Health System Approach Research Articles

Results of a health systems approach to identify barriers to population-based cervical and colorectal cancer screening programmes in six European countries

The aim of this study was to identify barriers to effective cervical and colorectal cancers screening programmes in Europe. The Barriers to Effective Screening Tool (BEST), based on a health systems approach, was completed by teams of three to six experts on cancer screening in each of the six countries involved in leading the EU-TOPIA project (TOwards imProved screening for breast, cervical and colorectal cancer In All of Europe). While the basic components of screening systems and the challenges they face, such as low participation, are similar, there are also many differences, both in the structures underpinning particular functions, such as maintenance of populationregisters and monitoring outcomes, and the ways that they operate. Many of these lie outside the strict organisational boundaries of screening programmes. BEST offers a means to identify and prioritise issues for further detailed exploration. The holistic health systems approach to assessing barriers differs from previous approaches. Those focus on individual characteristics that determine participation. The approach described here provides additional opportunities to improve outcomes with measures that are largely within the control of those managing the health system.

A health systems approach to identifying barriers to breast cancer screening programmes. Methodology and application in six European countries

The benefits of population-based screening for breast cancer are now accepted although, in practice, programmes often fail to achieve their full potential. In this paper, we propose a conceptual model that situates screening programmes within the broader health system to understand the factors that influence their outcomes. We view the overall screening system as having multiple sub-systems to identify the population at risk, generate knowledge of effectiveness, maximise uptake, operate the programme, and optimise follow-up and assurance of subsequent treatment. Based on this model we have developed the Barriers to Effective Screening Tool (BEST) for analysing government-led, population-based screening programmes from a health systems perspective. Conceived as a self-assessment tool, we piloted the tool with key informants in six European countries (Estonia, Finland, Hungary, Italy, The Netherlands and Slovenia) to identify barriers to the optimal operation of population-based breast cancer screening programmes. The pilot provided valuable feedback on the barriers affecting breast cancer screening programmes and stimulated a greater recognition among those operating them of the need to take a health systems perspective. In addition, the pilot led to further development of the tool and provided a foundation for further research into how to overcome the identified barriers.

A Learning Health System Approach to the Opioid Crisis

A Learning Health System Approach to the Opioid Crisis

Opportunities and Challenges for Dietary Arsenic Intervention.

Summary:The diet is emerging as the dominant source of arsenic exposure for most of the U.S. population. Despite this, limited regulatory efforts have been aimed at mitigating exposure, and the role of diet in arsenic exposure and disease processes remains understudied. In this brief, we discuss the evidence linking dietary arsenic intake to human disease and discuss challenges associated with exposure characterization and efforts to quantify risks. In light of these challenges, and in recognition of the potential longer-term process of establishing regulation, we introduce a framework for shorter-term interventions that employs a field-to-plate food supply chain model to identify monitoring, intervention, and communication opportunities as part of a multisector, multiagency, science-informed, public health systems approach to mitigation of dietary arsenic exposure. Such an approach is dependent on coordination across commodity producers, the food industry, nongovernmental organizations, health professionals, researchers, and the regulatory community. https://doi.org/10.1289/EHP3997

Cross-Cultural Notions of Risk and Liberty: A Comparison of Involuntary Psychiatric Hospitalization and Outpatient Treatment in New York, United States and Zurich, Switzerland.

Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.

Regulating Access and Protecting Traditional Health Knowledge through Intellectual Property Rights? Issues from a Holistic Health Systems Perspective

Traditional Health Knowledge (THK) has been a resource for modern pharmacology and the pharma-ceutical industry since its inception. Until the 2000s, there was little obligation to acknowledge the use of THK by the pharmaceutical industry. Now, with the intellectual property regime becoming a prominent mode of regulating use of pharmaceutical inventions and innovations, and attempts by the pharmaceutical industry to patent products based on THK, rights of THK holders are being fore-grounded. The World Intellectual Property Organization (WIPO) is seeking to protect the rights of THK holders through international legal instruments under the Intellectual Property Rights (IPR) framework. This article discusses dilemmas arising from this attempt at bringing together two diverse knowledge frameworks. It draws upon existing literature on the nature of THK and upon the debates of the WIPO’s Inter-Governmental Committee on Genetic Resources, Traditional Knowledge and Traditional Cultural Expression (WIPO-IGC), and analyses them from the standpoint of a holistic health systems approach (HHSA) in an era of Sustainable Development Goals (SDGs). The approach leads to the conclusion that deliberations and promulgations of the WIPO-IGC will have long-lasting implications for the survival of diversity and context-specificity in healthcare. Therein lies the significance of thinking through the policy and legal measures to be adopted nationally and internationally.

Northern NSW Health Literacy Project

Introduction: 60% of Australian adults do not have the level of health literacy needed to understand and act on day to day health information. Low health literacy is linked to poorer health status, low use of preventive health services and higher rates of preventable hospitalisation. Faced with a growing and aging population and increasing rates of chronic and complex conditions, Northern NSW health services and health professionals must provide clear, accessible information that empowers patients, families and carers to understand and manage health conditions. Practice change implemented: The Northern NSW Health Literacy Project empowers people to understand and manage health conditions by: Developing health information that is easy to access, understand and act upon. Partnering with consumers to develop health information, assess service design and deliver health education. Building the capacity of the health workforce to improve communication with people in their care. Aim and theory of change: The Project aims to improve health communication and engage the community to empower people to be partners in their health care and understand and manage health conditions. Improving health literacy in this way can improve health outcomes and health service quality, safety and efficiency. Targeted population and stakeholders: The target population are people with chronic and complex conditions, their families and carers. Key stakeholders are the Northern NSW Local Health District (NNSW LHD) and North Coast Primary Health Network (NCPHN). Timeline: The Project commenced in July 2016. Highlights: The Project is jointly funded and implemented by NNSW LHD and NCPHN, allowing a unique whole of health system approach. The Health Literacy Website is the first of its kind in Australia. It contains information, resources and an online library of patient resources developed to meet health literacy standards. Visit http://healthliteracy.nnswlhd.health.nsw.gov.au/. Health Literacy Awareness and Workshops have been designed and delivered to over 700 health professionals and community members with significant impact on heath literacy knowledge and skills. 100% of surveyed attendees intended to implement at least one health literacy strategy. Health professionals are now developing and reviewing resources and communication practices in partnership with consumers to ensure health information is easy to access, understand and act on. Community members engaged in these processes report greater health literacy as a result of their involvement. Sustainability: The Project has resulted in systemic changes, building the foundations for a culture of health literacy. Health literacy is embedded in policy, and there is an increase in health literacy knowledge, confidence and skills among patients and workforce. The Website ensures sustainability, already continually expanding and improving. Transferability: The Website is easily transferable and accessible across health settings and geographical boundaries. Utilising digital technologies allows transferability within and outside NNSW. Conclusions: Improving the health literacy of health services and health professionals and empowering people to understand and manage their health can improve health outcomes and health service quality, safety and efficiency. The NNSW Health Literacy Project has demonstrated significant progress towards these aims and continues to build on these achievements.

Approaching quality improvement at scale: a learning health system approach in Kenya

In 2002, we identified major shortcomings in the management of sick newborns and children at the first referral or district hospital level in Kenya.1 Failure in the dissemination of knowledge...

Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia.

Objectives:To assess the effect of two health system approaches to distribute HIV self-tests on the number of female sex workers’ client and nonclient sexual partners.Design:Cluster randomized controlled trial.Methods:Peer educators recruited 965 participants. Peer educator–participant groups were randomized 1 : 1 : 1 to one of three arms: delivery of HIV self-tests directly from a peer educator, free facility-based delivery of HIV self-tests in exchange for coupons, or referral to standard-of-care HIV testing. Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, 1 and 4 months, and the number of nonclient partners they had in the past 12 months (at baseline) and in the past month (at 1 month and 4 months).Results:At 4 months, participants reported significantly fewer clients per night in the direct delivery arm (mean difference −0.78 clients, 95% CI −1.28 to −0.28, P = 0.002) and the coupon arm (−0.71, 95% CI −1.21 to −0.21, P = 0.005) compared with standard of care. Similarly, they reported fewer nonclient partners in the direct delivery arm (−3.19, 95% CI −5.18 to −1.21, P = 0.002) and in the coupon arm (−1.84, 95% CI −3.81 to 0.14, P = 0.07) arm compared with standard of care.Conclusion:Expansion of HIV self-testing may have positive behavioral effects enhancing other HIV prevention efforts among female sex workers in Zambia.Trial Registration:ClinicalTrials.gov NCT02827240.

Integrated children\u2019s clinic care (ICCC) versus a self-directed care pathway for children with a chronic health condition: a multi-centre randomised controlled trial study protocol

BackgroundChildren with chronic health conditions have better health-related outcomes when their care is managed in a personalised and coordinated way. However, increased demand on Australian ambulatory care hospital services has led to longer waitlist times to access specialists and appropriate intervention services; placing vulnerable children at increased risk of poorer short-term (e.g. social difficulties) and long-term (e.g. convictions) health and social outcomes. Traditional approaches to increasing frequency and service of delivery are expensive and can have minimal impact on caregiver burden. A community based service-integration approach, rather than self-directed care is proposed as increased service linkages are more likely to occur and improve the health outcomes of children with a chronic health condition.MethodsAn open, unblinded, multi-centre randomised controlled trial in two Australian public hospitals. 112 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for management of their chronic health condition: (1) integrated children’s care clinic (ICCC) or (2) self-directed care pathway. All children and caregivers will be interviewed at 1 week, and 3, 6 and 12 month time intervals. Primary outcome measures include the Pediatric Quality of Life (PedQOL) questionnaire, Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL) and Rotter’s Locus of Control Scale. Secondary outcome measures include the total number of medical appointments, school days missed and quantity of services accessed. Our main objectives are to determine if the ICCC results in better health and economics outcomes compared to the self-directed care pathway.DiscussionThe success of a health systems approach needs to be balanced against clinical, mortality and cost-effectiveness data for long-term sustainability within a publicly funded health system. A clinical pathway that is sustainable, cost-effective, provides efficient evidence-based care and improves the quality of life outcomes for children with chronic health conditions has the potential to reduce waitlist times, improve access to health services, increase consumer satisfaction; and prevent costs associated with poorly managed chronic health conditions into adulthood. This study will be the first to provide clinical and health economics data on an integrated care pathway for the management of chronic health conditions in children. On a broader scale, results from this study will help guide care coordination frameworks for children with chronic health conditions; particularly with the introduction and implementation of a National Disability Insurance Scheme (NDIS) across Australia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12617001188325. Registered: 14th August, 2017.

When food isn't medicine - A challenge for physicians and health systems.

Food can be powerful medicine. Good nutrition helps promote health and prevent and treat disease. Yet nutrition is not often part of a physician's training or clinical practice. Food might not be medicine when it's importance is under-recognized and healthful eating is under-prescribed. Moreover, food cannot be medicine when it is not available to patients (or when available only in the form of unhealthful fare). This paper considers evolving thinking about when food isn't medicine by chronicling the experience of one physician—from college coursework to providing patient care and conducting research. The paper is framed around the experience of a representative patient struggling with diet-related chronic conditions, and describes some community-focused initiatives to help address issues related to food access in challenged communities. A principal focus is the over-abundance of foods from ‘plants’ (the industrial processing kind) and the low availability of food from ‘plants’ (the living botanical kind). Physicians and health systems can support access to healthier food and healthier eating, and the idea of food as medicine, through a variety of approaches that extend beyond hospital and clinic walls. Examples of such physician and health-system approaches are provided.

Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe

ABSTRACTBackground: Despite increased support for voluntary medical male circumcision (VMMC) to reduce HIV incidence, current VMMC progress falls short. Slow progress in VMMC expansion may be partially attributed to emphasis on vertical (stand-alone) over more integrated implementation models that are more responsive to local needs. In 2013, the ZAZIC consortium began implementation of a 5-year, integrated VMMC program jointly with Ministry of Health and Child Care (MoHCC) in Zimbabwe.Objective: To explore ZAZIC’s approach emphasizing existing healthcare workers and infrastructure, increasing program sustainability and resilience. Methods: A process evaluation utilizing routine quantitative data. Interviews with key MoHCC informants illuminate program strengths and weaknesses.Methods: A process evaluation utilizing routine quantitative data. Interviews with key MoHCC informants illuminate program strengths and weaknesses.Results: In start-up and year 1 (March 2013–September, 2014), ZAZIC expanded from two to 36 static VMMC sites and conducted 46,011 VMMCs; 39,840 completed from October 2013 to September 2014. From October 2014 to September 2015, 44,868 VMMCs demonstrated 13% increased productivity. In October, 2015, ZAZIC was required by its donor to consolidate service provision from 21 to 10 districts over a 3-month period. Despite this shock, 57,282 VMMCs were completed from October 2015 to September 2016 followed by 44,414 VMMCs in only 6 months, from October 2016 to March 2017. Overall, ZAZIC performed 192,575 VMMCs from March 2013 to March, 2017. The vast majority of VMMCs were completed safely by MoHCC staff with a reported moderate and severe adverse event rate of 0.3%.Conclusion: The safety, flexibility, and pace of scale-up associated with the integrated VMMC model appears similar to vertical delivery with potential benefits of capacity building, sustainability and health system strengthening. These models also appear more adaptable to local contexts. Although more complicated than traditional approaches to program implementation, attention should be given to this country-led approach for its potential to spur positive health system changes, including building local ownership, capacity, and infrastructure for future public health programming.

Gender-Based, Public Health Systems Approaches to Improving Women and Girls’ Health: Results from the USA Office on Women’s Health, Coalition for a Healthier Community Initiative

Gender-Based, Public Health Systems Approaches to Improving Women and Girls’ Health: Results from the USA Office on Women’s Health, Coalition for a Healthier Community Initiative

The World Heart Federation Roadmap for Nonvalvular Atrial Fibrillation.

The World Heart Federation has undertaken an initiative to develop a series of Roadmaps to promote development of national policies and health systems approaches, and to identify potential roadblocks on the road to effective prevention, detection, and management of cardiovascular disease in low-and middle-income countries (LMICs) and develop strategies for overcoming these. This Roadmap focuses on atrial fibrillation (AF). AF is the most common, clinically significant arrhythmia and, among other clinical outcomes, is associated with increased risk of stroke. Development of this Roadmap included a review of published guidelines and research papers, and consultation with an expert committee comprising experts in clinical management of AF and health systems research in LMICs. The Roadmap identifies 1) key interventions for detection, diagnosis, and management of AF; 2) gaps in implementation of these interventions (knowledge-practice gaps); 3) health system roadblocks to implementation of AF interventions in LMICs; and 4) potential strategies for overcoming these. More research is needed on determinants and primary prevention of AF. Knowledge-practice gaps for detection, diagnosis, and management of AF are present worldwide, but may be more prominent in LMICs. Potential barriers to implementation of AF interventions include long distances to health facilities, shortage of health care professionals with training in AF, including interpretation of ECG, unaffordability of oral anticoagulants for patient households, reluctance on the part of physicians to initiate oral anticoagulant (OAC) therapy, and lack of awareness of the importance of persistent adherence to OAC therapy. Potential solutions include training of nonphysician health workers and pharmacists in pulse-taking, use of telemedicine technologies to transmit electrocardiogram results, engagement of nonphysician health workers in OAC therapy adherence support, and country-specific support and education programs for noncardiologist health care professionals. AF affects millions of people worldwide and, left untreated, increases the risk and severity of stroke and heart failure. Although guidelines for the detection, diagnosis, and management of AF exist, there are gaps in implementation of these guidelines globally, and in particular in LMICs. This Roadmap identifies some potential solutions that may improve AF outcomes in LMICs but require further evaluation in these settings.

Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach.

Adaptive and adequately resourced health systems are necessary to achieve good health outcomes in post-conflict settings, however domains beyond the health system are also critical to ensure broader wellbeing. This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. Our findings highlight why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork (consisting of in-depth and key informant interviews as well as group discussions in Gaza, Liberia and Sri Lanka involving a total of 386 respondents across the three countries), we argue that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls. These include: tailoring services to ensure gender and age-sensitivity; investing in capacity building of service providers to promote service uptake; and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.

Following the Biosimilar Breadcrumbs: When Health Systems and Manufacturers Approach Forks in the Road.

The author received no outside funding support and has nothing to disclose.

Community Coalitions’ Gender-Aware Policy and Systems Changes to Improve the Health of Women and Girls

BackgroundAddressing environmental barriers and community conditions through policy and systems change provides the foundation for creating sustainable public health change at the population level. In an effort to influence population-level change that is gender aware, the United States Department of Health and Human Services Office on Women's Health funded the Coalition for a Healthier Community initiative supporting 10 grantees in the implementation of gender-based, public health systems approaches to improve women and girls' health. MethodsA national evaluation assessed the extent to which these gender-aware public health systems approaches result in programs and policies that are sustainable and cost effective in addressing health disparities in women and girls. For this paper, a review of policies reported on in grantees' quarterly progress reports was conducted, and policies were categorized based on each policy's status, level, sector affected, and whether it was gender aware. ResultsThe review revealed 77 policies at varying stages of development or implementation intended to facilitate systems-level change at the coalition, school, organizational, local, or state level. Fifty-one percent of these policies were identified as being gender aware, because they were intended to reduce barriers to or increase facilitators of gender equity. ConclusionsCommunity coalitions, like the Coalition for a Healthier Community coalitions, can be valuable channels for promoting policy change, as demonstrated by the many policies developed and/or supported by the Coalition for a Healthier Community grantees in their attempt to meet the needs of women and girls.

World Heart Federation Cholesterol Roadmap.

The World Heart Federation has undertaken an initiative to develop a series of Roadmaps. The aim of these is to promote development of national policies and health systems approaches and identify potential roadblocks on the road to effective prevention, detection and management of cardiovascular disease (CVD) in low-and middle-income countries (LMIC), and strategies for overcoming these. This Roadmap focuses on elevated blood cholesterol, a leading risk factor for myocardial infarction, stroke, and peripheral arterial disease. Through a review of published guidelines and research papers, and consultation with a committee composed of experts in clinical management of cholesterol and health systems research in LMIC, this Roadmap identifies (1) key interventions for primordial, primary and secondary prevention of CVD through detection, treatment, and management of elevated cholesterol and familial hypercholesterolemia (FH); (2) gaps in implementation of these interventions (knowledge-practice gaps); (3)health system roadblocks to treatment of elevated cholesterol in LMIC; and (4) potential strategies for overcoming these. Despite strong evidence of the importance of cholesterol levels in primary or secondary prevention of CVD, and the effectiveness of statin therapy for cholesterol lowering and reduction of CVD risk, gaps exist in the detection, treatment, and management of high cholesterol globally. Some potential roadblocks include poor access to laboratory facilities or trained professionals for cholesterol management, low awareness of FH among the general population and health professionals, unaffordability of statins for patient households, and low awareness of the importance of persistent adherence to lipid-lowering medication. Potential solutions include point-of-care testing, provision of free or subsidized lipid-lowering medication, and treatment adherence support using text message reminders. Known effective strategies for detection, treatment, and management of elevated cholesterol and FH exist, but there are barriers to their implementation in many low-resource settings. Priorities for health system intervention should be identified at the national level, and the feasibility and effectiveness of proposed solutions should be assessed in specific contexts. Many solutions proposed in this Roadmap mayapply to other cardiovascular conditions and present opportunities for integration of CVD care in LMIC.

A system approach to improving maternal and child health care delivery in Kenya: innovations at the community and primary care facilities (a protocol)

BackgroundMaternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under 5 health indicators, more rapid progress is needed to meet the targets including the Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain the targets of the SDG 3 by 2030. We describe the structure and methods of a study to assess the impact of an innovative system approach on maternal, neonatal and under-five children outcomes.This will be implemented in two clusters in the Counties of Busia and Bungoma in Kenya. There will be 4 control clusters in Kakamega, UasinGishu, Trans Nzoia and Elgeyo Marakwet Counties in Kenya. The study population will be pregnant women, newborns and under-five children identified over the study period. The objective of the study is to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies six WHO pillars of the health system and community owned initiatives including Community Based Organisations and Income Generating Activities.Methods/DesignA five year quasi-experimental design will be used to compare the outcomes of the implementation of the EHC using the Find Link Treat and retain (FLTR) strategy in one cluster, community owned initiatives in one cluster and four control clusters at baseline and at the end of the study. A Baseline survey will be conducted in year one and an endline in the fifth year in which maternal, neonatal and underfive childhood outcomes will be compared.DiscussionThe expected findings from the study include showing trends in improvement in the intervention clusters for morbidity, mortality, health service utilization and access indicators. Use of the health systems approach in health care provision is expected to provide a holistic improvement in the quality of care in the study populations in the intervention clusters that will lead to improved health indicators including morbidity and mortality. It is expected that the findings will inform health policy of the national and county governments in Kenya and worldwide.

Active Engagement in APA Called Remedy to Burnout

Back to table of contents Previous article Next article Professional NewsFull AccessActive Engagement in APA Called Remedy to BurnoutMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Jul 2017https://doi.org/10.1176/appi.pn.2017.8a16AbstractSuicide deaths of medical students, residents, and physicians have brought the subject of physician well-being to public attention and turned the issue into an acute one for organized medicine.Burnout—the phenomenon of mental exhaustion and emotional depletion—is experienced and understood by physicians perhaps more so than many other professionals. When physicians talk about burnout, other physicians—that is, you—know what they are saying. That’s why Psychiatric News will be featuring commentary over the next year from APA members offering their unique perspectives on burnout, wellness, and resilience. Experts from the recently appointed APA Work Group on Physician Wellness and others who have a special insight on the subject will provide personal accounts of their experience of burnout and strategies for maintaining wellness and resilience, and offer knowledgeable commentary about research, treatment, and institutional and health system approaches to dealing with the problem.“Burnout is pervasive in modern medicine,” said APA President Anita Everett, M.D., who has made the subject a priority of her presidential year. She noted that a December 2015 report in Mayo Clinic Proceedings found that in 2014, roughly 54 percent of the physicians surveyed had at least one symptom of burnout. When compared with 2011, rates of burnout among physicians were higher in 2014, and satisfaction with work-life balance was lower (41 percent versus 49 percent).Everett added that many aspects of modern American medicine—with its cumbersome electronic health records, excessive productivity quotas, limits on the time physicians can spend with each patient, loss of professional autonomy, and excessive documentation requirements—have become sources of professional dissatisfaction. Some stressors adversely affect psychiatrists uniquely: limited resources, high work demands, and patient violence. “Most of us have felt some degree of compassion fatigue in our careers,” she said. “Some of us may have even experienced deep and pervasive episodes of burnout that have had an impact both on our practice of medicine and on our home lives.”Tragically, Everett noted, suicides by medical students, residents, and physicians have brought the subject of physician well-being to public attention and turned the issue into an acute one for organized medicine.Everett believes the subject of burnout—powerfully impacting the professional lives of APA members—is ripe for address by professional organizations like APA. And active engagement of members in the organizational life of APA can be a strong deterrent to burnout, she believes. “Involvement in a professional society can empower members, providing a sense of collegial community and a venue for re-embracing the passion that caused us to want to be physicians in the first place,” she said.The Psychiatric News series will begin in the next issue with a report from work group chair Richard Summers, M.D., on the town hall discussion on burnout that was held at APA’s 2017 Annual Meeting in San Diego. Other subjects to be addressed in coming issues include evidence-based interventions for physicians with depression, perspectives on burnout and resilience from senior psychiatrists, efforts to promote medical student wellness, incorporation of mindfulness training into professional practice, ACGME efforts around the issue of wellness and burnout, physician mental health issues and state licensing boards, and organized-medicine and institutional-level approaches to preventing and treating burnout. Everett said she believes the Psychiatric News series will be a popular feature and one that members will look forward to from one issue to the next. “It is my hope that the series will provide real tools that our members can use in their daily professional lives to stay healthy and to remain passionate about the vital work we do with our patients,” she said. ■ ISSUES NewArchived