Prospective payment: Its impact on psychology's role in health care.

Describes the new Medicare payment system based on diagnosis-related groups (DRGs) and its impact on professional psychology. DRGs represent medically oriented notions about how many inpatient days a physician needs to effectively treat a patient who suffers from a specified disease. It is argued that for the most part, DRGs ignore the behavioral variables that moderate entry into the tertiary care system and the subsequent use of hospital resources. Under DRGs, the development and use of behavioral treatments for somatic disorders could be discouraged. For example, many newer behavioral medicine techniques may be more time-consuming and/or expensive than traditional treatment options and thus not fall within the time period allotted for such disorder, regardless of comparative effectiveness. Also, under the new system, psychologists can no longer bill separately for their inpatient services. It is concluded that the framers of health care policies should recognize and support psychologists because many of their techniques can reduce the cost of health care by reducing behavioral risk factors, increasing compliance with medical regimens, and preparing patients psychologically for stressful medical procedures. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional psychology's role in hospice care.

This article explores the existing and potential contributions that professional psychology brings to the growing hospice movement. It explores hospice care's unique philosophy in treating dying patients and their families and provides a psychologically based justification for this philosophy. To do so, the author draws on the literature of health psychology, behavioral medicine, and thanatology (death studies). The article ends with a discussion of recent developments in hospice care that provide expanding opportunities for professional psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-cultural psychology's challenges to our ideas of children and development.

Historically, cross-cultural psychology has been expected to contribute to an understanding of children and development by increasing the generality of the experiences to which children are exposed and thus providing a broader base from which to report how experience affects development. A variety of difficulties with this basic enterprise are summarized in terms of the difficulty of isolating independent variables and ambiguities in the interpretation of dependent variables. A major, current contribution of cross-cultural psychology is to the processes by which relations between culturally organized experience and development are investigated. It seems clear that a close interplay between laboratory and observational research in which experiments are used as self-conscious models of potentially important cultural experiences will be needed to enable psychologists to gain the benefits from cross-cultural research which its founders envisioned. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenges of health care restructuring

Since the late 1980s, virtually every developed, and many developing, countries have re-examined the structure of their health care systems. Health care reform has become a truly global phenomenon with considerable potential for cross-nation lesson-learning. In countries where the state has been the central actor in the health sector, its role is being reassessed and, in some cases, reconfigured. The introduction of market principles to health care is a feature of many countries: market romantics believe markets in health care will improve efficiency, empower consumers, control costs, and overthrow monolithic bureaucracies. But will they? The evidence, such as it is, suggests otherwise. The greatest pressure for change and for introducing markets into health care has been in the relative role of the private sector in the operation, and in some countries also the financing of health care services. But it is not a simple case of the state versus the market. The issues are much more complex and various hybrid models are emerging involving some sort of public-private mix. The move is towards greater diversity and pluralism, an inevitable consequence of which is growing fragmentation in the funding and provision of care with all the associated on-costs in terms of increased coordination and management that this entails. The policy aim is to harness the benefits of market behaviour without also adopting the inherent weaknesses of markets with regard to questions of distributive justice and equity.     

Some new challenges.

Poses several challenges to the science and profession of psychology. These include (a) the development of an authentic science of man rather than the outdated Newtonian type of scientism; (b) the development of a future-oriented, preventive social planning function; (c) the elimination of the system of credentials and licensing, since they fail to protect the public and create evils of bureaucracy and rigidity; (d) the development of the whole person, feelings as well as intellect, to overcome the dehumanization of education; and (e) the exploration of other possible realities not open to the 5 senses. It is concluded that if these challenges are met, psychology will be enhanced. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some Negro perceptions of psychologists: an observation on psychology's public relations.

Using 14 colored undergraduates given rudimentary training in interviewing, 51 Southern Negroes' perceptions of the general activities of psychologists and their specific work in the area of Negro-white relations were secured. The implication of these results for APA public relations is noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Third-party payment and national health insurance: An update on psychology's efforts toward inclusion.

The interprofessional rivalry between psychologists and psychiatrists is currently focused on the inclusion of psychologists as primary service providers in existing third-party reimbursement programs and national health insurance. Included is an examination of both sides' basic arguments regarding training and competence and of clinical psychology's progress in its quest for parity under the national health insurance umbrella. Stumbling blocks contributing to the current malaise are discussed. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Great psychologists and their times: Scientific insights into psychology's history: Book review.

This book (D. K. Simonton [2002]; see record 2002-17019-000) organizes a series of studies into a single volume on eminence in psychology. The reviewer contends that this is not a typical work on the history of psychology but prides itself as a work based largely on "historiometric methods" (with some results of psychometric studies included). Historiometrics is the use of archival data in almost any available form and bringing it to bear on questions of greatness or eminence in a particular field or fields. Hence, one can study the greatness of scientists, politicians, literary figures, and so on by counting their works, citations, analyzing the content of their works for various components, examining generational factors, biographical factors, personal factors, and so on. Technical details are few and the book reads somewhat like an advanced undergraduate textbook that of course enhances its accessibility but occasionally leads to rather superficial analyses. Despite these quibbles, it does stand as a solid representative of the historiometric tradition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some aspects of health care in rural Nigeria

1973 and 1974 surveys of Ibo women of childbearing age were undertaken in order to obtain baseline information for developing a community health program. Findings from the village of Ebendo show extremely high fertility rates and infant and maternal mortality levels as well as high desired family size. An examination of the traditional health care and family planning attitudes suggests that a health program offering family planning services in this region should consider offering subfertility counseling; providing services free or nearly free; and focusing on the younger women who are more receptive to family planning.     

Advancing nursing practice: acute care nurse practitioners meet challenges at and beyond the health care horizon

Preparation of advanced practice nurses (APNs) with acute care skills relevant to today's health care environment is a challenge faced by nurse educators, care providers, professional organizations, and regulatory agencies. The acute care nurse practitioner (ACNP) is prepared to provide multidimensional, risk-appropriate management of medically vulnerable patients with serious illness in a variety of settings. ACNPs conduct comprehensive health assessments, order and interpret diagnostic tests, diagnose and manage health problems and disease-related symptoms, prescribe and evaluate drugs and treatments, and coordinate care during setting transitions. Working independently and collaboratively the ACNP enhances access to care and quality of care for patients and families through cost-effective, outcome-oriented practice. This article describes health care market factors fostering ACNP practice, ACNP practice domain, the University of Washington ACNP program, and collaborative contributions from educators, care providers, professional organizations, and regulatory groups needed to implement the role.     

Public health approaches to family maltreatment prevention: Resetting family psychology's sights from the home to the community.

The authors review recent trends within the family maltreatment research field toward a public health approach, discuss the rationale for community-level interventions for family maltreatment, and sketch the history and development of community-level prevention approaches. Next, to illustrate the both the logistic and the scientific challenges of such work, the authors discuss the development and testing of an empirically guided, research-community partnership for the prevention of family maltreatment, the United States Air Force's NORTH STAR initiative (New Orientation to Reduce Threats to Health From Secretive Problems That Affect Readiness). Finally, recommendations are made for effective and disseminable family maltreatment prevention interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School psychology and health care: Moving service delivery into the twenty-first century.

Contends that school psychology must articulate its legitimate relationship with health care. Failing to do so, the field risks becoming marginalized in American professional psychology. In light of the central educational elements of psychotherapy and major health crises such as smoking, the indirect contributions of education to health, and the need to focus more aggressively on prevention, the field of school psychology has the potential to make important contributions to health care. Given that some form of health care reform is imminent, school psychology now has a unique opportunity to realize long-standing agendas for role expansion and enhance the quality of services provided to children, youth and adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

It is past time: Moving psychology into primary health care.

It is past time for psychologists to expand their services into primary health care. For too long, psychological work has been limited to mental health care. Psychology also has much to offer in primary health care. One of my major initiatives during my tenure as president of the American Psychological Association (APA) was to focus on psychologists' contributions to health care in general, particularly on what psychologists are doing to help cancer patients. A great need exists for professional psychologists to expand into these areas. To illustrate the value of psychological interventions in primary health care, I focus on two major health care problems: heart disease and cancer. Both are particularly important areas for health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Orientational research into dismissed managers in health care

One hundred and eighteen competitors, with spinal injuries, attending the First International Ex-Service Wheelchair Games, held in July 1993, were interviewed. Athletes from 17 countries attended. Sixteen competitors were tetraplegic and 102 paraplegic, their injuries are detailed below. The injuries had occurred on average 14.0 years previously: 35 injuries were war injuries a further 10 due to combat training. The paraplegic athletes had spent 9.6 months and the tetraplegic 12.3 months in hospital. Fifty-five spinal stabilizations had been performed, and this was associated with a reduced inpatient stay for the paraplegic athletes (7.7 months vs 11.3 months). Spinal fixation did not affect later employment. Thirty-one athletes worked, and the amount of pension had no significant bearing on the numbers working. There was a mean delay of 38.3 months from injury until return to sport, and only 11.8% of competitors took up sport in the initial rehabilitation period. The differences between operative treatment, inpatient stay and numbers working from the different countries are compared. Financing of attendance and training seemed to be informal, with just over half of the athletes financed by their governments. The role of sport in rehabilitation of those patients with spinal injuries, and specifically those injured whilst serving in the armed forces, is discussed.     

Integrating mental health services into primary medical care

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.     

Needle entrance into the maxillary sinus during retrobulbar anesthesia

Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose.