Toward a new predoctoral model: Education and training in clinical psychopharmacology.

A ubiquitous research finding in regional and national studies is that at least 40% of persons with mental disorders cannot access mental health services, and pharmacotherapy in particular. The American Psychological Association's (APA) designated programs for the provision of education and training in clinical psychopharmacology can be of great help in alleviating this national need. We address key developments relevant to the foundation of a predoctoral model of clinical psychopharmacology education and training.

Implementation of Patient Safety Structures and Processes in the Patient-Centered Medical Home.

Although most patient-clinician interactions occur in ambulatory care, little research has addressed measuring ambulatory patient safety or how primary care redesign such as the patient-centered medical home (PCMH) addresses patient safety. Our objectives were to identify PCMH standards relevant to patient safety, construct a measure of patient safety activity implementation, and examine differences in adoptions of these activities by practice and community characteristics. Using a consensus process, we selected elements among a widely adopted, nationally representative PCMH program representing activities that, according to a physician panel, represented patient safety overall and in four domains (diagnosis, treatment delays, medications, and communication and coordination) and generated a score for each.

Health care gap affects 20% of United States population: Transition from pediatric to adult health care.

Transition-aged youth and young adults, ages 12 to 26, represent almost 20% of the US population, and an estimated 25%-35% have one or more chronic conditions. The vast majority of youth with and without special health care needs do not receive the necessary and professionally recommended services to transition from pediatric to adult care. Without adequate support during this transition, youth and young adults face an increased risk of adverse outcomes.

Economic impact of outreach athletic trainers on a health system: implications for program growth and sustainability.

Objectives: There are numerous benefits of organized athletics, but there is an inherent risk with competitive participation. The need for proper care for high school and community athletes can be met with comprehensive community sports medicine programs, and the employment of certified athletic trainers (AT-Cs). The benefit of clinic-based AT-C has been clearly demonstrated, but there has been little published on the economics of outreach AT-C serving directly in the community.

The medical home and integrated behavioral health: advancing the policy agenda.

There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health.

Clinical documentation in the 21st century: executive summary of a policy position paper from the American College of Physicians.

Clinical documentation was developed to track a patient's condition and communicate the author's actions and thoughts to other members of the care team. Over time, other stakeholders have placed additional requirements on the clinical documentation process for purposes other than direct care of the patient. More recently, new information technologies, such as electronic health record (EHR) systems, have led to further changes in the clinical documentation process.

A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients.

Background: African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations.

Objective: To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups.

Design of a quality and performance improvement project for small primary care practices: reflections on the Center for Practice Innovation.

Background: Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency.

Aims: To report on an effort to assist small primary care practices in improving quality of care and efficiency of practice management to meet the needs of patients, improve physician satisfaction and enhance the ability of these small practices to survive.

Methods: We report on an intervention design and the reflections of the implementers on what they learned and what went well or poorly during implementation.

Patient-centered medical home cyberinfrastructure current and future landscape.

The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit.

A simple intervention promoting patient safety improvements in small internal medicine practices.

Background: small primary care practices may face difficulties in staying abreast of patient safety recommendations and implementing them. Some safety issues, however, may be easily and inexpensively addressed, given the necessary information on what is required.

Aim: to assess changes in patient safety measures in small practices and describe simple mechanisms that appear to have facilitated change.

Lessons for the new CMS innovation center from the Medicare health support program.

The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs.

Specialists/subspecialists and the patient-centered medical home.

This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices within the PCMH model is described, with a focus on the potential for these practices to serve as a PCMH for a subgroup of patients or, alternatively, as a PCMH "neighbor" that interfaces effectively with PCMH practices.

A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045.

Background: Disparities in health and healthcare are extensively documented across clinical conditions, settings, and dimensions of healthcare quality. In particular, studies show that ethnic minorities and persons with low socioeconomic status receive poorer quality of interpersonal or patient-centered care than whites and persons with higher socioeconomic status. Strong evidence links patient-centered care to improvements in patient adherence and health outcomes; therefore, interventions that enhance this dimension of care are promising strategies to improve adherence and overcome disparities in outcomes for ethnic minorities and poor persons.

The great ambivalence: factors likely to affect service user and public acceptability of the pharmacogenomics of antidepressant medication.

Whilst antidepressant medications are widely used, they are ineffective for nearly 40 per cent of users and cause numerous adverse drug reactions. The pharmacogenomics of depression attempts to better understand the role of genetic variation in antidepressant metabolism in the hope of improving drug efficacy and tolerability. In this paper we present findings from a series of focus groups with the general public and with mental health service users in four European sites.

Advanced Asia's health systems in comparison.

There is growing interest in comparing patterns of social and health service development in advanced Asian economies. Most publications concentrate broadly on a range of core social services such as education, housing, social security and health care. In terms of those solely focused on health, most discuss arrangements in specific countries and territories.