Interventions to improve teamwork and wellbeing in primary care settings: a mixed method review : Maria Panagioti

Background General practices are experiencing increasing pressures due to rising demand, declining staff numbers, and knock-on impacts on patient care. The COVID-19 pandemic has added further challenges and reinforced the importance of teamwork and organisational settings. We undertook a mixed-method systematic review to explore which interventions can improve teamwork within primary care and improve inter-sector partnerships with other health and social care services. Methods Five major bibliographic databases were systematically searched for relevant studies from inception to February 2022. We included controlled intervention study designs and linked qualitative studies. For amenable data, meta-analysis is being undertaken using random effects models taking into account the between study heterogeneity (quantified using the I2 statistic) and potential publication bias (funnel plots and Egger's test). The qualitative studies are analysed using thematic analyses. Results The original search yield of 3012 studies, of which 14 studies with 1,534 participants were include in our analyses. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements in the quality of teamwork in primary care. Meta-analysis and narrative synthesis is undertaken to examine the impact of the teamwork interventions on staff outcomes (team attitudes, knowledge, and functioning;wellbeing), and patient outcomes (e.g. quality of patient care, patient satisfaction/experience). Conclusions The findings provide information of immediate importance for the mental health and wellbeing and teamwork support of professionals entering primary care and for the organisation of primary care services.

Contributors to stress and burnout in junior doctors during the COVID-19 pandemic

Introduction: Junior doctors have reported high levels of burnout and additional stressors emerging from the COVID-19 pandemic may further accelerate burnout. There is a need to identify which stressors are most likely to lead to burnout in order to develop appropriate interventions. This project therefore aims to compile a comprehensive list of stressors relevant to junior doctors and assesses which stressors are most strongly associated with burnout. Materials and Methods: An anonymous online questionnaire was sent in July 2020 to 1000 randomly selected junior doctors in the North West of England. It included 37 questions on general and pandemic specific stressors and the Maslach Burnout Inventory Health Services Survey. Stepwise regression analysis was undertaken to explore associations between stressors and burnout. Results and Conclusions: In total, 326 responses were received. Six of the 10 highest rated stressors were specific to the pandemic. Fatigue (β=0.43), pandemic-related workload increase (β=0.33) and feeling isolated (β=0.24) had the strongest associations with Emotional Exhaustion. Fatigue (β=0.24), uncertainty around COVID-19 information (β=0.22) and doing unfulfilling tasks (β =0.22) had the strongest associations with Depersonalisation. Lacking in ability (β=-0.24) and not feeling valued (β=-0.20) had the strongest associations with Personal Accomplishment. In conclusion, junior doctors reported a combination of general and pandemic-specific stressors that significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigate burnout in junior doctors.