Background: Recent support has been shown for physicians to recommend e-cigarettes to patients who are trying to quit smoking. Supporters of this recommendation argue that e-cigarettes are not combustible products and are less harmful and more effective cessation products than regular cigarettes, with less inherent risk. Those who oppose this idea argue that little reliable evidence suggests that e-cigarettes are better cigarette cessation devices than currently available nicotine replacement therapies, and that they pose as much risk as cigarettes. This study was conducted to explore family physicians' perceptions of recommending e-cigarettes as smoking cessation aids to patients who smoke cigarettes.Methods: The study used a mixed-methods approach whereby a 12-item survey was sent to 154 family physicians throughout the state of Kansas. Data were collected from 117, a 76% response rate. A multidisciplinary team used an immersion-crystallization approach to analyze the content of respondents' qualitative data; contingency table analysis was used to evaluate the quantitative data.Results: The results showed that family physicians have negative perceptions of e-cigarettes and do not recommend them for smoking cessation. Family physicians are concerned about the effectiveness of e-cigarettes and the uncertainty regarding safety.Conclusions: The results suggest that most family physicians do not recommend e-cigarettes for smoking cessation, citing lack of evidence on effectiveness and uncertainty regarding short-and longterm safety. (J Am Board Fam Med 2017;30:448 -459.)

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Introduction. Healthcare professionals who participate in regular exercise better manage job related stressors, utilize fewer sick days, and discuss fitness with patients at increased rates. Although resident physicians are aware of the health benefits of exercise their rates of exercise are much lower than among medical trainees and practicing physicians. Resident physicians have reported lack of time for traditional structured workouts as one of the greatest barriers to fitness. This study sought to increase resident physician well-being by providing brief workouts through a motivational fitness curriculum. Methods. This pilot study utilized a nonexperimental design; a pre-/post-intervention consisted of a 10-month motivational fitness curriculum. Thirteen family medicine residents at a training program in the midwestern United States participated in this study. The Depression Anxiety Stress Scale-21 (DASS-21) and the Abbreviated Maslach Burnout Inventory (MBI-9) were used to measure the participants’ well-being, pre- and post-curriculum. Standard descriptive statistics and paired samples t-test were used to analyze the data. Results. Twenty-eight percent (13/36) of eligible first-year and second-year family medicine resident physicians participated in the study. On the DASS-21, study participants displayed an improvement in depression, anxiety, and stress scores post-curriculum. On the MBI-9, the participants reported decreased score in emotional exhaustion, but there were no changes in depersonalization and personal accomplishment scores over time.Conclusion. A motivational fitness curriculum may be a convenient way to support well-being among resident physicians. These findings were salient, as graduate medical education programs can implement similar initiatives to support resident physicians’ psychological and physical well-being.

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Background and Objectives: Physicians are increasingly confronted with patients’ interrelated psychosocial and physiological issues. To assist physicians in managing the psychosocial needs of patients, integrated behavioral health (IBH) has become increasingly common. This study was completed in a large, Midwestern family medicine residency program where the authors sought to (1) identify physicians’ perceptions of IBH implementation and areas of needed IBH improvement, and (2) recognize educational needs to be addressed when providing behavioral health training to resident physicians. Methods: The authors utilized a pre/post design to measure physician perception of access and quality of an integrated behavioral health program. For quantitative data, we performed standard descriptive statistics, likelihood ratio χ2 tests, independent sample t test, and linear mixed-model analysis. For qualitative data, we completed phenomenological analysis, derived from a focus group. Results: Physician satisfaction with access and quality of behavioral health services significantly improved after the implementation of the IBH (P<.01). Perception of behavioral health management also improved, including the commitment of the residency program to mental health well-being, benefit from consultations with BHPs, and physician ownership of managing patients’ mental health needs. Themes from the focus group indicated a desire for increased communication with BHPs, as well as additional assessment and intervention skills to manage psychiatric disorders. Conclusions: Family physicians value IBH in supporting patients’ behavioral health treatment, and resident physicians hone behavioral health management skills through collaborating with BHPs and completing behavioral health training. Residencies should increase focus on teaching essential skills in behavioral health management.

Introduction: Given the recent reports of e-cigarette, or vaping, product use-associated lung injury (EVALI) and harm of e-cigarettes, the authors evaluated changes in the perception of e-cigarettes as smoking cessation tools in 2019 relative to 2016. The authors also evaluated the sources family physicians most commonly use to receive information regarding e-cigarettes. Methods: Authors conducted a cross-sectional online survey of 248 community family physicians in Kansas from October to December 2019. The authors used a 11-item questionnaire to measure the participants’ perceptions of recommending e-cigarettes to patients for tobacco cessation. The authors used a mixed method approach to collect, analyze, and interpret the data. Standard descriptive statistics, Likelihood-Ratio/Fisher’s exact tests, and immersion-crystallization approached were used to analyze the data. Results: The response rate was 59.3% (147/248). Proportion of the family physicians who did not recommend e-cigarettes for smoking cessation was significantly higher in 2019 than in 2016 (86% vs 82%; χ2 [1, n = 261] = 12.31; P < .01). Several reasons regarding respondents’ perception of e-cigarettes as smoking cessation tools were reported. The medical literature and news media were the top sources where family physicians accessed e-cigarettes information. Conclusion: Our study has suggested that the majority of family physicians in our data do not currently recommend e-cigarettes for tobacco cessation. Opinions regarding the efficacy and safety of e-cigarettes are influenced by information source. Future, larger studies would be beneficial to further determine physicians’ beliefs and practices regarding e-cigarettes as smoking cessation products.

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Background and Objective: There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program. Methods: A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures.  Results: Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P&lt;.004), stress (P&lt;.001), perceived resilience (P&lt;.001), and compassion (P&lt;.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21. Conclusion: This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.