A paradigm shift in the scope of practice for health psychologists: Training health psychologists to be primary care case managers.

Innovative programs in the Department of Defense have challenged health psychologists to broaden their scope of practice. To this end, health psychologists at Tripler Army Medical Center independently admit and discharge patients and serve as primary care managers during hospitalization and follow-up aftercare. A conceptual overview of the Tripler health psychology training philosophy and how the training model has guided Army health psychology in managing, rather than simply consulting, on the care of patients will be offered. Practical considerations and a training curriculum are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care psychologists in the Netherlands: 30 years of experience.

The primary care psychologist (PCP) in the Netherlands has 30 years of experience. The PCP is a generalist who, in close cooperation with the family physician and other providers of primary health care, has a mindset and manner of working that is largely determined by the context in which the PCP works. The specific attitudes and role of the PCP are described. The PCP provides services for a clearly delimited geographic region and is responsible for the provision of brief psychological help from a biopsychosocial perspective. In addition to psychological assessment and the provision of stepped care, the PCP also devotes considerable attention to prevention and health promotion. An orientation toward the community and the empowerment of clients stands central. The various tasks of the PCP are described in detail, and an educational curriculum for the specific 1-year training of the PCP is outlined. Lessons for other European countries and the United States are deduced from the Dutch experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preventive health paradigm for health care psychologists.

Developed a preventive health paradigm for health care psychologists by building on public health and preventive mental health models of primary, secondary, and tertiary prevention. Adoption of a "biopsychosocial" perspective on health and illness is basic to the preventive health paradigm. Examples of preventive health programs are considered along with a wide range of preventive health activities by psychologists in health care settings. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A training curriculum for professional psychologists in primary care.

Primary care psychology is a growing field that requires specific training opportunities for successful practice. The knowledge and skills that practitioners need for work in this setting are outlined here in detail. This curriculum integrates literature and experience in family psychology, health psychology, and pediatric psychology; considers multiple levels of education and training; and provides illustrative examples. It is a first attempt in an evolving process of integrating historical and cutting edge literature from many areas of psychology and other disciplines to contribute to comprehensive primary care psychology training. It can be used by programs and individual practitioners alike in designing education and training experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role functions of pediatric and health psychologists in health care settings.

686 pediatric and health psychologists completed questionnaires requesting background information concerning years of experience, current work settings, graduate training, and professional identification. Ss were also asked to describe services and functions they performed, difficulties they encountered, and general consultation goals. Results suggest that both groups are involved in a wide range of diagnostic, treatment, and consultative activities in health care settings and that there are many similarities in the ways they conceptualize their roles and how they function. However, pediatric psychologists were especially involved in clinical assessment activities, whereas research was a high priority for health psychologists. Other aspects of the roles, functions, and activities of these 2 groups are described. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral health in the pediatric primary care setting: Needs, barriers, and implications for psychologists.

Pediatric primary care providers (PPCPs) are increasingly being called on to assess children and adolescents for emotional and behavioral disorders, as well as to manage their care. The authors present the results of a survey of PPCPs regarding their comfort in assessing or diagnosing and treating or managing 19 emotional and behavioral problems, their expectations of how reasonable it is for PPCPs to assess and treat disorders, the actions they would take, barriers they face, and interest in developing formal relationships with mental health specialists. The authors discuss implications and opportunities for psychologists. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Difficulties in family practice residency training: Recommendations for training health psychologists in primary care settings.

We attempt to pursue a model for health psychologists by developing recommendations for behavioral science input into family practice residencies, gleaned from experiences of several health psychologists specifically trained to be directors of behavioral science programs of such medicine departments. This information is accumulated and based on a 7-year period at one university-based, inner-city program and two community-based hospitals. These recommendations are offered in the hope that health psychology training specialists will anticipate roadblocks associated with family practice residency training programs and will plan accordingly. Specifically, we make recommendations regarding program overview and training background, roadblocks (including medicine as the final authority), theoretical versus practical teaching orientation, resident time constraints, administrative support and priorities, and training effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical practice guidelines for managing major depression in primary care practice: Implications for psychologists.

Clinical practice guidelines are being developed by professional and governmental bodies to improve the quality of health care. The guidelines developed by the US Public Health Service Agency for Health Care Policy and Research seek to improve the primary care physician's ability to diagnose and treat major depression. Clinical, educational, and research implications for psychologists are considered in light of how the recommended guidelines potentially will influence the nature and quality of care provided for mood disorders by generalist physicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing psychology and psychologists for new health care markets.

Because our training models in Clinical Psychology have not kept pace with the rapid changes in the health care marketplace, we may be in danger of preparing psychologists for markets that no longer exist. The next generations of psychologists will require the skills of the entrepreneur and the leader in addition to a range of core clinical skills. At the same time, our profession's historic commitment to science as the best epistemic game in town may founder if we fail to pay better attention to knowledge translation (i.e., how to move scientific findings expeditiously from the laboratory into practice). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Innovative projects earning psychologists spots on hospital health care teams.

Innovative hospital projects initiated by psychologists include the use of video games to restore and measure mental functions in seriously injured patients, biofeedback therapy, the use of behavioral techniques to reduce and eliminate pain associated with cancer or with chemotherapy, and the monitoring of high-risk infants. While psychologists have had to fight for hospital privileges, there seems to be a slow movement toward allowing these privileges. Psychologists could also be useful in such areas as stress management, the design of special wheelchairs, and behavior modification for smokers and the obese. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Military health care providers' views on prescribing privileges for psychologists.

Selected military psychologists have been trained and privileged to independently prescribe psychotropic medications. To explore the attitudes of health care professionals toward prescribing authority, a survey of 395 military psychiatrists, psychologists, primary care physicians, and social workers was conducted. Psychologists, physicians, and social workers supported prescribing privileges and continuation of the training programs. Results suggested that support by physicians and social workers is based on improving access to comprehensive mental health care for their patients. Psychologists advocating prescribing privileges at the state level need to pursue the training and licensing authority to prescribe independently. The opposition of organized psychiatry seems assured. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The education and training of clinical psychologists in the Netherlands.

With the reduction of the doctorandus program in the Netherlands to 4 yrs, a graduate program has been created that is significant to clinical psychology because it separates the research and applied orientations. The research orientation leads to the PhD, the applied orientation to a certificate of professional registration. This distinction has effectively ended the scientist–practitioner model underlying the training of clinical psychologists. In moving clinical psychology from its scientific research base, psychology has become more fragmented, and in a way that has far-reaching implications for the discipline and the profession in the Netherlands. These developments are of interest due to the debate in the US and elsewhere on training and licensure of clinical psychologists and concern about the unity of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative practice in primary care: Integrated training for psychologists and physicians.

Managed health care has forced psychologists and primary care physicians to expand their practices into areas for which they have traditionally lacked training or experience. This article describes a training program designed to foster collaboration and to bridge the gap between the 2 specialties by having psychology interns and medical residents comanage patients in a primary care setting under the joint preceptorship, of a psychologist and a physician. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical psychologists in the 1970s.

Reports a survey of 855 members of the Division of Clinical Psychology. Among the topics surveyed were professional activities, occupational setting, theoretical orientation, primary professional self-view of respondents, and satisfaction with the APA, graduate training, and choice of career. An ideology scale was administered to appraise attitudes along an intuitive-objective dimension and in terms of psychodynamic and behavioral value orientations. In general, the sample was very positive toward their choice of career and relatively so with regard to their graduate education. Approximately 41% of the respondents' time was devoted to clinical acitivities, 35% to training and research. Certain differences between subgroups are found with the greatest divergence noted between academic clinical psychologists and private practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concluding remarks: Dimensions of role conflict for health care psychologists.

Discusses 3 dimensions—tradition vs innovation, autonomy vs interdependence, and paradigm congruence vs clash—of the identity or role conflicts that health care psychologists may experience, and presents examples of these conflicts and various efforts to resolve them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A patient-initiated system for preventive health care. A randomized trial in community-based primary care practices

PURPOSE OF THE STUDY: From 1983 to 1986, 156 alumina/polyethylene combination hip arthroplasties (131 patients) were performed at the Henri Mondor Hospital. Before 1983, the stainless-steel/polyethylene combination was performed. In this follow-up study, the outcome of the first 156 consecutive alumine-polyethylene combination hip arthroplasties were analyzed with clinical and radiological features. The comparison of the two combinations was analyzed. A survival analysis was performed over a ten years interval. MATERIAL AND METHODS: The femoral component of the prosthesis was made of Titanium alloy (TiA16V4). The femoral head was made of dense alumina (A1203). The head diameter was 32 mm. The socket was made of ultra-high-molecular-weight polyethylene (UHMWPE). Fixation of head to stem was obtained through conical sleeving. We used a posterolateral approach, and a cemented THA without pressurization. At last follow-up evaluation, 90 patients were reviewed, 9 patients were interviewed by phone. Three patients were dead and 20 patients were lost for follow-up evaluation, in the first year. Nine failures were reoperated. The major cause of failure was septic complication of the THA (8). The average age of patients at arthroplasty was 58.1 year. The clinical evaluation was performed with the Merle d'Aubigné, Postel scoring system. The radiographs of 117 hips out of the 156 were available for this evaluation. Radiolucents, failures and wear were analyzed. RESULTS: There was a 5 per cent rate (8 hips) of deep infection due for two hips to the underlying pathology. Ten (6.5 per cent) of the 156 hips had had an episode of dislocation at last follow-up. Eighty-nine per cent of the hips were rated excellent, very good, and good; 9.3 per cent were rated fair: and 1.7 per cent were rated poor. The radiographs of the socket revealed 54 per cent of bone-cement radiolucent and three failures at last follow-up. The radiographs of the stem revealed 29 per cent of bone-cement radiolucent and one failure at last follow-up. There was no revision of the femoral stem. Survival analysis (aseptic failures) depicted 93.45 per cent durability of the arthroplasty at 10 years. The survival analysis for the socket alone, using the same criteria for failure, demonstrated 94.53 per cent survival success at 10 years, and 98.91 per cent for the stem component. The comparison of the two combinations gave us a survival analysis for the socket alone, using aseptic failure as criteria, 79.84 per cent for stainless-steel/polyethylene combination at 8 years, and 97.63 per cent for alumina/polyethylene at the same time. CONCLUSION: The alumina/polyethylene combination with a 32 mm head diameter gave better results than the stainless-steel/polyethylene combinations. The improvement was noted on the acetabular component.     

Financially independent primary health care drug supply system in Cameroun

The drug supply system in the North-west Province of Cameroun differs from 'simple' health financing projects in three important respects. Firstly, the system does not promote drug sales for cofinancing purposes but aims at supporting the prescribers to provide better medical care, and patients' access to the most essential drugs at fair prices. Secondly, the project guarantees equal prices and services throughout the Province regardless of distance from the central warehouse and sales at a given location. Thirdly, along with the revolving fund-financed drug supply system, a community-based legal framework has been established. Built-in management alert mechanisms helped the project resist common causes of collapse such as uneconomic behaviour and political interference. The drug supply system has gained full independence from subsidies and external authorities. Its strong community participation promotes good governance.     

Clinical effectiveness and primary dental care. 2. The influence of health economics

The first paper gave an overview of the issues concerning clinical effectiveness and primary dental care. However, the rise of evidence-based health care has the potential to increase as well as control costs. With the demands on health care ever increasing, the costs of interventions as well as their benefits must be assessed concurrently. This is the area covered by the science of health economics, which will play an increasing role throughout all health services as an aid to prioritising the deployment of resources. It is inevitable, therefore, that the theories and methods of health economics will affect the delivery of primary dental care in the future.