.
| S-EPMC7580905 | biostudies-literature
Project description:IntroductionThe patient-centered medical home model is transforming the delivery of outpatient care, with improved quality of care, better patient experiences, and enhanced processes of care. However, teams of interprofessional health care workers have diverse viewpoints that occasionally present instances of miscommunication. In addition, few materials exist that provide potential assessments for graduate-level interprofessional trainees. We constructed an interprofessional objective structured clinical examination (IPOSCE) to assess patient-centered behaviors of nurse practitioner residents and third-year internal medicine residents.MethodsThis IPOSCE comprises two phases. First, learners interact with a standardized patient with complex medical and psychosocial issues. Next, they engage in a series of stations with standardized interprofessional colleagues, each of whom is trained to deliver a non-patient-centered challenging line during their interaction.ResultsTrainees felt that the cases reasonably reflected their typical outpatient practices but had some concerns about logistics and thought the cases may have presented heightened communication challenges compared with typical practice.DiscussionIn sum, this IPOSCE workplace simulation successfully assessed communication skills of our resident trainees with standardized patients and standardized instructors in a realistic setting.
| S-EPMC6440411 | biostudies-literature
Project description:BackgroundQuality health services build communities' and patients' trust in health care. It enhances the acceptability of services and increases health service coverage. Quality primary health care is imperative for universal health coverage through expanding health institutions and increasing skilled health professionals to deliver services near to people. Evidence on the quality of health system inputs, interactions between health personnel and clients, and outcomes of health care interventions is necessary. This review summarised indicators, successes, and challenges of the quality of primary health care services.MethodsWe used the preferred reporting items for systematic reviews and meta-analysis extensions for scoping reviews to guide the article selection process. A systematic search of literature from PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), Scopus, and Google Scholar was conducted on August 23, 2022, but the preliminary search was begun on July 5, 2022. The Donabedian's quality of care framework, consisting of structure, process and outcomes, was used to operationalise and synthesise the findings on the quality of primary health care.ResultsHuman resources for health, law and policy, infrastructure and facilities, and resources were the common structure indicators. Diagnosis (health assessment and/or laboratory tests) and management (health information, education, and treatment) procedures were the process indicators. Clinical outcomes (cure, mortality, treatment completion), behaviour change, and satisfaction were the common indicators of outcome. Lower cause-specific mortality and a lower rate of hospitalisation in high-income countries were successes, while high mortality due to tuberculosis and the geographical disparity in quality care were challenges in developing countries. There also exist challenges in developed countries (e.g., poor quality mental health care due to a high admission rate). Shortage of health workers was a challenge both in developed and developing countries.ConclusionsQuality of care indicators varied according to the health care problems, which resulted in a disparity in the successes and challenges across countries around the world. Initiatives to improve the quality of primary health care services should ensure the availability of adequate health care providers, equipped health care facilities, appropriate financing mechanisms, enhance compliance with health policy and laws, as well as community and client participation. Additionally, each country should be proactive in monitoring and evaluation of performance indicators in each dimension (structure, process, and outcome) of quality of primary health care services.
| S-EPMC10464348 | biostudies-literature