Community Health Centers: a Key Partner to Achieve Medicaid Expansion.

Medicaid expansion is an important feature of the "Affordable Care Act" and also is proposed as a component of some incremental plans for universal healthcare coverage. We describe (1) obstacles encountered with Medicaid coverage, (2) their potential resolution by federally qualified community health centers (CHCs), (3) the current status and limitations of CHCs, and (4) a proposed mega CHC model which could help assure access to care under Medicaid coverage expansion. Proposed development of the mega CHC model involves a three-component system featuring (1) satellite neighborhood outreach clinics, with team care directed by primary care nurse practitioners, (2) a hub central CHC which would closely correspond to the logistics and administration of current CHCs, and (3) a teaching hospital facilitating subspecialty care for CHC patients, with high-quality and cost-effectiveness.

Community Health Centers Could Provide Better Outsourced Primary Care for Veterans.

The "VA Mission Act of 2018" will expand the current "Choice Program" legislation of 2014, which has enabled outsourcing of VA care to private physicians. As the ranks of Veteran patients swell, Congress intended that the Mission Act will help relieve the VHA's significant access problems. We contend that this new legislation will have negative consequences for veterans by diverting support from our VA system of 1300 hospitals and clinics.

A New Community Health Center/Academic Medicine Partnership for Medicaid Cost Control, Powered by the Mega Teaching Health Center.

Community health centers (CHCs), a principal source of primary care for over 24 million patients, provide high-quality affordable care for medically underserved and lower-income populations in urban and rural communities. The authors propose that CHCs can assume an important role in the quest for health care reform by serving substantially more Medicaid patients. Major expansion of CHCs, powered by mega teaching health centers (THCs) in partnership with regional academic medical centers (AMCs) or teaching hospitals, could increase Medicaid beneficiaries' access to cost-effective care.

Alzheimer Disease: Pharmacologic and Nonpharmacologic Therapies for Cognitive and Functional Symptoms.

Alzheimer disease comprises a syndrome of progressive cognitive and functional decline. Treatments should target cognitive and functional symptoms. Cholinesterase inhibitors, memantine, and a combination of a cholinesterase inhibitor and memantine have produced statistically significant but clinically small delays in various domains of cognitive and functional decline in select patients with Alzheimer disease.

Assessing Idaho Rural Family Physician Scope of Practice Over Time.

Context: An important consideration determining health outcomes is to have an adequate supply of physicians to address the health needs of the community.

Purpose: The purpose of this investigation was to assess scope of practice factors for Idaho rural family physicians in 2012 and to compare these results to findings from a 2007 study.

Methods: The target population in this study was rural family physicians in Idaho counties with populations of fewer than 50,000.

A proposal for reform of the structure and financing of primary care graduate medical education.

Accessible, high-quality, cost-effective health care systems are anchored in primary care, yet decreasing production from graduate medical education (GME) jeopardizes the primary care workforce and the nation's health. The GME Initiative recommends Congress (1) invigorates primary care physician (PCP) supply through GME benchmarking and enforcement by creating a workforce that is at least 40% PCPs, holding teaching hospitals accountable, and increasing the primary care residency position cap, (2) establishes a GME system supported by all insurers-public and private-and implements a fixed floor funding of direct GME (DME) at $100,000 per resident per year for residencies that produce graduates who truly go on to practice primary care, (3) reallocates some indirect GME (IME) to support primary care residency education, including enhanced PCP education outside hospitals, including teaching health centers, (4) restores funding for the 1997 full-time equivalent (FTE) PCP residency slots cut for training outside the teaching hospital, (5) allows states expanding Medicaid through the Patient Protection and Affordable Care Act (ACA) to increase PCP education capacity through Medicaid DME and/or IME at the enhanced Federal Medical Assistance Percentage (FMAP).

Association of "grit" and satisfaction in rural and nonrural doctors.

Background: One potential psychological construct, grit, may help to explain the non-cognitive traits that account for both rural physician satisfaction and retention. We investigated (1) the psychological construct grit among rural and non-rural primary care/specialty care physicians, (2) satisfaction levels and (3), the relationship between the psychological construct grit and satisfaction across combinations of rural/non-rural and primary care/specialty care physicians.

Methods: We mailed a cross-sectional questionnaire to 2126 active members of the Idaho Medical Association and Idaho Academy of Family Physicians measuring their self-reported level of grit, satisfaction level and area of specialty.

The patient-centred medical home in the USA.

Rationale: The Patient-Centred Medical Home (PCMH) is a new model of health care delivery in the USA at the primary care level that emphasizes integrated and coordinated care around the patients' needs and desires. The PCMH emphasizes a practice-wide team approach to provide high quality, accessible and cost-effective health care for acute, chronic and prevention-oriented problems.

Method: This article is a descriptive overview of the PCMH in the USA.

Rural Idaho family physicians' scope of practice.

Context: Scope of practice is an important factor in both training and recruiting rural family physicians.

Purpose: To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status.

Methods: A survey instrument was developed based on a literature review and was validated by physician educators, practicing family physicians and executives at the state hospital association.

Treatment of lateral epicondylitis.

Lateral epicondylitis is a common overuse syndrome of the extensor tendons of the forearm. It is sometimes called tennis elbow, although it can occur with many activities. The condition affects men and women equally and is more common in persons 40 years or older.

The LIFE program: a wellness approach to weight loss.

The LIFE (lifestyle change, individual readiness, fitness excellence, eating healthy) wellness program was an intensive, out-patient, healthy lifestyle change program with participants from the Army, Navy, Air Force, and Marine Corps. Our objective was to describe the LIFE program and to present before and after test results for this 1-year program. Fifty-three participants completed the 5-day intensive outpatient and 1-year follow-up program and maintained average weight losses of >10 pounds and 14 pounds for men and women, respectively.

Traumatic stress disorders following first-trimester spontaneous abortion.

Provide counsel and support to women after a spontaneous abortion. Research indicates that many women will talk with their physician about their emotional distress and that physicians provide good information after the spontaneous abortion. Evaluate women for acute stress disorder (ASD) after a spontaneous abortion.

Tick-borne relapsing fever.

Tick-borne relapsing fever is characterized by recurring fevers separated by afebrile periods and is accompanied by nonspecific constitutional symptoms. It occurs after a patient has been bitten by a tick infected with a Borrelia spirochete. The diagnosis of tick-borne relapsing fever requires an accurate characterization of the fever and a thorough medical, social, and travel history of the patient.

Residency Review Committee for Family Medicine: an analysis of program citations.

Background And Objectives: The Residency Review Committee for Family Medicine (RRC-FM) is responsible for the accreditation of the nation's 474 residencies in family medicine. This analysis of RRC-FM actions was done to help residency directors and faculty better understand its operations and to provide a context for interpretation of its decisions.

Methods: All actions by the RRC-FM for the calendar year 2002 were reviewed and analyzed by program administrative format, accreditation actions, cycle length, and types of citations listed.

Diagnosis, prevention, and treatment of osteoporosis in men.

Though commonly seen as a disease afflicting only women, osteoporosis affects more than 5 million men in the United States with significant morbidity and mortality. Alcohol abuse, glucocorticoid excess, and hypogonadism are the principle risk factors for osteoporosis in men. Radiographs alone are insufficient in detecting the presence of the disease.