Does Mental Health Care Integration Affect Primary Care Clinician Burnout? Results from a Longitudinal Veterans Affairs Survey

• Published in: Journal of general internal medicine : JGIM Vol. 35; no. 12; pp. 3620 - 3626
• Main Authors: Leung, Lucinda B., Rose, Danielle, Rubenstein, Lisa V., Guo, Rong, Dresselhaus, Timothy R., Stockdale, Susan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2020; Springer Nature B.V
• Subjects: Burnout; Burnout, Professional - epidemiology; Communication; Cross-Sectional Studies; Design analysis; Exhaustion; Health care; Humans; Independent variables; Integration; Internal Medicine; Job Satisfaction; Medicine; Medicine & Public Health; Mental disorders; Mental Health; Occupational health; Organizational aspects; Original Research; Patients; Polls & surveys; Primary care; Primary Health Care; Ratings; Regression analysis; Regression models; Standard error; Surveys and Questionnaires; United States - epidemiology; United States Department of Veterans Affairs; Veterans; Well being; United States; primary care; veterans; burnout; communication; mental health
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-020-06203-4

ABSTRACT
Background
Burnout among primary care clinicians (PCPs) is associated with negative health and productivity consequences. The Veterans Health Administration (VA) embedded mental health specialists and care managers in primary care to manage common psychiatric diseases. While challenging to implement, mental health integration is a team-based care model thought to improve clinician well-being.
Objective
To examine the relationships between PCP-reported burnout (and secondarily, job satisfaction) and mental health integration at provider and clinic levels
Design
Analysis of 286 cross-sectional surveys in 2012 (
n
 = 171) and 2013 (
n
 = 115)
Participants
210 PCPs in one VA region
Main Measures
Outcomes were PCP-reported burnout (Maslach Burnout Inventory emotional exhaustion subscale), and secondarily, job satisfaction. Two independent variables represented mental health integration: (1) PCP-specialty communication rating and (2) proportion of clinic patients who saw integrated specialists. Using multilevel regression models, we examined PCP-reported burnout (and job satisfaction) and mental health integration, adjusting for PCP characteristics (e.g., gender), PCP ratings of team functioning (communication, knowledge/skills, satisfaction), and organizational factors.
Key Results
On average, PCPs reported high burnout (29, range = 9–54) across all VA healthcare systems. In total, 46% of PCPs reported “very easy” communication with mental health; 9% of primary clinic patients had seen integrated specialists. Burnout was not significantly associated with mental health communication ratings (
β
coefficient = − 0.96, standard error [SE] = 1.29,
p
 = 0.46), nor with proportion of clinic patients who saw integrated specialists (
β
 = 0.02, SE = 0.11,
p
 = 0.88). No associations were observed with job satisfaction either. Among study participants, PCPs with poor team functioning, as exhibited by low team communication ratings, reported high burnout (
β
 = − 1.28, SE = 0.22,
p
 < 0.001) and low job satisfaction (
β
 = 0.12, SE = 0.02,
p
 < 0.001).
Conclusions
As currently implemented, primary care and mental health integration did not appear to impact PCP-reported burnout, nor job satisfaction. More research is needed to explore care model variation among clinics in order to optimize implementation to enhance PCP well-being.