Hospices: Perspectives on the public policy debate.

The public policy debate on hospice care centers on the appropriate mix of medical and supportive services for terminal cancer patients and how such services should be paid for within existing insurance programs. Past decisions to change health care reimbursement that are applicable to the hospice debate are reviewed, the benefits and costs of hospice care are examined, and the role of research in the formulation of social policy is discussed. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional associations' strategies for revitalizing professional psychology.

The professional associations of psychologists are working to revitalize professional psychology. In response to recent challenges, these associations have attempted to (a) remove barriers to quality services within the mental care health delivery system; (b) help psychologists become better integrated within the overall health care system, as opposed to being narrowly defined as mental health professionals; and (c) help more psychologists move into services outside of the health care delivery system. These 3 strategies are motivated by a vision of psychology as a broad problem-solving discipline that can contribute to human welfare in a varied range of domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Veterans Administration psychology: A professional challenge for the 1980s.

Discusses the role that psychology has played in the Veterans Administration (VA) since the 1940's, a role that has increased in prominence over the years. Psychologists in the VA's Department of Medicine and Surgery have been involved in the delivery of health and mental health care services, research efforts, and training programs for psychology interns. It is noted that despite psychology's long-standing involvement in the VA, concerns have arisen recently regarding the status of psychology within the VA. Events contributing to these concerns involve decreased administrative visibility, attempts to exclude psychologists from medical staff membership, threats of psychology staff reductions, and proposals to place psychologist practitioners under the direction of physicians. Psychology's legislative and regulatory efforts to address these concerns are discussed. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdoctoral training in primary care health psychology: Duties, observations, and recommendations.

The need for postdoctoral training in health psychology has taken on added importance following transformations of the U.S. health care delivery system toward primary care models of delivery. This transformation provides psychologists with the opportunity to work as primary care practitioners, educators, and researchers, and it suggests the need for postdoctoral training that prepares students for those opportunities. The author addresses issues relevant to postdoctoral training from the perspective of a former participant in a postdoctoral fellowship training program in primary care health psychology. The duties and contributions of a primary care health psychologist are described. These include the provision of graduate medical education and clinical services tailored to primary care. The author also offers recommendations regarding postdoctoral health psychology training in order to enhance psychologists' ability to collaborate with medical professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reperfusion injury delays healing of intestinal anastomosis in a rat

This SAEM position paper clarifies the role of emergency medicine in health care delivery. It builds upon the working definition of emergency medicine developed by the American College of Emergency Physicians in 1994 by describing the health care role of emergency physicians (EPs). EPs are first-contact providers who care for all patients regardless of age, gender, time of presentation, or ability to pay. They remain the only continuously accessible specialty for patients seeking help and solace in the health care system. They are an essential link in the health care continuum between primary care physicians, specialists, the out-of-hospital system, the patient, inpatient services, and communication services. The EP's role is in organizing and monitoring the emergency care delivery system. Part of this role is to better align the health care provider training and ability with the specific medical needs of a patient. The emergency health care system remains the essential medical safety net for all individuals needing care in this country.     

La psychologie et la santé.

This article traces the historical development of Canadian medicare and its significant influence on shaping not only the clinical services provided within Canada's public health care system but also its major impact on the nation's overall health research agenda. Particular emphasis is placed on how this has influenced the development and role of psychology in the public health care system. It is argued that all psychologists, whether their work is focused on the applied or experimental areas of the discipline, have much to offer Canadians across the entire health care spectrum. Nevertheless, psychological services in the public health care system, and particularly in hospitals, have mainly developed within and continue to be primarily focused around mental health. Services in nonmental health areas of health have been more limited, although their importance is well recognized. The current situation partly reflects the limited training in general health issues that clinical psychologists-in-training generally receive in many graduate school programs in Canada. However, it also reflects the overall influence of medicare on the development of Canada's health care system. Medicare has tended to focus the activities of Canada's health care system primarily on treating illness rather than on preventing it and/or maintaining health. Also, medicare has oriented Canada's health care system mainly toward delivering medical services rather than providing more comprehensive health services (e.g., the "medically necessary" criterion for funding). However, times are changing. The growing emphasis among health policymakers in Canada on illness prevention and health promotion (e.g., the creation of the federal government Public Health Agency of Canada in 2004) will significantly expand psychology's role across all areas of health. Psychology education and training programs are urged to seriously examine whether psychology practitioners and researchers are being adequately prepared at present for the much broader array of future interdisciplinary professional, research, and educational activities and responsibilities that will emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and health.

This article traces the historical development of Canadian medicare and its significant influence on shaping not only the clinical services provided within Canada's public health care system but also its major impact on the nation's overall health research agenda. Particular emphasis is placed on how this has influenced the development and role of psychology in the public health care system. It is argued that all psychologists, whether their work is focused on the applied or experimental areas of the discipline, have much to offer Canadians across the entire health care spectrum. Nevertheless, psychological services in the public health care system, and particularly in hospitals, have mainly developed within and continue to be primarily focused around mental health. Services in nonmental health areas of health have been more limited, although their importance is well recognized. The current situation partly reflects the limited training in general health issues that clinical psychologists-in-training generally receive in many graduate school programs in Canada. However, it also reflects the overall influence of medicare on the development of Canada's health care system. Medicare has tended to focus the activities of Canada's health care system primarily on treating illness rather than on preventing it and/or maintaining health. Also, medicare has oriented Canada's health care system mainly toward delivering medical services rather than providing more comprehensive health services (e.g., the "medically necessary" criterion for funding). However, times are changing. The growing emphasis among health policymakers in Canada on illness prevention and health promotion (e.g., the creation of the federal government Public Health Agency of Canada in 2004) will significantly expand psychology's role across all areas of health. Psychology education and training programs are urged to seriously examine whether psychology practitioners and researchers are being adequately prepared at present for the much broader array of future interdisciplinary professional, research, and educational activities and responsibilities that will emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care policy, psychotherapy research, and the future of psychotherapy.

In a quest for accountability in the delivery of health services, health care policymakers in both government and private sectors are creating clinical practice guidelines, many of which heavily emphasize medical and pharmacological approaches. Yet, there are now sufficient data to support the efficacy of psychotherapeutic procedures for a wide variety of specific disorders, and it seems now is the appropriate time to communicate these findings to health care policymakers and the public at large. At the same time, data must be developed on the delivery of these interventions by frontline clinicians in the settings where they practice. The emergence of practice research networks may accomplish this latter goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging perspectives on the role of psychologists in the delivery of health and mental health services in schools.

This introductory article presents an overview of the APA Committee for the Advancement of Professional Practice Working Group on Schools as Health Care Delivery Sites. Additionally, it provides a health care reform context for exploring the emerging role for psychologists in the delivery of health and mental health services to children in the school setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alternatives in mental health care and criteria for quality assurance.

The present mental health delivery system is composed largely of hospital services and outpatient office-based services. Alternatives to traditional mental health services have been slow to develop, although their cost-effectiveness is well demonstrated. A major reason for this is that 3rd-party payers are reluctant to reimburse for these services. The present study reviews the development of nontraditional, or alternate, approaches to mental health care and suggest applicable quality assurance strategies. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foundations for Medical Care.

Notes that, in California, what began as the San Joaquin County Medical Society's answer to Kaiser-Permanente (i.e., the San Joaquin Foundation for Medical Care) has spread to a growing movement that is now nationally recognized as a viable, effective, competitive model of health care delivery. Each foundation is a federation of fee-service practitioners into an organizational entity that can contract to provide designated services on a prepaid basis within a geographical area. This gives the foundation for medical care (FMC) many of the attributes of the health maintenance organization, and indeed, they are recognized in the Health Maintenance Organization Act of 1973, PL 93-222, as individual practice associations (D?rken, 1974). Additional details about the foundations are provided, including the participation of practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and health care.

Recent advances in health care psychology are noted, especially those involving the conceptualization and treatment of lifestyle and chronic health problems. The contributions to health care psychology of community psychology, brief psychological treatments, behavioral medicine, and health psychology are outlined. The central task of both organized psychology and individual psychologists is to create an underlying structure of clear boundaries and standards for clinical practice and training in health care psychology. Initially, this task should involve an inventory of Canadian psychologists currently providing health care services and the nature and amount of those services. Subsequently, a need exists for the profession to examine and create guidelines in psychological service delivery, professional role models, training, and scientific methods pertaining to general health care. (French abstract) (27 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investments in behavioral health services: Strengthening the safety net.

As the primary Federal agency at the U.S. Department of Health and Human Services for improving access to health care services to the medically, financially and geographically vulnerable, the Health Resources and Services Administration (HRSA) is committed to improving health outcomes and achieving health equity by funding access to quality services, a skilled health workforce, and innovative delivery programs. Furthermore, HRSA recognizes the importance of access to quality behavioral health services. This article describes HRSA's current efforts to address behavioral health needs within the safety net through the delivery of quality health services and a strengthened workforce. Also, it highlights HRSA's commitment to providing good quality mental health and substance abuse services through key federal and nonfederal partnerships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Design of a statewide system for health education.

Eight explicitly identified assumptions about the nature of the health care delivery problem were used to design a statewide health education system based in a university medical center. The system design and how it is being implemented in one state (West Virginia) are discussed. Three unexpected outcomes regarding coordination of agency services, the political attractiveness of the system, and the system as a resource to new health education programs are briefly discussed. Two prerequisites for system development and the importance of the assumptions in a system's design are identified. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and primary health care for children.

There is an emerging consensus among those responsible for primary health care to children that such care should not only include medical concerns but also should assist parents with common problems of development and behavior. Psychologists are increasingly included among the personnel of medical groups that provide primary care to children. A model for this relatively new type of practice is described. Such pediatric primary-care settings also offer new research opportunities for psychologists. An important public policy issue concerns how comprehensive primary health care, including psychological services, can be made accessible to all children, and how research to evaluate such services and improve their efficacy can be encouraged. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatrists' and internists' knowledge and attitudes about delivery of clinical preventive medical services

OBJECTIVE: Changes in the health care environment have placed a greater responsibility on psychiatrists to deliver basic primary care services. The study assessed baseline knowledge and attitudes about clinical preventive medical services among psychiatric faculty and psychiatric residents at a tertiary care medical center. METHODS: Residents and faculty in psychiatry and general internal medicine completed a structured questionnaire, including 20 case scenarios, that assessed their baseline knowledge of clinical preventive medical services, their attitudes concerning delivery of those services, and their beliefs about the effectiveness of those services in changing patients' behavior. The case scenarios and knowledge questions were based on the clinical preventive medical services recommendations outlined by the U. S. Preventive Services Task Force. RESULTS: Psychiatrists reported more frequent assessment of and counseling about the use of illicit drugs and weapons, and internists were more likely to query about measures related to physical health such as cancer screening and immunizations. The two groups reported similar attitudes toward the need for and the efficacy of preventive medical services. Commonly cited barriers to the delivery of preventive care included lack of time and education. Psychiatrists scored reasonably well on baseline knowledge about guidelines for preventive medical services, particularly given their recent lack of specific education in these matters. CONCLUSIONS: Psychiatrists believe clinical preventive services are important and express interest in their delivery. Additional educational interventions are needed to train psychiatrists in clinical preventive services to avoid missed clinical opportunities for intervention in psychiatric populations that may have poor access to other medical care.     

Emergency medical services for children: Beyond lights and sirens.

This article describes the history of emergency medical services for children and identifies important mental health issues. It discusses the roles of psychologists in such services, including intervening with children and their families during times of crisis, helping others who are providing the physical care of children to mitigate rather than exacerbate children's emotional distress, and attending to the emotional needs of health care providers who treat children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional disorders in primary care.

Individuals with emotional disorders are more likely to use primary medical care than specialty mental health services, but these disorders are likely to be undetected or inadequately treated. Recognition of the importance of primary medical care for the treatment of mental disorder has resulted in pressing new research priorities. One set of issues concerns the adequacy of existing nosological systems for conceptualizing emotional disorder in primary care and identifying need for treatment. Another concerns the difficulties translating efficacious treatment into effective strategies that can be integrated into the competing demands of primary medical care. Psychologists have played only a limited role in defining and addressing emerging questions. Irreversible changes in mental health services have created the need for the development of a psychosocial perspective for what would otherwise be defined as narrowly biomedical issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)