Showing papers in "Families, Systems, & Health in 2003"

Integrated Primary Care: Organizing the Evidence.

Abstract: The evidence for bringing behavioral health services into primary care can be confusing. Studies are quite varied in the types of programs assessed, what impacts are assessed, what kind of therapy is offered, for what populations, and on how broad a scale. By organizing the evidence into categories: whether the program is coordinated, co-located or integrated, whether for a targeted or non-targeted patient population, offering specified or unspecified behavioral health services, in a small scale or extensive implementation, programs can be compared more easily. By noting what sorts of impacts are reportedimproved access to services, clinical outcome, maintained improvement^ improved compliance, patient satisfaction, provider satisfaction, cost effectiveness or medical cost offset-the most comprehensive overall assessment of this important approach to patients' needs can be encouraged.

Mindful Practice in Action (I): Technical Competence, Evidence-Based Medicine, and Relationship-Centered Care

Abstract: In this first of a 2-part series of articles, mindfulness is defined as a purposeful, non-anxious, reflective presence that can be applied to any aspect of practice. More than an occasional flash of insight, mindfulness is a state of mind that permits insight, presence, and reflection. Mindfulness applies equally to cognitive, technical, and interpersonal aspects of medicine, and invites a deeper examination of the process of care. Mindful practice includes core features: attentive observation, critical curiosity, “beginner’s mind,” and presence. Mindfulness can be recognized, and requires practice to become habitual. Although mindfulness is not taught explicitly in medical training, it is often invoked through clinical stories and by observing exemplary practitioners. Levels of mindfulness extend from mindless imitation to embodied presence, and are described in the text.

Mindful practice in action (II): Cultivating habits of mind.

Abstract: Habits of mind, such as attentiveness, curiosity, and presence, are fundamental to effective medical practice and physician wellbeing. In this second of two articles about mindfulness, I propose an 8-fold method for promoting mindful practice in medicine: (a) Priming—setting the expectation of selfobservation, (b) Availability—creating physical and mental space for exchange, (c) Reflective questions to open up possibilities and invite curiosity, (d) Active engagement— direct observation and exchange, (e) Modeling while "thinking out loud" to make mental processes more transparent, (f) Practicing attentiveness, curiosity, and presence, (g) Praxis—consolidation of learning by experience, and (h) Assessment and confirmation. I include examples from medicine, music, and meditation.

Helpful events in family discussion groups with chronic-pain patients: a qualitative study of differences in perception between therapists/observers and patients/family members

Abstract: In this study we investigated differences in perception of helpful events between the therapeutic team and families with a chronic-pain patient in Family Discussion Groups (FDG). Nineteen patients, fortyone family members, eight therapists, and seventeen observers participated in four different FDG cycles. Events helpful for the individual, the family, and the group were explored after each session. The results showed that the therapeutic team and the families experienced many helpful

Partners in Diabetes: A Collaborative, Democratic Initiative in Primary Care

Abstract: Contemporary healthcare is in a state of rapid and constant change. With these developments has come an increased appreciation for the complex landscape of competing constituencies and multifaceted elements that define it. As efforts in medicine extend beyond visit-based services into the comparatively less familiar territory of preventive and patient-oriented care, a call has emerged for increased partnerships between providers and patients (Hayes, 1996; Standridge, 2000). These partnerships are in contrast to traditional hierarchal modes of care that position providers as experts who deliver services to passive patients, and can overcome commonplace barriers of limited resources and time constraints that frequently impede new initiatives. Active patient involvement can thereby tap important and already existing resources that have not been tapped previously for the of individuals and communities.

Building Research Relationships With Managed Care Organizations: Issues and Strategies.

Abstract: Managed care is now the dominant form of healthcare in the United States. The need for clinical research about the organization, delivery, and outcomes of primary care services in managed care models is high, yet access to managed care organizations as sites for clinical research may be problematic. The purpose of this article is to describe issues involved in obtaining access to managed care settings for clinical research and practical strategies for successful collaboration using literature review and case description. Three steps for developing collaborative relationships with managed care organizations (MCOs) are presented: 1) assessment of organizational structure, history, and culture; 2) finding common ground; and 3) project implementation. These steps are discussed within the context of MCO systems issues and a relationship-centered approach to communication between researchers and individuals from the MCO. Successful relationships with MCOs for clinical research are possible when careful attention is paid to inclusion of MCOs as collaborators in the development of the research questions and design, and as partners in the research implementation process.