Clinical applications of telehealth in mental health care.

This article introduces the concept of telehealth and examines how telehealth expands both provider and patient access to health care. Current clinical applications are presented including equipment, research, and examples of direct clinical care. The article focuses on store-and-forward and video teleconferencing technologies providing information about the equipment and research pertaining to the clinical use of the equipment. The status of behavioral telehealth programs in the United States is reviewed and two case examples are provided. The first example discusses a direct patient care system and the second a remote clinical supervision system. The article concludes with suggestions for determining the value of adding telehealth to existing clinical practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radiographic and endoscopic evaluation of the upper GI tract

As the U.S. population grows increasingly diverse, health care professionals will need to develop skills that allow them to provide quality care to patients from a variety of racial and ethnic backgrounds. Chief among these skills is the ability to communicate effectively. This article discusses the demographic shifts occurring in the United States today and reviews the concept of cultural diversity. It also presents information about how to communicate with patients from diverse cultural backgrounds.     

Children's mental health problems and services: Current federal efforts and policy implications.

This article discusses the current federal role in the collection of information about the mental health problems of children and the provision of mental health services to children. It also describes the federal programs that help finance mental health services, support their coordination, and provide funding for research and training of mental health researchers and clinicians. Recent changes in federal policy are also described. This article, and the Office of Technology Assessment report on which it is based, conclude that although it is in some ways considerable, the federal role in providing mental health services to children is fragmented. This lack of cohesive policies toward children and across service programs may create difficulties for those who would move public policy toward the continuum of care that many observers conclude is needed to address children's mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moving toward a broader model of health care.

This article looks at how we can move toward a broader model of health care. It discusses advances in U.S. health care, the issue of health care coverage for all Americans, the need for a biopsychosocial model of health care, and the impact that psychologists can make in improving health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Medical Expenditure Panel Survey: a national health information resource

This article describes the Medical Expenditure Panel Survey (MEPS), the third in a series of nationally representative surveys of medical care use and expenditures sponsored by the Agency for Health Care Policy and Research. The MEPS is designed to provide extensive data on the types of health care services American use, how frequently they use them, how much is paid for the services, and who pays for them. It also will provide information on the types and costs of private health insurance available to the U.S. population. The survey is unparalleled in its degree of detail, as well as its ability to link medical care use, payments, and health insurance coverage to specific survey respondents and their families. It allows analysts to examine how individual and family characteristics, including the characteristics of their health insurance, affect medical care use and spending. This article discusses each of the MEPS components, focusing on design enhancements that have been made since the survey was last conducted nearly a decade ago.     

In search of the CPR

In 1991, the National Academy of Sciences' Institute of Medicine defined, endorsed, and called for the implementation of the computerized patient record (CPR) by 2001. Seven years later, in 1998, health care is still arguing about what a CPR is, how it's to be implemented, and when. This article discusses the origins of the CPR and its initial development efforts. It explores the roadblocks that stalled its development and how managed care may have jump-started the process. Finally, it explains current CPR development efforts and what's on the horizon.     

The privatization of public services. The case of health services in Costa Rica

This article analyzes the role of the State and public enterprises in the development of nations, from a particular standing point, and inquires into the privatization issue, reviewing both its concept and the possible mechanisms for its implementation. Also, emphasis is made on the selling of public enterprises as one of the several ways to privatize. Within this context, some measures for the reorganization of the Costa Rican National Health System are proposed. These measures uphold fundamental values of social justice. This article is based on a theoretical-conceptual framework from an innovative experience in health services management in Costa Rica, in which a self-managing cooperative society (a nonprofit enterprise) manages, by contract with national health care public institutions, an urban local health care system.     

Cost offset: Past, present, and future.

The health of the U.S. health care system is precarious. Calls for reform in areas such as cost, quality, and equal access to health care are widespread and growing louder each day. Action is required on each of these issues, yet the lack of progress is cause for serious concern. A central problem is the reluctance to acknowledge the roles that the mind and behavior play in health and illness. One solution is the integration of psychological health care into the general health care system. A major vehicle for advancing the integration of health care is the "cost-offset" effect, a concept that involves paying systematic attention to psychological factors in order to reduce overuse of medical services and thereby decrease costs. Despite data demonstrating that the cost-offset hypothesis is quite robust, little has been done to implement integrated health care. This article reviews the literature on cost offset, discusses the policy implications, and considers its application to the public sector. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emergency department as a violence prevention center

No longer confined to the criminal justice system alone, violence is now regarded as a major health care issue in America. Changes are apparent not only in health care delivery, but also in medical school curricula, residency training board examinations, and accreditation. Although tertiary prevention demands the most acute attention, opportunities for secondary prevention are important and often neglected, especially when the immediate health care issue is not related to violence. This article describes the development of the Emergency Department as a Violence Prevention Center program, established at The George Washington University Medical Center. The program moves beyond responding to acute cases of violence only and considers the hospital emergency department as an active player in a community-wide effort to end violence. It does this through universal screening, assessment, treatment and other interventions, documentation, and patient and professional education.     

Fatal combined infection with Haemoproteus noctuae and Leucocytozoon ziemanni in juvenile snowy owls (Nyctea scandiaca)

The concept of a phenomenon known as readiness will be analyzed. Using the Wilsonian method, the concept is broken down into a practical definition that allows nurses to assess this phenomenon in clinical practice. Nurses in AIDS care work with a patient population whose optimal health is often dependent on the ability to incorporate major lifestyle changes into their daily lives. Nursing interventions that assist patients to incorporate change must be presented to patients at a time when the patient's ability to succeed is optimal. The ability to recognize readiness in patients is essential for nurses providing AIDS care. This article discusses the concept of readiness, which may be necessary before behavior modification can occur. The phenomenon of readiness has application for various changes in behaviors, including adherence to primary prevention strategies.     

Protective effect of GV150526A on the glutamate-induced changes in basal and electrically-stimulated cytosolic Ca++ in primary cultured cerebral cortical cells

Medical care in the United States continues to face tremendous financial pressures. Public and private health policy claim to encourage primary care and preventive services, but also discourage services that have not been demonstrated to be effective and/or cost-effective. This article suggests a model to illustrate the conceptual relationship between traditional American medical care and "evidenced-based" medicine. It further examines how the lack of an adequate research base makes a move to purely evidence-based care premature for primary care and prevention services. The paper defines a new conceptual statistic, the uncertainty index, as the proportion of non-refuted current practice that is also not corroborated by research evidence. The greater the uncertainty index, the less appropriate is a clinical model restricted to evidence-based care. Specific theoretical barriers to outcomes research in prevention are discussed and simple criteria to determine the desirable components of care are suggested. The need for theoretical and empirical research into primary care and prevention, especially for children, is emphasized. Care that is of low risk, not of extremely high cost, and that is generally believed useful by the community of practitioners is particularly desirable in the absence of data refuting its value.     

The culture of female circumcision

The issue of female circumcision takes on special significance as more women migrate to the United States from countries where the practice has religious and traditional underpinnings. Female circumcision is a problem unfamiliar to most Western health care practitioners. This article describes an ethnographic study of the types of female circumcision, the reasons for and against the practice, the health implications of this practice, and cultural attitudes of circumcised women both in Western Africa and as migrant refugees living in the United States. Ethical dilemmas in dealing with this practice and implications for nurses and health care providers are discussed.     

Improving health care delivery for persons with multiple sclerosis

Persons with multiple sclerosis (MS) have a close-to-normal life span and can look forward to a high level of consumption of health care services for an average of 40 to 50 years. As expensive new treatments for MS are developed and better rehabilitation techniques are implemented, lifetime health care costs for MS patients can be very great. This article discusses ways in which these costs can be managed.     

Adapting cognitive-behavioral therapy for Mexican American students with anxiety disorders: Recommendations for school psychologists.

Mexican American students are the fastest growing group in U.S. public schools. There is a growing body of research indicating that Mexican American families underutilize mental health services and are more likely to drop out of care prematurely when they do seek help. These findings may indicate that our health care system is not providing ethnic minorities with culturally competent care. Although cognitive?behavioral interventions are considered to be evidence-based treatments for child anxiety disorders, previous protocols have not taken cultural factors into account. This article discusses how to adapt cognitive?behavioral therapy (CBT) for Mexican American students with anxiety disorders. Working within the Psychotherapy Adaptation and Modification Framework (PAMF), this article offers adaptation principles that may guide school psychologists in implementing CBT strategies when working with Mexican American youth and their families. A case study is provided illustrating how cultural modifications of CBT can lead to positive outcomes for Mexican American students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Measurement, Health Care Policy, and Implications for Rehabilitation Services.

Provision of reliable, valid, and informative data to the public for evaluating the performance of health care services has been inconsistent at best and erroneous at worst. This article examines how private and governmental agencies are addressing this issue by concentrating on a well-defined set of performance indicators for several key diseases. In order to fully consider the implications of these developments for rehabilitation, the author discusses 4 topics: (a) how quality and safety concerns influence health care policy, (b) watershed events over the past half century that have contributed to a quality and safety dilemma in health care, (c) the difference between process and outcome indicators and implications for robust performance measurement, and (d) emerging coordination efforts by accreditation and regulatory agencies that will shape clinical service delivery in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Myocardial infarction and percent arteriographic stenosis of culprit lesion: report from the Program on the Surgical Control of the Hyperlipidemias (POSCH)

Domestic violence is a significant public health issue affecting women. Numerous medical organizations have recommended that routine screening of women be conducted to assist in the prevention, identification, and care for victims of violence. This article examines the scope of domestic violence in women, reviews ways to recognize abuse, examines the potential impact of abuse upon health and discusses the management of victims.     

Understanding and using the medical subject headings (MeSH) vocabulary to perform literature searches

The United States National Library of Medicine's (NLM) MEDLINE database is the largest and most widely used medical bibliographic database. MEDLINE is manually indexed with NLM's Medical Subject Headings (MeSH) vocabulary. Using MeSH, a searcher can potentially create powerful and unambiguous MEDLINE queries. This article reviews the structure and use of MeSH, directed toward the nonexpert, and outlines how MeSH may help resolve a number of common difficulties encountered when searching MEDLINE. The increasing importance of the MEDLINE database as an information resource and the trend toward individuals performing their own bibliographic searches makes it crucial that health care professionals become familiar with MeSH.     

Research in health economics: a survey

This paper surveys the types of issues with which health economists have been concerned. It is intended to introduce noneconomists to the kinds of questions that economists have regarded as important. Economists' work in the health economics area may be usefully divided into "positive" and "normative" studies. Positive studies are those designed to describe, or make predictions about, how the health care system, or parts of it, actually operate. Conversely, normative studies are intended to provide statements as to how the health care system should operate. The major areas surveyed include the concept and estimation of the "production function" for health, the distinction between private and social costs, determinants of prices of medical inputs, and benefit-cost analysis.     

The integration of psychology into primary care: Personal perspectives and lessons learned.

The purpose of this article is to discuss the integration of psychology into a Veterans Affairs Medical Center Primary Care clinic, as experienced by the authors. There has been an evolving need for psychology's presence in primary care, due in part to the increasing number of primary care patients who present with complex physical and psychological issues, as well as institutional procedures for first-line treatment of more common mental health concerns (e.g., depression). Concurrent with the expansion of Medical Center services and patient population, an increasing demand has been placed upon psychology in primary care. To better accommodate the workload, a consultation-oriented model of treatment has been implemented. Within this integrated model, primary care providers and psychologists collaborate to provide multidisciplinary care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foreword.

The purpose of this special issue was to collect data and to bring to the attention of the psychological community the need for well-integrated high-impact psychological science and services in the overall health system. The reader will note by scanning titles of the various articles that this special issue is not a systematic review of literature. However, the articles contain valuable insights about the current state of the art on how psychotherapy interfaces with the general health system and the mental health system in particular. It must be noted that psychotherapy is a broad gauge concept involving a variety of applications and interventions which promote better health. It is evident from the contents herein that there is an evolution in the health care field regarding the incorporation of psychotherapy. That is, psychotherapy is becoming more a technique targeted toward specific problems or specific populations and subject to detachment from its scientific base. (PsycINFO Database Record (c) 2010 APA, all rights reserved)