Academic psychiatry and health care reform: strategic initiatives for sustaining the clinical mission.

Health care reform has posed special challenges for departments of psychiatry in academic medical centers. This report describes one department's strategic responses to a marketplace with high penetration by managed care and provides examples of the kinds of faculty concerns that can arise when major departmental reorganizations are attempted. The department's successful adaptation to a radically altered professional environment is attributed to the following five initiatives: vertical integration and diversification of clinical programs, service line management, outcomes measurement, regional network development, and institutional managed care partnerships Although the authors did not design their adaptive efforts as a research study, they offer objective data to support their conclusion that the viability of their overall clinical enterprise has been sustained despite an external environment inhospitable to academic psychiatry.

[Psychiatry and HIV].

Are there specific psychiatric issues in the treatment of human immunodeficiency virus (HIV) that force us to modify our typical model of care delivery in most communities? This appears to be the case. Most of these issues stem from the fact that the HIV-positive population has a high prevalence of a variety of psychiatric disorders. The integration of the psychiatric treatment with general medical treatment improves psychiatric and medical outcomes.