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Controlled Interventions to Reduce Burnout in PhysiciansA Systematic Review and Meta-analysis

Educational Objective
To evaluate the effectiveness of interventions to reduce burnout in physicians.
1 Credit CME
Key Points

Question  Are interventions for reducing burnout in physicians effective?

Findings  This meta-analysis of 20 controlled interventions on 1550 physicians found that existing interventions were associated with small and significant reductions in burnout. The strongest evidence for effectiveness was found for organization-directed interventions, but these interventions were rare.

Meaning  More effective models of interventions are needed to mitigate risk for burnout in physicians. Such models could be organization-directed approaches that promote healthy individual-organization relationships.

Abstract

Importance  Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians.

Objective  To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects.

Data Sources  MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched.

Study Selection  Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians.

Data Extraction and Synthesis  Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified.

Main Outcomes and Measures  The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals.

Results  Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [SMD] = −0.29; 95% CI, −0.42 to −0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = −0.45; 95% CI, −0.62 to −0.28) compared with physician-directed interventions (SMD = −0.18; 95% CI, −0.32 to −0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared with interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings.

Conclusions and Relevance  Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.

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Article Information

Accepted for Publication: September 12, 2016.

Corresponding Author: Maria Panagioti, PhD, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Oxford Rd, Williamson Bldg, Manchester M13 9PL, United Kingdom (maria.panagioti@manchester.ac.uk).

Published Online: December 5, 2016. doi:10.1001/jamainternmed.2016.7674

Author Contributions: Dr Panagioti had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Panagioti, Chew-Graham, van Marwijk, Esmail.

Acquisition, analysis, or interpretation of data: Panagopoulou, Bower, Lewith, Kontopantelis, Dawson, van Marwijk, Geraghty.

Drafting of the manuscript: Panagioti, Chew-Graham, Dawson, van Marwijk.

Critical revision of the manuscript for important intellectual content: Panagioti, Panagopoulou, Bower, Lewith, Kontopantelis,

Dawson, van Marwijk, Geraghty, Esmail.

Statistical analysis: Panagioti, Bower, Kontopantelis, Dawson.

Obtained funding: Panagioti, Chew-Graham, Esmail.

Administrative, technical, or material support: Panagioti, Dawson, Geraghty.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by the UK National Institute of Health Research (NIHR) School for Primary Care Research (Study No. R119013). The Medical Research Council Health eResearch Centre grant MR/K006665/1 supported the time and facilities of Dr Kontopantelis.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health.

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