Clinician Burnout and Satisfaction with Resources in Caring for Complex Patients

Objective: To describe primary care clinicians\u27 self-reported satisfaction, burnout and barriers for treating complex patients. Methods: We conducted a survey of 1554 primary care clinicians in 172 primary care clinics in 18 health care systems across 8 states prior to the implementation of a collaborative model of care for patients with depression and diabetes and/or cardiovascular disease. Results: Of the clinicians who responded to the survey (n=709; 46%), we found that a substantial minority (31%) were experiencing burnout that was associated with lower career satisfaction (P\u3c.0001) and lower satisfaction with resources to treat complex patients (P\u3c.0001). Less than 50% of clinicians rated their ability to treat complex patients as very good to excellent with 21% rating their ability as fair to poor. The majority of clinicians (72%) thought that a collaborative model of care would be very helpful for treating complex patients. Conclusions: Burnout remains a problem for primary care clinicians and is associated with low job satisfaction and low satisfaction with resources to treat complex patients. A collaborative care model for patients with mental and physical health problems may provide the resources needed to improve the quality of care for these patients

Vaccination and allergy: EAACI position paper, practical aspects

Immunization is highly effective in preventing infectious diseases and therefore an indispensable public health measure. Allergic patients deserve access to the same publicly recommended immunizations as non-allergic patients unless risks associated with vaccination outweigh the gains. Whereas the number of reported possible allergic reactions to vaccines is high, confirmed vaccine-triggered allergic reactions are rare. Anaphylaxis following vaccination is rare, affecting <1/100 000, but can occur in any patient. Some patient groups, notably those with a previous allergic reaction to a vaccine or its components, are at heightened risk of allergic reaction and require special precautions. Allergic reactions, however, may occur in patients without known risk factors and cannot be predicted by currently available tools. Unwarranted fear and uncertainty can result in incomplete vaccination coverage for children and adults with or without allergy. In addition to concerns about an allergic reaction to the vaccine itself, there is fear that routine childhood immunization may promote the development of allergic sensitization and disease. Thus, although there is no evidence that routine childhood immunization increases the risk of allergy development, such risks need to be discussed

Comparing Implementation Models Across Two Kaiser Permanente Regions to Improve Outcomes for Patients With Comorbid Depression and Diabetes

Background/Aims: The Care for Mental, Physical, and Substance-use Syndromes (COMPASS) initiative was funded by the Centers for Medicare & Medicaid Services (CMS) to implement collaborative care in primary care settings for patients with comorbid depression and diabetes, coronary artery disease and/or substance-use disorders. Here we compare implementation strategies in Kaiser Permanente Colorado (KPCO) and Southern California (KPSC) to inform potential dissemination strategies across other HMO sites. Methods: COMPASS patients are enrolled if they have PHQ9 scores \u3e 10 and poorly controlled diabetes (HbA1c \u3e 8.0). The proposed collaborative care model requires a team with a consulting psychiatrist, consulting physician and care manager. The care manager provides both behavioral health interventions and medical care, and facilitates a weekly structured case review to determine treatment intensification. The program lasts at least six months with six months of maintenance. COMPASS implementation at KPCO included a dedicated, centralized nurse care manager and therapist working together who telephonically outreached and followed patients. COMPASS implementation at KPSC used an existing depression care management program in primary care at four medical center service regions, requiring care managers to change their scope of practice to address diabetes. Both KPCO and KPSC held weekly structured case reviews. KPCO was centralized and KPSC was done by teams at each participating medical center. Results: The initiative began in 2012. To date, KPCO has enrolled 303 patients and KPSC 712. Remission rates for depression are 26% in KPCO and 39% in KPSC patients. Control rates for diabetics are 39% for KPCO and 38% for KPSC. Discussion: Centralized care management may increase uniformity and fidelity of implementation, but limit reach and compromise outcomes without additional local primary care support. Conversely, adding care management tasks to existing staff may increase reach but attenuate outcomes without adequate staff training in co-management of psychological and medical care needs. Funded by the U.S. Department of Health and Human Services via CMS (#1C1CMS331048-01-00), the contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies