Lead/Presenter: Eric Apaydin, COIN - Los Angeles
All Authors: Apaydin EA (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA), Rose DE (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA), Meredith LS (RAND Corporation, Santa Monica, CA) Stockdale SE (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA)
Primary care transformation entails cultural changes that can result in emotional exhaustion (a central component of burnout) and attrition among workers, undermining the success of the care model. We analyzed provider attitudes towards the primary care transformation model of Patient-aligned Care Teams (PACT) at the Veterans Health Administration (VA), and their relation to emotional exhaustion (EE) and intent to remain in VA primary care practice.
We surveyed a cross-section of 116 providers (physicians; nurse practitioners; physician assistants) in 21 facilities between September 10, 2015 and January 8, 2016 in one VA region. We then estimated the relationships between attitudes towards PACT and the emotional exhaustion subscale of the Maslach Burnout Inventory or the intent to remain in VA primary care using logistic regression models, adjusted for provider type and site characteristics. Analyses were clustered by facility and weighted for nonresponse.
Forty percent of providers reported high emotional exhaustion burnout ( > = 27 points) and 61% reported an intent to remain in VA primary care for the next two years. Providers were more likely to report high emotional exhaustion when describing high difficulty with several core elements of the PACT program, including: reviewing and responding to patient email (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.37-14.1), and identifying and implementing improvements for day-to-day panel care (OR 3.63, 95% CI 1.23-10.7). Difficulty coordinating care with specialists (OR 0.270, 95% CI 0.0914-0.796) was associated with a lower intent to remain. Providers who reported high emotional exhaustion were also 66% less likely to intend to remain in VA primary care.
Provider-reported difficulty with primary care transformation was associated with higher emotional exhaustion and a lower intent to remain in primary care practice at the VA. Emotional exhaustion was related to a lower intent to remain in practice.
To reduce burnout and turnover during primary care redesign, primary care providers may need additional support and training to address challenges with implementing Patient-aligned Care Teams.