query object

    array(53) {
  [0]=>
  int(85502)
  [1]=>
  int(70754)
  [2]=>
  int(43732)
  [3]=>
  int(17233)
  [4]=>
  int(17216)
  [5]=>
  int(17188)
  [6]=>
  int(17176)
  [7]=>
  int(17164)
  [8]=>
  int(17156)
  [9]=>
  int(17136)
  [10]=>
  int(17125)
  [11]=>
  int(17116)
  [12]=>
  int(17104)
  [13]=>
  int(17087)
  [14]=>
  int(17044)
  [15]=>
  int(17025)
  [16]=>
  int(17035)
  [17]=>
  int(17052)
  [18]=>
  int(17075)
  [19]=>
  int(17016)
  [20]=>
  int(17008)
  [21]=>
  int(17060)
  [22]=>
  int(17067)
  [23]=>
  int(129618)
  [24]=>
  int(129189)
  [25]=>
  int(128968)
  [26]=>
  int(128679)
  [27]=>
  int(128420)
  [28]=>
  int(128241)
  [29]=>
  int(127937)
  [30]=>
  int(127712)
  [31]=>
  int(127427)
  [32]=>
  int(127147)
  [33]=>
  int(126957)
  [34]=>
  int(126705)
  [35]=>
  int(126174)
  [36]=>
  int(125833)
  [37]=>
  int(125542)
  [38]=>
  int(125258)
  [39]=>
  int(125103)
  [40]=>
  int(124822)
  [41]=>
  int(124303)
  [42]=>
  int(123984)
  [43]=>
  int(123790)
  [44]=>
  int(123039)
  [45]=>
  int(122846)
  [46]=>
  int(122599)
  [47]=>
  int(122390)
  [48]=>
  int(121978)
  [49]=>
  int(122036)
  [50]=>
  int(121836)
  [51]=>
  int(121627)
  [52]=>
  int(121491)
}

feature query posts

    array(4) {
  [0]=>
  object(WP_Post)#5047 (24) {
    ["ID"]=>
    int(129618)
    ["post_author"]=>
    string(5) "45524"
    ["post_date"]=>
    string(19) "2024-03-22 10:03:26"
    ["post_date_gmt"]=>
    string(19) "2024-03-22 14:03:26"
    ["post_content"]=>
    string(14445) "

Ketamine clinic popularity has surged in recent years, with a growing number of psychedelic med spas appearing across the United States and globally. However, patients and providers alike have raised regulatory, legal, efficacy, and safety concerns about these clinics.

Ketamine: From Club Drug to Breakthrough Therapy

In the 1970s, ketamine was considered a single-use anesthetic confined to intravenous or intramuscular injection at a surgeon’s office. But it wasn’t long before ketamine emerged beyond the walls of the inpatient setting onto the club scene, where it became a highly popular recreational drug given its dissociative effects. By 1999, this gained the attention of the Drug Enforcement Administration (DEA), which then classified ketamine as a Schedule III controlled substance due to its high risk of dependence, lethal side effects, and potential for abuse.1

Despite its controversial history, interest in ketamine for therapeutic applications began to build around 2015 and in recent years there has been a rapid rise of ketamine clinics, enthusiastic to meet this newfound demand. These clinics offer off-label ketamine for a wide range of conditions, including neuropathic pain, anxiety, Lyme disease, and rheumatoid arthritis.2 As ketamine clinics popped up around the country, the Food and Drug Administration (FDA) approved a nasal spray containing esketamine (the S+ enantiomer) in 2019, called Spravato®, which is approved in conjunction with an oral antidepressant for 1) treatment-resistant depression and 2) patients with major depressive disorder (MDD) presenting with acute suicidal ideation or behavior.3

Although only meant for these specific indications, the approval of Spravato® helped drive ketamine’s perceived legitimacy for chronic disease management. Shortly after Spravato® was approved, the COVID-19 pandemic took over the world and led to a major shift in medical treatment modality as telehealth became both necessary and increasingly popular. As a result, a deregulated ketamine marketplace flourished online under the cover of telemedicine. This expanding market has raised serious red flags among healthcare providers and government agencies, now playing catch-up to protect public safety.4

"
These safeguards don’t apply to the off-label ketamine often provided at ketamine clinics.

To understand if today’s ketamine clinics are serving patients' best interests — or simply taking advantage of a lucrative loophole — we spoke with Lisa M Harding, MD, Board Certified Psychiatrist and Assistant Clinical Professor at Yale School of Medicine, and Griffen Thorne, JD, Partner Attorney at Harris Sliwoski, to learn more.

Do Ketamine Clinics Benefit Patients?

On the surface, ketamine clinics seem to improve access to care for patients in rural areas or places with limited resources. However, Dr Harding is skeptical about the sudden proliferation of ketamine clinics, especially as they don’t take insurance.5 “Access to care has never meant giving substandard care. The folks operating in a space with no formal rules say they are improving access to seem less nefarious,” she explained. “There is no way that one kind of treatment required by the FDA to be delivered in a medical setting is equal to a similar treatment delivered outside of a medical setting just because there are no written rules. The safety challenges are still there.”

While early ketamine clinics relied on intravenous infusion centers with medical supervision, today’s online clinics allow clients to fill generic prescriptions in the form of lozenges that they then take at home with the help of a designated “sitter” — who isn’t necessarily a medical professional.5

“Ketamine is now prescribed online, and in some cases even mailed to patients,” shared Thorne. But this wasn’t always the case. “A federal law, the Ryan Haight Act of 2008, prohibited physicians from prescribing controlled substances without at least 1 in-person evaluation beforehand. But this requirement was suspended during the COVID public health emergency declaration, so now things that weren’t available before are now available online. Some of these laws didn’t immediately change back after the COVID emergency ended,” he said.

Nonetheless, some patients argue that at-home ketamine has been a life-changing treatment and advocate for the continued allowance of telemedicine ketamine treatment. “The DEA is trying to work through a middle ground where telehealth is still available for those who need it,” explained Thorne.

However, many psychiatrists and regulators worry that ketamine treatment outside of a medical setting puts patients at risk.4 Dr Harding explained,

Ketamine was only studied in the short term. No long-term efficacy study has been done on ketamine. Many papers look at retrospective data or comment on models implemented at academic institutions. For example, most patients in treatment with intravenous ketamine get treated once a month with an infusion and are evaluated with a face-to-face physician visit every 3-6 months once they are stable.

However, she shared that esketamine does have a long-term safety study (the Sustain III trial), which enabled the approval of Spravato®. “Patients are treated once a week or once every two weeks, and the data published at the 4-year mark show no new safety signals. Patients in maintenance are assessed by their care team.”

Dr Harding notes in her published work that esketamine is the only antidepressant of its kind to be researched and FDA-approved for depression symptoms in suicidal patients. It works within hours of administration, offering a significant advantage over other antidepressants that can take weeks.6

The FDA only approved Spravato® to be administered in a regulated environment. A Risk Evaluation and Mitigation Strategy (REMS) requires patients to stay in an approved facility for monitoring 2 hours after treatment and data is recorded after every treatment.7 These safeguards don’t apply to the off-label ketamine often provided at ketamine clinics.4

Ketamine can regularly be administered under the supervision of a licensed doctor in a medical setting, but ketamine prescriptions for at-home use aren’t legal in every state.8 Thorne advised, “Physicians who want to administer ketamine need a DEA registration like any other Schedule III controlled substance.”

Because of the many state, federal, and healthcare regulations that exist, Thorne recommends having a robust compliance plan before operating a ketamine clinic.9 He said the rules change regularly, and what works in some states won’t pass in others. For example, certain states like New York and California have a rule called the Corporate Practice of Medicine (CPOM). This means that businesses like ketamine clinics generally must be owned by a licensed physician. However, CPOM laws vary greatly from state to state, so the requirements in one state may be completely inapplicable to its neighbor. Furthermore, states that don’t require CPOM may have different licensing requirements that need to be followed.

“With ketamine, you deal with healthcare regulations, which are very complicated. And it’s all regulated under state law.” He discussed how this differs from cannabis, which is a Schedule 1 controlled substance. Any time a state legalizes cannabis for recreational use, it still cannot legally be prescribed because it is a Schedule I controlled substance. Doctors can recommend cannabis to patients who can purchase it themselves from a dispensary. But ketamine, which requires a prescription and is subject to greater penalties, is much more heavily regulated in its prescription and administration.

Thorne also noted that just because someone is a doctor and has the legal authority to prescribe ketamine, it doesn’t necessarily mean they’re the best person for the job. “There are all kinds of licensed folks who try to get in on the action, which can lead to some concern, like if you’re dealing with ketamine therapy and you’re actually a podiatrist. Typically, anesthesiologists are involved, especially with infusions. Getting the right people is one of the main issues, especially if you want the drug to be given in a safe, effective, and appropriate way,” said Thorne.

The Future of Ketamine and Other Drugs

Thorne admits that some providers push the limits when it comes to prescribing off-label ketamine. He predicts that more regulation is likely as a result. He also suspects that certain psychedelic drugs are likely to get approved in the next few years, and the DEA will make more rules on how clinics can operate.

“There’s a big interest in all the psychedelics, and there’s a strong chance of approval by 2026, if not sooner, for MDMA and maybe even psilocybin drugs,” Thorne explained. “Oregon has some state allowances for psilocybin, which are soon to come for Colorado. But there isn’t a retail market where you can buy and take it home. It’s all in an office or ‘service center,’ and someone licensed needs to watch you through the course of the drug. If a physician is to participate in that process, it’s not clear to say whether the state boards will approve it.”

Thorne goes on to describe how cost can be a barrier.

It would be a challenge to have insurance cover it. In some ways, these state-level programs are designed to fail because it’s a long time for a licensed facility to be there monitoring. It’s not a sustainable market because only a select group of people can afford it. If it’s going to be so expensive, people will need it to be insured at the federal level, which won’t happen with things like MDMA and psilocybin until the FDA approves them, at the very least. Even with ketamine, which has been used clinically for years, most physicians still only take cash.

According to Dr Harding, the need for more mental health therapies is apparent, but she’s not convinced that ketamine or psychedelics are the answer. “To date, there is no cure for depression,” she shared. “Data tells us that if a patient has more than three bouts of depression, they will be in care for the majority of their life and will always be at risk. Treatment is always individualized, and there must always be informed consent. Patients must understand the risks, benefits, alternatives, and risks of no treatment at all.”

Dr Harding agreed that patients need more options to care for their mental health, but only when supported by solid evidence. “I think there should be further trials to support mood disorders. We don't have good treatments for [post-traumatic stress disorder] or bipolar depression. But we need clinical trials to support us,” she said.

For now, Dr Harding encourages providers and patients to use caution when it comes to ketamine. “For providers, there is a lot of continuing education through the American Psychiatric Association to understand specific state laws… For patients, talk to your current treating providers. They are connected in communities and can connect you with care. Not every treatment is right for you. If an expert tells you that they don't think it will help, they are probably right,” she advised.

" ["post_title"]=> string(71) "The Rising Popularity of Ketamine Clinics Sparks Legal, Safety Concerns" ["post_excerpt"]=> string(168) "In response to the rise of ketamine clinics, Lisa M Harding, MD, and Griffen Thorne, JD, discuss the legal and safety concerns expressed by both providers and patients." ["post_status"]=> string(7) "publish" ["comment_status"]=> string(6) "closed" ["ping_status"]=> string(6) "closed" ["post_password"]=> string(0) "" ["post_name"]=> string(21) "ketamine-clinic-legal" ["to_ping"]=> string(0) "" ["pinged"]=> string(0) "" ["post_modified"]=> string(19) "2024-03-22 10:05:46" ["post_modified_gmt"]=> string(19) "2024-03-22 14:05:46" ["post_content_filtered"]=> string(0) "" ["post_parent"]=> int(0) ["guid"]=> string(43) "https://www.psychiatryadvisor.com/?p=129618" ["menu_order"]=> int(0) ["post_type"]=> string(4) "post" ["post_mime_type"]=> string(0) "" ["comment_count"]=> string(1) "0" ["filter"]=> string(3) "raw" } [1]=> object(WP_Post)#5102 (24) { ["ID"]=> int(129189) ["post_author"]=> string(5) "45554" ["post_date"]=> string(19) "2024-03-15 10:12:55" ["post_date_gmt"]=> string(19) "2024-03-15 14:12:55" ["post_content"]=> string(9921) "

The Advisory Council on Alzheimer’s Research, Care, and Services presented updates on Alzheimer Disease (AD) and AD and related dementias (ADRD) treatments and ongoing AD research in a virtual meeting held in January. 

Representatives from the National Alzheimer Project Act (NAPA) research committee, Washington University School of Medicine (WashU), and the Alzheimer’s Association reported on the developments in disease modifying therapies (DMTs), funding, resources for dementia caregivers, and the connection between AD and Down syndrome.1

DMTs for AD

From 2016 to 2023, researchers have observed advancements in AD treatment. Most recently, the US Food and Drug Administration (FDA) approved Leqembi (lecanemab), an amyloid beta-targeting antibody for patients with AD and those in the mild cognitive impairment (MCI) or mild dementia stage of the disease. The FDA’s decision on donanemab, also an amyloid beta-targeting antibody, for the treatment of patients with early AD, is anticipated in the first quarter of 2024. 

The approved route of administration for lecanemab is intravenous (IV). Eisai Pharmaceuticals is testing a subcutaneous route of administration. Compared with the IV route, initial reports suggest that subcutaneous formulations clear 14% more plaque, have an 11% higher area under the curve (AUC), and have lower systemic injection reaction rates.2

On January 31, 2024, Biogen Inc. decided to discontinue Aduhelm (aducanumab-avwa) production, sales, and the affiliated clinical study. Instead, they will allocate their resources to the development of other treatment methods for AD and prioritize moving forward with lecanemab.3

Growing Resources for Dementia Caregivers

With recent progress in AD treatments, progress has also been made in the availability of resources for dementia caregivers. The Alzheimer's Association collaborated with the Centers for Disease Control and Prevention (CDC), Building Our Largest Dementia (BOLD) Public Health Center of Excellence on Dementia Caregiving, and Emory University to initiate a free interactive public health curriculum for clinicians, students, and educators. The goal is to increase awareness and knowledge about the importance of dementia caregiving and how public health may affect it. 

Representatives of the advisory board addressed further initiatives concerning racial/ethnic diversity needs between patients and caregivers and demanded an increase in caregiver wage. Although a resolution has not been reached, caregiving networks are optimistic to find ways to implement changes in the near future.4 

"
The research and the investments that have been made over the past decades led to these advancements in understanding the disease, how it starts and progresses, and figuring out ways to intervene in it.

Revisions and Updates to Funding AD Research

Various extensions and reauthorizations have been made to continue AD research. There is bipartisan agreement that AD research needs more attention. The National Institutes of Health (NIH) and the CDC are looking to: 

  • Extend and reauthorize NAPA
  • Continue advising the Centers for Medicare and Medicaid Services (CMS) to implement a dementia care management model

In the senate budget requests for the 2024 fiscal year, the NIH requested a $321 million increase and the CDC requested $35 million for the BOLD infrastructure for the Alzheimer Act. The Act focuses on AD diagnosis, treatment, and dementia caregiving.5

Increases in federal funding have advanced AD research and the progression of clinical trials. “It’s research that changes the cookbook of medicine ... The research and the investments that have been made over the past decades led to these advancements in understanding the disease, how it starts and progresses, and figuring out ways to intervene in it,” Randall Bateman, MD, Charlotte and Paul Hagemann distinguished professor of neurology at WashU in St. Louis, said at the meeting.6

https://infogram.com/na_feature_advisory_council_ad-1hnq41ok39dlp23?live

Challenges in AD Research

Researchers at WashU have identified challenges that have limited treatment objectives.7  

Overall Barriers to AD Research 
Racial & Ethnic Disparity- Racial and ethnic groups are excluded from testing
- Overall lack of research about patients with AD who belong to racial and ethnic groups
Accessibility to Infusion Centers- Patients who live in rural areas have difficulty accessing infusion centers
- Infusion treatments are time consuming. Patients often miss due to vacation, travel, and other illnesses.
- 6–8-month waitlist for treatment
- Small window for treatment 
Cost of treatment - Treatment costs $50,000 per year
- Medicare finances only 80% of treatment expenses, which could leave patients with ~$10,000 bill out of pocket
- AD biomarker testing is not offered insurance coverage
Effectiveness of DMTs- Need for precision medicine for an individual's unique disease profile
- Dosage and duration vary per patient
- Some patients need to switch medications 

Although limitations are presented in the infrastructure for AD/ADRD treatment, the researchers highlight initiatives for AD prevention. These include the early administration of lecanemab and the implementation of the combination of DMTs.8 

The Connection Between AD and Down Syndrome

In highlighting the existing challenges with AD treatments, Elizabeth Head, MA, PhD, professor at the University of California, spoke about the connection between AD and Down syndrome (DS). By age 40, patients with DS have sufficient plaque and tangle pathology for an AD diagnosis. Dr Head mentioned that it is widespread for older patients with DS to develop AD, and it is one of the leading causes of death for this patient population.

Though there is a connection between AD and DS, patients with DS are often excluded from AD trials, presenting a barrier in research. Ultimately, there is a lack of racial and ethnic diversity in trials; only White patients have a higher survival rate.

Since there is still a limited amount of evidence, it is difficult to identify pharmacologic intervention effectiveness for cognitive decline in patients with DS. Dr Head urged that researchers should begin to expand AD studies to this patient population. The inclusion of patients with DS in cohort trials would result in advanced AD research and a better understanding of DS.9

" ["post_title"]=> string(75) "Advisory Council Releases Updates on Alzheimer Disease Treatments, Research" ["post_excerpt"]=> string(151) "Researchers from WashU, NAPA, and the Alzheimer’s Association presented updates on advancements in Alzheimer disease treatments, research, and care. " ["post_status"]=> string(7) "publish" ["comment_status"]=> string(6) "closed" ["ping_status"]=> string(6) "closed" ["post_password"]=> string(0) "" ["post_name"]=> string(62) "advisory-council-updates-alzheimer-disease-treatments-research" ["to_ping"]=> string(0) "" ["pinged"]=> string(0) "" ["post_modified"]=> string(19) "2024-03-15 10:13:04" ["post_modified_gmt"]=> string(19) "2024-03-15 14:13:04" ["post_content_filtered"]=> string(0) "" ["post_parent"]=> int(0) ["guid"]=> string(43) "https://www.psychiatryadvisor.com/?p=129189" ["menu_order"]=> int(0) ["post_type"]=> string(4) "post" ["post_mime_type"]=> string(0) "" ["comment_count"]=> string(1) "0" ["filter"]=> string(3) "raw" } [2]=> object(WP_Post)#5073 (24) { ["ID"]=> int(128968) ["post_author"]=> string(5) "45524" ["post_date"]=> string(19) "2024-03-08 09:42:39" ["post_date_gmt"]=> string(19) "2024-03-08 14:42:39" ["post_content"]=> string(12147) "

As the global population becomes older, physicians are increasingly navigating the complexities of geriatric medicine. Older adults often have multiple chronic conditions that require ongoing treatment, which frequently results in the practice of polypharmacy — typically defined as the concurrent use of 5 or more medications.1

Although polypharmacy begins as a well-intentioned effort to manage cooccurring conditions, the interaction of these different medications can become a health hazard instead of an optimal solution. Given the increased risks for adverse drug interactions, medication errors, and cognitive impairment, addressing polypharmacy and developing a nuanced approach to geriatric care is crucial to safeguarding the health of older adults.

Increasing Prevalence of Polypharmacy in Older Adults

In a chapter on polypharmacy published in Geriatric Rehabilitation, co-authors Parulekar and Rogers noted that while only 13% of the United States population was aged 65 years and older, this age group accounted for 33% of total prescription medications.2 More than 50% of older adults with multimorbid conditions receive 5 or more medications, with the rate varying between 10% and 55% globally.3 Furthermore, a study of survey data from the Centers for Disease Control and Prevention (CDC) found that the majority of older adults in the US had major polypharmacy and nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common medication type.4

The prevalence of polypharmacy is even higher among women. Research suggests that women are more likely than men to require more than 1 or more specialized medications,1 and older women have higher rates of multimorbidity relative to men — with a consequently higher prevalence of polypharmacy.5

"
Managing polypharmacy requires careful monitoring and coordination by health care providers to deprescribe, optimize medication regimens, and minimize risks for patients.

Erika Ramsdale, MD, an associate professor at the Department of Medicine, Hematology/Oncology at the University of Rochester Medicine, has studied the effects of polypharmacy on older adults initiating cancer treatment6 and spoke about this issue. “Polypharmacy and potentially inappropriate medications are very, very common in older adults, and especially within certain populations, such as older adults with cancer. [However], there is not an easy way to estimate the burden of medication-related adverse effects on patients and the health care system as a whole,” she remarked.

Risk factors for polypharmacy include both patient-level factors (eg, increased age, difficulty self-managing medications, multimorbidity, disabilities) as well as health care system-level components, such as poor continuity of care, prescribing cascades, the use of multiple pharmacies, and inadequately updated medical records.7,8

While polypharmacy is often deemed necessary to treat multimorbidity, the concurrent use of medications has been shown to cause harm in and of itself. In a retrospective cohort study published in 2023, older adults who received multiple medications experienced significantly higher rates of severe comorbidity relative to those who did not experience polypharmacy. Patients with polypharmacy also had a greater rate of all-cause hospitalizations and emergency department (ED) visits.9

Polypharmacy also carries specific neurologic and psychiatric risks. Older adults with polypharmacy and multimorbidity demonstrate greater levels of cognitive impairment, relative to their peers with fewer comorbidities and medications,10 and has been associated with worse self-reported health and depression in older adults.11

Given the risks associated with multiple medications in older adults, many experts have called into question the “appropriate” vs “inappropriate” use of polypharmacy.2 To this aim, Mohamed and colleagues conducted a study to examine the associations between polypharmacy, potentially inappropriate medications, and adverse treatment outcomes in a large national cohort of older adults with advanced cancer. They found that 67% of patients received 1 or more inappropriate medications, and the use of inappropriate medications increased the odds of unplanned treatment-related hospitalization. Additionally, polypharmacy overall was associated with increased risk for postoperative complications, hospitalizations, and mortality risk.8

Dr Ramsdale emphasized the importance of not just the number of medications prescribed to a patient, but also their appropriateness. “Some patients have polypharmacy by number, but all their medications are needed and appropriate.”

Further complicating this medication management issue, Dr Ramsdale addressed the challenge of differentiating between patients who develop symptoms from polypharmacy vs a root cause issue, such as comorbidities/disease. “Often, there is not one ‘root cause’ for a symptom or adverse effect in older adults. There are generally multiple contributing factors and you have to look at all of them and also how the factors interact with each other. One thing you can say is that medications are very often contributing and need to be considered each time something happens.”

Concerns & Barriers in the Management of Polypharmacy in Clinical Practice

Although a wealth of evidence has demonstrated the adverse health risks associated with polypharmacy, the question remains as to how health care systems should best manage this issue. Researchers conducted a study across 14 countries, including the US and UK, to identify the barriers associated with addressing polypharmacy in primary care. They found the most common barriers were a lack of evidence-based guidance, a lack of communication and decision-making systems, and gaps in support.12

From a clinician’s perspective, Dr Ramsdale stated,

Older adults tend to have many doctors who are all prescribing [medications], sometimes in different health systems, leading to fragmentation of care. Providers also may not want to alter [a medication] that another provider has prescribed.

In-depth review of medications takes a lot of time and thought, as each patient’s situation is unique and everyone has different goals and preferences. In addition, clinicians often do not have the time or resources to accomplish this for all patients because of the way our health care system is set up and [the type] of care it prioritizes.

Because one of the major concerns regarding polypharmacy is the increased risk for drug-to-drug interactions that are associated with adverse events and even death,13 there is a critical need to support physicians in these complicated — but increasingly common — cases of medication management.

How Can Providers Manage Polypharmacy in Older Adults?

Researchers have agreed that screening and interventional tools to optimize medication usage for improved outcomes may be beneficial.9 However, the frequency of prescribing multiple medications needs to be evaluated to reduce adverse events and medication burden in this patient population.4 Clinical studies have shown that one of the ways of reducing exposure to polypharmacy is through the practice of “deprescribing” medications.12

Deprescribing medications involves the identification of inappropriate or unnecessary medications to ultimately taper or discontinue their use. In 2019, the American Academy of Family Physicians (AAFP) developed recommendations for clinicians to help in deprescribing medications and reducing the risks for polypharmacy.7 Some of the key guidelines include the identification and prioritization of medications to discontinue, conducting informed decision-making with the patient, ensuring routine follow-up visits, and considering the risks vs benefits when refilling medications.

“Patients and their caregivers can be excellent advocates. All older adults should be [encouraged to] ask questions about the [safety] of their medications. The US Deprescribing Research Network and the Canadian Medication Appropriateness and Deprescribing Network have excellent patient resources available,” Dr Ramsdale recommended.

One of the key aspects in reducing polypharmacy is medication reconciliation, which can be more effectively achieved by improving the communication between provider and patient and the process of discharge from hospitalization. With the increased use of artificial intelligence and clinical decision support systems, the risks for polypharmacy may be minimized.14

Given that many older patients experience some degree of polypharmacy, pharmacists, specialist nurses, and physician assistants play a vital role in medication management, quality prescribing practices, and safety monitoring.4 Managing polypharmacy requires careful monitoring and coordination by health care providers to deprescribe, optimize medication regimens, and minimize risks for patients. Overall, polypharmacy in older adults is directly related to health care service outcomes,9 which warrants the need for a multidisciplinary, holistic approach to address and evaluate its use among patients.

" ["post_title"]=> string(68) "Polypharmacy in Older Adults: Deprescribe to Optimize Medication Use" ["post_excerpt"]=> string(161) "Dr Erika Ramsdale discusses the risks and complications of polypharmacy in older adults, an increasingly prevalent medication management and public health issue." ["post_status"]=> string(7) "publish" ["comment_status"]=> string(6) "closed" ["ping_status"]=> string(6) "closed" ["post_password"]=> string(0) "" ["post_name"]=> string(28) "polypharmacy-in-older-adults" ["to_ping"]=> string(0) "" ["pinged"]=> string(0) "" ["post_modified"]=> string(19) "2024-03-12 14:21:13" ["post_modified_gmt"]=> string(19) "2024-03-12 18:21:13" ["post_content_filtered"]=> string(0) "" ["post_parent"]=> int(0) ["guid"]=> string(43) "https://www.psychiatryadvisor.com/?p=128968" ["menu_order"]=> int(0) ["post_type"]=> string(4) "post" ["post_mime_type"]=> string(0) "" ["comment_count"]=> string(1) "0" ["filter"]=> string(3) "raw" } [3]=> object(WP_Post)#5057 (24) { ["ID"]=> int(128679) ["post_author"]=> string(5) "45554" ["post_date"]=> string(19) "2024-03-01 09:12:40" ["post_date_gmt"]=> string(19) "2024-03-01 14:12:40" ["post_content"]=> string(11470) "

In the demanding and emotionally-charged field of health care, physicians often find themselves at the forefront of providing care and support to patients and their loved ones. While empathy and compassion are essential qualities in this profession, the constant exposure to suffering and the pressure to deliver optimal care can take a toll on the emotional well-being of health care professionals. These concerns are particularly true in certain environments like palliative care settings.1 In addition, intense workloads and limited resources during the COVID-19 pandemic further highlighted the mental health crisis facing many health care workers.2

A specific form of psychological distress known as compassion fatigue has emerged as an important topic in need of further research and attention. Compassion fatigue is a state of emotional exhaustion that can reduce your capacity for empathy,1 ultimately putting patient care at risk. To remain effective, health care professionals need strategies to identify the signs of compassion fatigue and alleviate its symptoms before the cumulative stress of work takes over.

How to Recognize Compassion Fatigue

Compassion fatigue is a psychological and physical state that occurs when health care professionals become emotionally drained from their efforts to care for patients. It is often a result of prolonged exposure to patients' suffering, traumatic events, or the inability to alleviate their pain. Experts have defined compassion fatigue as a combination of secondary traumatic stress and burnout.1 It may be viewed as, “the phenomenon of stress resulting from exposure to a traumatized individual rather than from exposure to the trauma itself.”3

As physicians experience increased levels of stress and burnout, they may feel emotionally detached and helpless, losing their sense of purpose. Some warning signs you shouldn't ignore include:

  • Apathy and cynicism: A growing sense of pessimism may develop, affecting interactions with patients, colleagues, family, and friends.
  • Decreased job satisfaction: Compassion fatigue often leads to frustration and dissatisfaction with one's profession, increasing absenteeism and making physicians question their career choices.3
  • Emotional withdrawal: Physicians may emotionally detach themselves from patients and colleagues, leading to numbness or indifference towards their work.
  • Physical exhaustion: Feeling constantly tired, irritable, or experiencing sleep disturbances, along with a lack of enthusiasm for work, are signs of compassion fatigue.
  • Reduced empathy: A once empathetic physician may find it challenging to connect with patients emotionally, leading to a decline in the quality of care provided.

Studies suggest that the greatest mental health concerns for health care providers during the pandemic included insomnia, anxiety, depression, post-traumatic stress disorder, and stress.2 Untreated compassion fatigue and mental health issues can lead to unhealthy coping strategies, including drug and alcohol use disorders.3

Physicians need to remember that their well-being matters. No one is immune to the weight of such significant responsibility. Getting lost in caring for others isn't sustainable. In fact, doing so may compromise patient care, resulting in widespread negative consequences both personally and professionally.2

Preventing Compassion Fatigue

Physicians can use proactive strategies to combat compassion fatigue that promote self-care and emotional resilience. Physicians must prioritize self-care by taking regular breaks, engaging in hobbies, maintaining a healthy work-life balance, and setting boundaries to protect their well-being. Practicing mindfulness and meditation techniques can help physicians stay present and grounded.4

The opposite of compassion fatigue, referred to as “compassion satisfaction” describes pleasure experienced from relieving patient suffering and enjoying a positive work environment.1 Perhaps one of the best ways to avoid compassion fatigue is by focusing on the satisfying aspect of work, taking time to document and reflect on the positive effects of your efforts, even if they seem small in the larger context of a patient’s eventual outcomes.

Seeking professional counseling or therapy can be immensely beneficial in processing emotional challenges and building coping mechanisms. Counseling can be an opportunity to share small wins and talk through traumatizing experiences. In addition, open communication and sharing with colleagues can create a supportive environment where physicians can seek guidance and understanding. Hospitals and medical institutions should provide training and education on compassion fatigue to help combat this increasing problem for physicians around the world.5

More experienced physicians who take time for their mental wellness can positively impact the culture of medicine by setting a healthier example for students and residents entering the field. As research, awareness, and resources related to compassion fatigue increase, the stigma of mental health care should continue to decrease.5

Alleviating Compassion Fatigue

Despite best efforts, compassion fatigue in health care can seem unavoidable. Physicians must first acknowledge and accept that they are experiencing compassion fatigue. Denying or ignoring these feelings can exacerbate the problem.

It is crucial to lean on support systems, whether it be friends, family, colleagues, or professional counselors. Supervisors can also be a supportive resource. Talking about emotions and seeking understanding can help reduce the burden.1 In addition, therapy can help physicians understand their boundaries and limitations, including the fact that it’s not always possible to change a patient’s outcome or circumstances.1 To shift the focus to compassion satisfaction, physicians must find ways to see the rewards and accomplishments in their work.1

Long shifts and physical exhaustion often make it harder to weather the demands of working in health care. Therefore, time off to rest is vital. Physicians should not hesitate to use their leave entitlements when needed. Time off is critical to staying engaged and should be viewed as a necessary aspect of the job. It should also be used wisely as an active time to rejuvenate. In addition, activities that promote relaxation and joy, such as physical exercise, fun hobbies, or spending time in nature, can help reduce stress levels so you can bring your best self to work.1

Resources for Physician Self-Care

Many health care providers face unrealistic expectations, traumatic experiences, and a challenging work environment. Fortunately, more institutions and organizations recognize and provide resources to address burnout and compassion fatigue. If you're struggling with compassion fatigue (or simply trying to prevent it), you may want to seek out some of the following resources:

  • Employee assistance programs (EAPs): Many health care facilities offer EAPs that provide confidential counseling and support services for employees facing emotional challenges.
  • Peer support groups: Some medical institutions organize support groups for physicians to share their experiences, struggles, and coping strategies in a safe and understanding environment.
  • Therapy: Many medical societies and organizations provide access to professional counseling services specialized in supporting health care professionals.
  • Wellness workshops and retreats: Hospitals and medical associations often conduct workshops and seminars on stress management and promoting physician well-being.

Helping Yourself to Help Others

Compassion fatigue is a significant challenge faced by health care professionals, particularly physicians, who dedicate their lives to caring for others. By recognizing the signs of compassion fatigue, taking preventive measures, and utilizing available resources, physicians can safeguard their emotional well-being and continue providing exceptional patient care.

Acknowledging and addressing compassion fatigue is not a sign of weakness but a demonstration of strength and dedication to your profession and patients. Unfortunately, despite an increased awareness of physician burnout and compassion fatigue, there’s still no official guidelines for treatment.5 More research into this common phenomenon can help promote the development of more effective interventions.3 By promoting a culture of understanding, and support, health care institutions can contribute to a healthier and more resilient workforce, improving physicians’ lives and patient outcomes.

" ["post_title"]=> string(61) "Compassion Fatigue: What to Do When Care Becomes Overwhelming" ["post_excerpt"]=> string(129) "Preventing compassion fatigue or managing it when it occurs can be difficult in the high stress environment of the medical field." ["post_status"]=> string(7) "publish" ["comment_status"]=> string(6) "closed" ["ping_status"]=> string(6) "closed" ["post_password"]=> string(0) "" ["post_name"]=> string(49) "compassion-fatigue-when-care-becomes-overwhelming" ["to_ping"]=> string(0) "" ["pinged"]=> string(0) "" ["post_modified"]=> string(19) "2024-03-08 09:56:54" ["post_modified_gmt"]=> string(19) "2024-03-08 14:56:54" ["post_content_filtered"]=> string(0) "" ["post_parent"]=> int(0) ["guid"]=> string(43) "https://www.psychiatryadvisor.com/?p=128679" ["menu_order"]=> int(0) ["post_type"]=> string(4) "post" ["post_mime_type"]=> string(0) "" ["comment_count"]=> string(1) "0" ["filter"]=> string(3) "raw" } }

Clinical Tools

Powered by

Powered by   

CME/CE

MORE COURSES