Does a training program for mental health counselors help reduce burnout and improve patient care?
Understand the patient and clinician experience of burnout in mental health clinicians.2. Test BREATHE using a randomized comparative effectiveness design to reduce clinician burnout and patient-centered processes and outcomes.3. Test a conceptual model linking clinician burnout to patient-centered...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
[2019], 2019
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Understand the patient and clinician experience of burnout in mental health clinicians.2. Test BREATHE using a randomized comparative effectiveness design to reduce clinician burnout and patient-centered processes and outcomes.3. Test a conceptual model linking clinician burnout to patient-centered processes and outcomes. METHODS: Participants included clinicians (ie, staff who provided direct clinical care) and patients at 2 community mental health centers (1 rural and 1 urban). For aim 1, we conducted focus groups with clinicians (3 groups, 27 participants) and with patients (5 groups, 45 participants). For aims 2 and 3, we enrolled 192 clinicians and a random sample of 470 adult patients recently seen by these clinicians. Clinicians were randomly assigned to receive either BREATHE or motivational interviewing (MI) training, an active control that could affect patient-centered care but was not expected to directly reduce burnout. LIMITATIONS: Clinicians had generally low levels of burnout at baseline and might have been less in need of intervention. However, study sites did have high levels of turnover (including study dropout), which may have interfered with finding intervention effects. Another limitation was in our ability to meaningfully link clinicians and patients. Patients were recruited based on having seen a particular clinician according to agency records; however, patients might not have known that clinician well, might have seen him or her infrequently, or could have been affected by the burnout of other clinicians, which could limit our ability to assess the impact of clinician burnout BACKGROUND: Clinician burnout (emotional exhaustion, cynical attitudes, and reduced personal accomplishment) has long been thought to negatively affect the quality of health care, yet little is known about the specific mechanisms of action. Guided by theory and previous research, we postulate that clinician burnout may negatively affect both the processes and outcomes of patient-centered care--ie, it may interfere with the ability to build a strong working alliance, involve patients in treatment, and improve patient outcomes (eg, depression and anxiety symptoms in mental health care settings). We developed an intervention--Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE)--that has shown promise in reducing burnout in mental health clinicians but has yet to be linked with patient-centered processes and outcomes. OBJECTIVES: The specific aims of this mixed-methods study were the following: 1. We then surveyed clinicians and interviewed patients over a 12-month period to examine changes in burnout (using the Maslach Burnout Inventory1) and patient-centered processes (perceived support for autonomy, working alliance), engagement (appointments missed, patient satisfaction), and outcomes (patient activation, depression/anxiety, and functioning). Finally, we tested a conceptual model linking clinician burnout to these patient-centered processes, engagement, and outcomes. RESULTS: In aim 1, patients noticed clinician burnout and stress; patients perceived most impacts as negative (eg, poor communication), although some patients identified positive impacts (eg, sense of connectedness/equality, feeling helpful). In aim 2, we found no comparative effectiveness for BREATHE or MI on burnout, patient-centered processes, or other outcomes; clinicians did not improve significantly in either condition, although a number of clinicians interviewed for a qualitative evaluation reported reduced burnout from BREATHE. Several patient-centered processes and outcomes significantly improved over time but not differentially by condition. Models tested for aim 3 suggested that clinician burnout did not reduce perceived patient-centeredness. In one model, higher baseline emotional exhaustion was related to more improvement of patient-rated quality of care over time. CONCLUSIONS: Although burnout was perceived to have predominantly negative effects on patient-centered care and outcomes, analyses testing the conceptual models did not support this, and neither intervention was effective. Alternative methods are needed to effectively address clinician burnout. |
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| Physical Description: | 1 PDF file (69 pages) illustrations |