Perceived Family Criticism and Primary Care Utilization: Psychosocial and Biomedical Pathways

We explored the relationship of perceived family criticism to subsequent healthcare utilization in patients attending a family medicine center. We examined: a) the relationship of perceived criticism to subsequent utilization for biomedical and psychosocial/somatic problems; b) the mediating effects of self-rated mental health and physical function; and c) the mediating effects of social support. The analyses were adjusted for age, sex, race, education, health insurance, and marital status. Higher perceived criticism predicted more psychosocial/somatic and biomedical visits. The relationship of perceived criticism with psychosocial/somatic visits was entirely mediated through self-rated mental health. The relationship of perceived criticism with biomedical visits was partly mediated through self-rated physical function and, in part, independent. Social support played no role in explaining these relationships. Further research is needed to determine whether lowering perceived family criticism lowers primary care utilization.     

Depression in Primary Care: Comorbid Disorders and Related Problems

Identifying and treating depression has been a major focus in primary care over the last decade. Unfortunately, treatments have not been as successful as originally hoped. The current study investigated factors that may contribute to poor outcomes in a sample of VA primary care patients. Results indicate that 15.5% of the patients in this investigation had significant symptoms of depression. The vast majority (89.6%) of these patients also had significant symptoms of at least one additional comorbid psychiatric condition. Furthermore, an association between depression and unhealthy behaviors (smoking, not exercising) was demonstrated. Finally, sexual dysfunction and chronic pain were more frequently observed in individuals with depressive symptoms. These findings illustrate that depression is only one of many problems for most primary care patients identified with depression. A multidisciplinary team in primary care is recommended to provide a coordinated approach to the treatment of depression and its associated problems.     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议.     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议。     

Early Identification and Intervention for Behavior Problems in Primary Care: A Comparison of Two Abbreviated Versions of Parent-Child Interaction Therapy

Behavioral screening and preventive intervention were implemented for 3- to 6-year-olds in pediatric primary care with subclinical behavior problems. One hundred eleven children were screened with the Eyberg Child Behavior Inventory. Thirty children who scored within one standard deviation of the normative mean whose mothers indicated wanting help for their child's behavior were randomized to one of two abbreviated versions of Parent-Child Interaction Therapy (PCIT) for use in pediatric primary care: (a) a 4-session group preventive intervention called Primary Care PCIT (PC-PCIT); or (b) written materials describing basic steps of PCIT and guidelines for practice, called PCIT Anticipatory Guidance (PCIT-AG). Decreases in child problem behaviors and ineffective parenting strategies, and increases in parental feelings of control were not significantly different between versions at post-intervention or 6-month follow-up. Changes during intervention were significantly larger for both groups than changes during pretreatment baseline, with moderate to large effect sizes. These brief versions of PCIT are both promising primary care preventive interventions that deserve further study.     

关于中小学数学教师对教学问题认知的调查分析

本研究主要采用问卷调查的方法,对中小学教师的教学问题意识及其影响因素进行了初步探讨。被试者为来自不同类型中小学校的数学教师共175名。结果表明:(1)中小学教师意识到的教学问题主要属于"教学技巧"或"胜任教学"层面的问题,此外教师意识到的属于教学条件、教学管理和教学评估方面的问题比较突出;(2)从整体上看,中小学教师的教学问题意识不强;(3)教师的条件性知识和实践性知识对其教学问题意识的强度有显著的预测作用。     

Physician Burnout and Patient Satisfaction with Consultation in Primary Health Care Settings: Evidence of Relationships from a one-with-many Design

Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient?Cprovider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, with staff burnout examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = ?.636, p < .01) and physician depersonalization (r = ?.541, p < .01). Mixed-effects multilevel models indicated that 34.4% of total variation in patients?? satisfaction occurred at the physician level, after adjustment for patients?? characteristics. Moreover, physician emotional exhaustion and depersonalization remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high-depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction.     

Assessment of Attention in Children with Attention Deficit Hyperactivity Problems in Primary Care Settings

Clinical child psychologists in primary care settings are often asked to evaluate children with suspected attention and learning problems. This paper will review some of the methods and assessments available to child psychologists to enable them to perform this task. Some problems with current practice will be described and some of the newer techniques will be introduced. A research-based understanding of areas of chronic impairment of children with Attention Deficit Hyperactivity Disorder (ADHD) will be discussed, and a new approach to the assessment of both executive functions and attention will be explored. This paper will primarily explore assessment in the primary care setting.     

Identification and Follow-Up by Primary Care Doctors of Children with PTSD After Terrorist Attacks

Abstract

Many children and adolescents were among the victims of the suicide bomb attacks in Israel since March, 2000. While the number with emotional and behavioral symptoms was expected to be high, very few children who developed terrorism-related posttraumatic stress disorder (PTSD) were actually referred to mental health professionals for assessment or treatment. Prolonged exposure to terrorism lowers even further the number of children who remain in treatment. This article discusses reasons and presents a training program for primary care providers (pediatricians, family doctors) in identifying PTSD in child victims, and for mobilizing them to carry out long-term follow-up of these children.     

Ethical,Legal, and Psychosocial Issues in Care of Transgender Adolescents

SUMMARY

Complete care for transgender adolescents must be considered in the context of a holistic approach that includes comprehensive primary care as well as cultural, economic, psychosocial, sexual, and spiritual influences on health. Not all transgender adolescents have gender dysphoria or wish to undergo sex reassignment. In this article we focus on general care of transgender adolescents by the non-specialist working in primary care, family services, schools, child welfare, mental health, and other community settings.     

Childhood Peer Relationship Problems and Psychosocial Adjustment in Late Adolescence

Using prospective longitudinal data from the Christchurch Health and Development Study, this paper examined the relationship between teacher reported peer relationship problems at age 9 and psychosocial adjustment in late adolescence. Results showed that, by age 18, children with high rates of early peer relationship problems were at increased risk of externalizing behavior problems such as criminal offending and substance abuse, but were not at increased risk of anxiety disorder or major depression. Subsequent analyses revealed that these associations were largely explained by the effects of child and family factors associated with both early peer relationship problems and later adjustment. The most influential variable in explaining associations between peer relationship problems and later adjustment was the extent of children's early conduct problems. These results suggest that reported associations between early peer problems and later adjustment are noncausal, and appear to reflect underlying continuities in behavioral adjustment.     

Motivational Interviewing in Primary Care

Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long term conditions. One goal of these efforts is the coproduction of activated, informed, engaged and motivated patients and citizens. The clinical, public health and financial benefits of achieving such a goal may be dramatic. Motivational Interviewing (MI) is a proven and practical front-line approach which can help deliver this goal whilst also helping to deliver such policy objectives and intermediate outcomes as increased levels of patient centered care, participatory or shared decision making, evidence-based healthcare and improved clinician-patient relationships. Until now, MI has been passively diffusing through the system as a result of the innovation and early uptake by insightful individuals and organizations. If healthcare systems want to breakthrough to higher levels of performance, investment in the conscious and deliberate implementation of MI into front-line settings may prove helpful.     

Delivering Parent Management Training in an Integrated Primary Care Setting: Description and Preliminary Outcome Data

This paper describes how behavioral health consultants (BHCs) in an integrated primary care setting use evidence-based principles that underlie parent management training (PMT) to assist caregivers of youth with externalizing behavior problems. Illustrated is the decision-making process that BHCs utilize from the moment they receive a patient referral from a primary care provider to how interventions are selected and delivered. When delivering PMT in integrated care, operant-based learning principles underlying PMT are often selected based on a combination of factors, including match with presenting problem, caregiver efficacy, caregiver beliefs about the causes and maintaining factors, and feasibility of implementation. We further present preliminary outcome data on the effectiveness of BHCs’ efforts to use PMT principles in a primary care setting. Participants were 21 caregivers and their children (M_age = 7.76 years, 38.1% female; 66.7% Hispanic) seen for an average of 2.38 visits. Pre-post data provided by caregivers (for youth 11 years or younger) and adolescents (self-report of patients 12–17 years of age) taken at the time of first and last sessions revealed significant reductions in global distress scores and high levels of satisfaction with services received. Findings support the viability of providing brief, focused PMT interventions for pediatric populations seen in primary care.     

Ethical Issues in Family-Centered Primary Care

In 1969 a new primary care medical specialty, family practice, was formally created. One element in the development of this specialty from the roots of general practice was an understanding of the importance of family process in health and health care. Family physicians are now trained to work with families in the provision of primary medical care, and many provide some formal family counseling and therapy. The family physician who works with families faces many of the same ethical conflicts with which family therapists are confronted. The primary relationship of the family physician to his or her patients, however, as the provider of continuing health care, modifies these conflicts and creates new and vexing problems.     

不同语境下的初级卫生保健

初级卫生保健一词在国内文献中涵义不同,研究发现《阿拉木图宣言》中的初级卫生保健更多的具有卫生体系变革的涵义,强调公平性、多部门合作、社区参与、适宜技术和适宜人力的原则;选择性初级卫生保健则以推广具有成本效益的卫生干预措施为重点;国内政策语境下的初级卫生保健则更多的是具体的卫生服务内容。     

重症医学科医生心理健康的损害及其调控策略

重症医学科医生由于工作对象及工作环境的特殊性,心理健康容易遭受损害。从目前重症医学科医生心理健康损害的现状入手,陈述其心理健康损害的具体表现,分析产生其心理健康问题的常见原因,并从多个角度提出了解决其不良心理健康问题的调控策略。     

An Employee Assistance Model of Health Care Management for Employees With Alcohol-Related Problems

An employee assistance model in which cost-effective, high-quality treatment can be offered for a complex range of alcohol-related problems is described. This system of care allows the employee to be treated in the least restrictive therapeutic environment, thus encouraging continued productivity at work.     

Primary Care Medical Provider Attitudes Regarding Mental Health and Behavioral Medicine in Integrated and Non-integrated Primary Care Practice Settings

Primary care medical providers (PCPs) have become de facto providers of services for the management of both mental and chronic illnesses. Although some reports suggest that PCPs favor having Behavioral Health colleagues provide behavioral health services in primary care, others demonstrate this view is necessarily not universal. We examined attitudes regarding behavioral health services among PCPs in practices that offer such services via onsite behavioral health providers (n = 31) and those that do not (n = 62). We compared referral rates and perceived need for and helpfulness of behavioral health colleagues in treating mental health/behavioral medicine issues. In both samples, perceived need was variable (5?C100%), as were PCPs?? views of their own competence in mental health/behavioral medicine diagnosis and treatment. Interestingly, neither sample rated perceived access to behavioral health providers exceptionally high. Referral rates and views about the helpfulness of behavioral health services, except in relation to depression and anxiety, were lower than expected. These results suggest a need for increased collaboration with and education of PCPs about the roles and skills of behavioral health professionals.