1. Physician burnout costs the U.S. health care system approximately $4.6 billion a year
Investing in strategies to reduce physician burnout may have significant economic benefits
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1422
Editorial: http://annals.org/aim/article/doi/10.7326/M19-1191
URLs go live when the embargo lifts
Physician burnout is a substantial economic burden, costing the U.S. health care system approximately $4.6 billion a year. Investing in strategies to reduce burnout may have economic benefits. Findings are published in Annals of Internal Medicine.
Physician burnout is a significant issue that has the potential to dramatically increase the cost of care to both patients and the health care delivery system. It is associated with poorer overall quality of patient care, lower patient satisfaction, and malpractice lawsuits, all of which have an economic impact. Despite the recent public interest the subject, only a few studies have attempted to quantify the economic magnitude of burnout in the form of easily understandable metrics. Without data, policymakers cannot holistically assess or address the issue.
A research team comprising members from the National University of Singapore, Stanford University, the Mayo Clinic, and the American Medical Association, developed a mathematical model using contemporary published research findings and industry reports to estimate burnout-associated costs related to physician turnover and reduced clinical hours at national and organizational levels. They found that on a national scale, physician burnout accounted for approximately $4.6 billion, or about $7,600 per employed physician per year. According to the researchers, these findings suggest that there may be substantial economic value for policy and organizational expenditures directed at reducing physician burnout.
The author of an accompanying editorial from The Permanente Federation and Southern California Permanente Medical Group says this research is much-needed because practicing medicine is harder than ever. His organization is dedicated to tackling burnout through establishing a culture of health and wellness, addressing needed changes to the practice environment, delivering emotional and peer support, and providing education on wellness and self-care strategies.
Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the lead author, Joel Goh, PhD, please contact Jack Loo at bizlooj@nus.edu.sg or +65-6516-5556.
2. Access to physician's notes may improve patient adherence to medications
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3197
Editorial: http://annals.org/aim/article/doi/10.7326/M19-1366
URLs go live when the embargo lifts
Giving patients access to their physicians' visit notes may improve their understanding of and comfort with their medications, as well as improve their adherence to medication regimens. A brief research report is published in Annals of Internal Medicine.
As many as half of Americans with chronic illness do not take their medications as prescribed and, on average, patients remember about half of the information conveyed during an office visit. As patients increasingly read their visit notes through online portals (http://www.opennotes.org), reports suggest that patient access to notes may improve adherence.
Researchers from Harvard Medical School, the University of Washington and Beth Israel Deaconess Medical Center surveyed more than 29,000 patients at the original OpenNotes pilot sites (Beth Israel Deaconess Medical Center, Geisinger, and the University of Washington Medical Center) to. The researchers found that many patients at all three survey sites reported that note reading helped them understand why a medication was prescribed, answered their questions, and made them feel more comfortable and in control of their medications. Very few of the respondents reported that notes made them feel worried or confused about their medications.
According to the authors of an accompanying editorial from The Commonwealth Fund in New York City, the study findings are reassuring, as they showed no adverse effects of sharing clinical records with patients. The editorial authors recommend several measures, including medical education, physician preparedness regarding privacy and security protection, collaboration on mobile applications, and improved incorporation of nontraditional sources of patient information (wearables, social media, mobile devices), to improve the chances that increased transparency will have the hoped-for beneficial effects on the clinical experiences of patients and physicians.
Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. The lead author, Dr. Catherine M. DesRoches, please contact Carolyn Assa at cassa@bidmc.harvard.edu.
3. Better supporting the care needs of older adults with disabilities could reduce Medicare spending
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2467
URLs go live when the embargo lifts
Implementation of comprehensive community-based long-term services and supports for older adults with disabilities may curb Medicare spending on this population in the long run. Findings from an observational study are published in Annals of Internal Medicine.
Nearly 15 million older Americans with disability live in the community and the availability and adequacy of support with daily activities has a profound effect on their participation in valued activities, quality of life, and health. While older adults with disability are heavy users of services and incur high health care spending, it is not known how adequacy of support may affect Medicare spending.
Researchers from the Johns Hopkins Bloomberg School of Public Health linked Medicare claims to data derived from in-person interviews with more than 3,700 community-living older adults with disability. The goal was to quantify differences in total Medicare spending by whether the participants experienced negative consequences due to inadequate support with household activities, mobility, or self-care. The researchers found that the participants with disability incurred Medicare spending that was more than twice as high as among those without disability. More than 1 in 5 older adults with mobility or self-care disability reported negative consequences due to no one being available to help and median per-person Medicare spending among those adults was significantly higher than for those who did not experience negative consequences.
According to the researchers, these findings suggest that the beneficial effects of comprehensive community-based long-term services and supports may extend beyond improved health, well-being and participation to reduced spending on health services. They propose greater use of strategies that target both health and function.
Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Jennifer L. Wolff, PhD, please contact Caitlin Hoffman at choffman@jhu.edu.
4. New Cholesterol guidelines focus on a healthy lifestyle and if likely to benefit, shared decision-making regarding statins
Abstract: http://annals.org/aim/article/doi/10.7326/M19-0365
URLs go live when the embargo lifts
New clinical practice guidelines on cholesterol management from the American Heart Association and American College of Cardiology (AHA/ACC) and multiple prevention oriented societies* endorse a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for atherosclerotic cardiovascular disease (ASCVD). For primary prevention, in those likely to benefit, the guidelines recommend a clinician-patient risk discussion before a decision is made about statin treatment. A synopsis of the guidelines is published in Annals of Internal Medicine.
In November 2018, the AHA/ACC and multiple prevention oriented societies* released a new clinical practice guideline on cholesterol management that was accompanied by an in-depth risk assessment report on primary prevention of ASCVD.
A panel of experts conducted a systematic review and meta-analyses of randomized controlled trials that examined cardiovascular outcomes. High-quality observational studies were used for estimation of ASCVD risk. An independent panel systematically reviewed the trial evidence about the benefits and risks of adding nonstatin medications to statin therapy compared with receiving statin therapy alone in persons who have ASCVD and judged to be at very high risk. Based on the evidence, the AHA/ACC Multi-Society recommendations include:
- Maintaining a healthy lifestyle over the lifespan.
- Use of maximally tolerated doses of statins in secondary prevention of ASCVD
- Use of nonstatin medications in addition to statin therapy for patients at very high risk for ASCVD.
- Use of statin therapy without risk stratification in severe primary hypercholesterolemia, often starting in childhood.
- Use of moderate-intensity statin therapy without risk stratification in adults aged 40 to 75 years with diabetes mellitus and an LDL-C level of 1.8 mmol/L (70 mg/dL) or higher.
- Clinician-patient risk discussion about statin therapy for adults aged 40 to 75 years without diabetes mellitus who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.
- Use of moderate-intensity statin therapy if a risk discussion favors their use in adults aged 40 to 75 years without diabetes mellitus who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.
- Use of a 3-tiered decision-making process in primary prevention in adults aged 40 to 75 years to personalize the risk decision. This includes enhancing factors such as family history of premature CAD, metabolic syndrome, chronic kidney disease, LDL-cholesterol level ?160 mg/dL; in women, history of pre-eclampsia or premature menopause (<40 y); inflammatory diseases such as psoriasis, rheumatoid arthritis, HIV), and high-risk ethnicity such as South Asian ancestry.
- Coronary artery calcium scoring to improve risk stratification in moderate-risk patients for whom the benefits of statin therapy are uncertain.
- Follow-up for adherence to medications and lifestyle and to assess adequacy of response.
*American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Physician Assistants, Association of Black Cardiologists, American College of Preventive Medicine, American Diabetes Association, American Geriatrics Society, American Pharmacists Association, American Society for Preventive Cardiology, National Lipid Association, and Preventive Cardiovascular Nurses Association
Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the corresponding author, Dr. Neil J. Stone, MD, please contact at n-stone@northwestern.edu.
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Journal
Annals of Internal Medicine