Rochester

Living labs open door to retirees who want to join studies.

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Despite the fact that the elderly account for the greatest proportion of patients for certain ailments, they are often underrepresented in medical research. In addition to explicit exclusion criteria included in many trials, scientists and drug companies are often loath to include senior citizens in their studies because of the myriad logistical challenges that old age presents. Elderly individuals might not have the mobility to travel to investigational sites, and they’re often less willing to switch physicians from the ones they’ve come to know and trust.

To encourage more participation in research among the over-65 crowd, an independent living facility at the Mayo Clinic in Rochester, Minnesota, is now trying to rethink what a study site has to look like.

On the fourth floor of a 21-story residential building, Mayo researchers have built a ‘living lab’ that spans 51,000 square feet and includes two mock-up apartments and rooms for convening focus groups. A small section on the floor above houses treadmills, electrocardiographs and other devices to measure physiology. Beyond simply bringing health studies closer to the elderly residents of the building, the research space has substantial built-in video recording infrastructure, allowing improved observation of how certain products and test ideas fare.

The combined space, known as the Healthy Aging and Independent Living (HAIL) lab, was established in 2011 at a retirement home called Charter House, which is affiliated with—and physically connected to—Mayo. In the past couple years, the HAIL lab has partnered with companies such as General Mills, United Healthcare and Best Buy to look at, for example, the acceptance of technology by the elderly. For now, the endeavor is concentrated on projects that are simple or observational, such as user feedback on products and exploring how video game participation might influence health in the elderly. However, “in the next five years, clinical trials with pharmacological agents might be forthcoming,” says Nicholas LaRusso, director of the Mayo Clinic Center for Innovation.

The vision of providing improved health research for the elderly is shared by another HAIL partner, the Good Samaritan Society, the largest nonprofit provider of senior care and services in the US. In an ongoing independent 1,200-person study at 5 of its 240 senior care facilities, the Good Samaritan Society is looking at the benefit of motion sensor technology. It has thus far found that the technology can detect repeat trips to the bathroom, which could indicate a urinary tract infection.

Kelly Soyland, director of innovation at the Sioux Falls, South Dakota–based society, says that his team has started exploring the idea of more traditional clinical research at some of their facilities at some point down the road: “We’re building the organizational capacity to work in that formal research space.”

Source: Nature

Burnout burden high among US physicians.

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Burnout appears to be more common among physicians than among other adults working in the United States, with nearly half of those who participated in a national survey reporting at least one symptom of burnout, data published in the Archives of Internal Medicine suggest.

Previous studies have examined the link between burnout and quality of care, increased risk for error and its role in physicians’ relationships, alcohol abuse and suicidal ideation. However, according to the study researchers, the June 2011 national survey is the first to evaluate the rates of burnout among a large, diverse sample of US physicians.

Study results

Tait D. Shanafelt, MD, of the department of internal medicine at Mayo Clinic in Rochester, Minn., and colleagues obtained a sample of physicians from all specialties from the American Medical Association Physician Masterfile. Of the 27,276 physicians who received an initial invitation to participate, 7,288 physicians completed the surveys. To develop a comparison with the general US population, researchers also surveyed a probability-based sample of 3,442 working US adults aged 22 to 65 years.

 

Researchers measured three domains of burnout — emotional exhaustion, depersonalization and low personal accomplishment — using the Maslach Burnout Inventory. The Primary Care Evaluation of Mental Disorders assessment was used to measure symptoms of depression, and other questions were asked to assess work–life balance concerns.

According to data, 45.8% of physicians reported at least one symptom of burnout; 37.9%, high emotional exhaustion; 29.4%, high depersonalization; and 12.4% expressed a low level of personal accomplishment.

Study researcher Liselotte N. Dyrbye, MD, MHPE, associate director of research applications in the department of medicine program on physician well-being at Mayo Clinic in Rochester, Minn., told Endocrine Today that characteristics of the job may account for the high prevalence of burnout among physicians.

“Given that nearly 50% of physicians have burnout, the problem stems from environment/work-related factors rather than character flaws/personal characteristics of a few susceptible physicians,” Dyrbye said.

Physicians in emergency medicine (P<.001), general internal medicine (P<.001), neurology (P<.01), radiology (P=.02) and family medicine (P=.001) had the highest rates of burnout. Those in pathology, dermatology, general pediatrics and preventive medicine, including occupational health and environmental medicine, had the lowest rates, researchers wrote.

Moreover, compared with the general population control group, physicians were more likely to have symptoms of burnout (37.9% vs. 27.8%) and be dissatisfied with work–life balance (40.2% vs. 23.2%).

“The study confirms that there is an alarmingly high prevalence of burnout among physicians, with the highest among physicians who are in the front line of care (family medicine, general internal medicine, ER) and among those who work longer hours. Burnout and struggles with work–life balance are greater for physicians than other US workers,” Dyrbye said.

A pooled multivariate analysis adjusted for age, sex, relationship status and hours worked per week also revealed an association between level of education and burnout. When compared with workers with high school degrees, physicians with DO or MD degrees had a higher risk for burnout (OR=1.36; P<.001) than those with bachelor’s degrees (OR=0.8; P=.048), master’s degrees (OR=0.71; P=.01) or professional or doctoral degrees other than DO or MD (OR=0.64; P=.04).

Implications

Drybye said the researchers hope the study results will generate discussion on how to address the problem of burnout.

“We hope that this study will fuel a national dialogue about how to minimize burnout. Efforts are needed to identify and address the work-related factors that are contributing to burnout among physicians. To date, the issue of physician burnout has not surfaced in any meaningful way during discussions of how to reform health care delivery,” Dyrbye said.

Besides this study, Dyrbye said she and Shanafelt have also written an article on how burnout threatens the success of health care reform regarding the Affordable Care Act.

“It isn’t so much preventive medicine subspecialists, but rather general internal medicine, general pediatrics and family medicine physicians who are most likely to be seeing more patients. This will place an additional strain on physicians in the front lines — many of whom are already struggling with burnout,” Dyrbye said.

The researchers wrote that it is up to policymakers and health care organizations to address this problem “for the sake of physicians and their patients.” – by Samantha Costa

For more information:

Shanafelt TD. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.3199.

Andrew F. Stewart

  • This is an interesting and important paper documenting that burnout and adverse work–life balance issues affect physicians disproportionately as compared to other US workers; and to explore the reasons for this. The results suggest, with appropriate cautions regarding limitations and confounders, that certain specialties within medicine are more severely affected than others.

With regard to the field of endocrinology, no specific information is available, since the many disparate general internal medicine subspecialties are combined into a single group. Thus, high-earning proceduralists (eg, cardiology, pulmonary, GI physicians with better personnel support systems) are lumped together with lower earning RVU/E&M coding non-proceduralists (eg, rheumatology, endocrinology, infectious disease physicians with little personnel or other ancillary support). One might reasonably infer that endocrinologists are most akin to family practitioners and general internal medicine physicians who are disproportionately affected by burnout and work–life balance issues. The authors may want to share their database with subspecialties for subset analysis, or analyze it more deeply themselves to see whether trends exist in specific subspecialties. This information would be of value to the Department of Health and Human Services, the AMA and other agencies interested in managing and financing health care reform.

As the authors point out, most studies in this area offer little in the way as to guidance regarding burnout- and life balance-prevention measures, other than counseling and support measures, and fail to address the organizational, procedural and support issues that lead to the occurrence of what is an obvious problem.

As they also point out, work–life balance issues and burnout predict both work force dropout and lower levels of quality of patient care.  There is no attempt to quantify these in the current study. This would be an attractive area for further study.

Overall, this is a timely and important study, although much more remains to be done analytically, and also with regard to interventions.

Source: Endocrine Today.