Decreasing Provider Stress in the Treatment of Complex Patients: A Brief Collaborative Training Program for PCPs and BHCs

As the demands on primary care providers (PCPs) are increasing, addressing the stress levels of PCPs, specifically daily stressors, is crucial (Bodenheimer & Sinsky, 2014). These stressors lead to burnout and are affecting PCPs at alarming levels. Bodenheimer and Sinsky (2014) report “…46% of US physicians experience symptoms of burnout…68% of family physicians would not choose the same specialty if they could start their careers anew”(p.574). While much of this frustration is associated with administrative work, this has had a ripple effect in leaving little time and energy for engaging with more difficult complex patients who present as some of the most draining of patient encounters (Babbott et al., 2014). Physicians report this is primarily due to lack of knowing what to do or how to help complex patients as they see non-adherence and little improvement realizing the training they received in medical school did not cover this (Linzer et al., 2002). What they are referring to is not the medical knowledge, but the additional skills of interacting with and understanding these patients in ways that could affect change. The intervention in this study will address new ways to do this for PCPs aiming at 1) teaching PCPs the spirit of motivational interviewing (MI) and basic MI skills 2) educating PCPs on complex patients and stress illness; diagnosis and treatment as many of these patients experience childhood stressors (trauma) or current stressors resulting in emotional, physical and/ or behavioral issues (Anda & Felitti, 1998). The participants in this study are patients, PCPs, and BHCs of a large integrated primary care practice. This study involves a two-part training comprised of 4 forty-five minute didactic, interactive and experiential group trainings along with optional individual BHC-PCP shadows involving real-time training. All components of training will be designed to be achievable within the fast pace of primary care. The goal of the study is to lower physician daily stress levels (DSLs) and improve treatment outcomes for complex patients with an intervention delivered by the behavioral health consultant (BHC) to the PCPs within the practice. With this intervention, the frustration associated with the treatment of these patients evolves into a collaborative relationship, employing joint decision-making processes, increasing patient adherence and improving treatment outcomes thereby reducing the PCP’s stress affiliated with visits and improving daily stress levels (Rollick et. al, 2008). The study is currently in progress.