RESUMEN
Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015-16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.
Asunto(s)
Relaciones Interprofesionales , United States Department of Veterans Affairs , Estados Unidos , Humanos , Estudios Retrospectivos , Curriculum , Atención Primaria de SaludRESUMEN
Experiencing maltreatment in childhood can have a lasting impact on how individuals identify and understand emotions in others. Research in this area has not examined parents' understanding of children's emotions, although emotion processing deficits may be one mechanism linking childhood maltreatment to subsequent parenting problems. In a matched case-control design, we test whether mothers with (n = 50) and without (n = 96) childhood maltreatment differ in their understanding of children's emotions on self-report measures and computer-based tasks. Compared to the control group, mothers who experienced maltreatment labeled more children with sad or angry emotions when given limited facial information and made different interpersonal inferences about children they labeled angry. They also reported more subjective difficulty interpreting emotions in unknown children and their own child. Results provide further evidence of emotion processing biases associated with childhood maltreatment. Interventions aimed at improving parental emotion understanding and mentalization may be particularly useful for mothers with a history of childhood maltreatment.
Asunto(s)
Maltrato a los Niños , Madres , Niño , Maltrato a los Niños/psicología , Emociones , Femenino , Humanos , Madres/psicología , Responsabilidad Parental , Padres , AutoinformeRESUMEN
The growth trajectory of ethnically and linguistically diverse individuals in the United States, particularly for youth, compels the education system to have urgent awareness of how diverse aspects of culture (e.g., Spanish-speaking, Black Latina student) are implicated in outcomes in American school systems. Students spend a significant amount of time in the school ecology, and this experience plays an important role in their well-being. Diverse ethnic, racial, and linguistic students face significant challenges and are placed at considerable risk by long-observed structural inequities evidenced in society and schools. Teachers must develop the capacity to be culturally sensitive, provide culturally responsive pedagogy, and regularly self-assess for biases implicated in positive academic outcomes for students in kindergarten through Grade 12. Research and practice have suggested that racism and discrimination in the form of racial microaggressions are observed daily in schools and classrooms. This article provides an overview of racial microaggressions in the school context and their damaging effects on students. We provide specific examples of microaggressions that may be observed in the U.S. classroom environment and how schools can serve as a positive intervention point to ameliorate racism, discrimination, and racial and language microaggressions. This comprehensive approach blends theory with practice to support the continued development of cultural humility, culturally sustaining pedagogy, and an equity-responsive climate.
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Lenguaje , Racismo , Adolescente , Humanos , Microagresión , Grupos Raciales , Instituciones Académicas , Estados UnidosRESUMEN
Musculoskeletal pain is a prominent complaint in primary care resulting in increased referrals to physical therapy (PT); however, the referral system often results in delays and discontinuation of care. Several models have been developed to improve the referral process including integrating PT into primary care clinics. The Veterans Health Administration (VHA) Center of Excellence in Primary Care Education (CoEPCE), which educates post-graduate trainees in interprofessional teams, began (in 2015) embedding physical therapists into primary care clinics enabling patients to see a physical therapist during their primary care visit. To evaluate the efficacy of this model we tracked the numbers of PT referrals, the number of completed referrals, and the length of time between referral and completion. PT referral parameters from PT-integrated trainees in the CoEPCE were compared to two traditional primary care training clinics at the same VHA site (Firm A and Firm B). Results indicate that the CoEPCE placed and completed more PT referrals and did so with a shorter turnaround time than was seen in the other two clinics. Further analysis suggests that the decreased turnaround time can be attributed to the integration of PTs into the primary care clinic. The results support extending the use of interprofessional clinics that integrate PT into primary care settings.
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Relaciones Interprofesionales , Atención Primaria de Salud , Instituciones de Atención Ambulatoria , Humanos , Modalidades de Fisioterapia , Derivación y ConsultaRESUMEN
BACKGROUND: Relapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24â¯h a day. METHODS: The current study was a 12-week randomized clinical efficacy trial of treatment-as-usual (TAU) only or RLâ¯+â¯TAU for methadone treatment patients with continued illicit drug use (Nâ¯=â¯82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of self-reported illicit drug abstinence and urine screens negative for illicit drugs. RESULTS: Days of self-reported illicit drug abstinence improved for patients in RLâ¯+â¯TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RLâ¯+â¯TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. CONCLUSIONS: Although the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.
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Terapia Cognitivo-Conductual , Metadona/uso terapéutico , Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Evaluación de Procesos y Resultados en Atención de Salud , Grupos de Autoayuda , Automanejo , Detección de Abuso de Sustancias , Trastornos Relacionados con Sustancias/terapia , Adulto , Terapia Combinada , Femenino , Humanos , Drogas Ilícitas , Masculino , Persona de Mediana Edad , Autoinforme , Trastornos Relacionados con Sustancias/tratamiento farmacológico , TeléfonoRESUMEN
The Society for Behavioral Medicine (SBM) urges restoration of Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention. Unfortunately, there have been no concerted CDC-funded research efforts in this area since 1996, due to the passage of the Dickey Amendment. To remedy the information-gathering restrictions caused by the Dickey Amendment bans, it is recommended that Congress remove 'policy riders' on federal appropriations bills that limit firearms research at the CDC; expand NVDRS firearms-related data collection efforts to include all fifty states; fund CDC research on the risk and protective factors of gun use and gun violence prevention; fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence; and support the development of evidence-based policy and prevention recommendations for gun use and ownership.
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Medicina de la Conducta/normas , Investigación Conductal , Centers for Disease Control and Prevention, U.S. , Armas de Fuego , Violencia con Armas , Sociedades Médicas/normas , Investigación Conductal/economía , Investigación Conductal/legislación & jurisprudencia , Centers for Disease Control and Prevention, U.S./economía , Centers for Disease Control and Prevention, U.S./legislación & jurisprudencia , Armas de Fuego/economía , Armas de Fuego/legislación & jurisprudencia , Violencia con Armas/economía , Violencia con Armas/legislación & jurisprudencia , Violencia con Armas/prevención & control , Humanos , Estados UnidosRESUMEN
The Recovery Line is an automated, computer-based intervention based on cognitive behavioral therapy (CBT) designed to provide real-time assistance by phone for patients in methadone maintenance. Preliminary efficacy findings were promising, however, as with other computer-based systems for substance use disorder, patient system use was less than recommended. Development and evaluation of system functions to increase patient engagement and use is needed. Thus, we conducted two randomized trials to evaluate system functions designed to increase patient use of the Recovery Line among methadone-maintained patients with continued illicit drug use. In Trial 1 (n = 60), patients received customized, system use recommendations or no recommendations on each Recovery Line call. Ratings of system usability were higher for customized recommendations (CR), but number of calls and total call time did not differ by condition. Trial 2 evaluated characteristics of reminder messages (message frame and reminder latency). Participants (N = 67) received gain- and loss-frame reminder messages, and were randomly assigned to immediate, short, or long term message latency. Although message framing had no effect, gender interacted with latency condition such that females did not differ by message latency, while males had significantly greater total contact time in the short latency conditions. Number of calls differed by condition over time such that the shorter latencies led to greater calls initially, but dissipated over time. Overall the study indicates that computer-based self-management systems can be adapted to increase patient engagement and use. (PsycINFO Database Record
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Analgésicos Opioides/uso terapéutico , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/terapia , Envío de Mensajes de Texto/estadística & datos numéricos , Terapia Asistida por Computador/métodos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/psicología , Tiempo de Reacción , Sistemas Recordatorios , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Video game addiction or Internet game disorder, as proposed by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), has similar criterion characteristics to other impulse control disorders. There is limited research examining video game addiction within a behavioral economic framework using delay discounting. The current study evaluated delay-discounting patterns of money and video game play by usual weekly hours of video game play. A total of 104 participants were split into 1 of 3 groups of video game players (low, medium, and high) and were asked to complete a monetary and video game discounting procedure through an online survey. Results showed significant differences between groups within both the monetary (p = 0.003) and video game discounting procedures (p = 0.004). Additionally, a positive linear relationship was noted between the groups across both procedures. The results of the current article reinforce previous findings that more hours of video game use are associated with greater impulsivity and provide implications for future research.