Objective
Behavioral science faculty in family medicine residencies work on inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that ...behavioral science faculty fill while working in such settings.
Method
Using a modified sequential explanatory study, researchers clarified the roles and responsibilities of behavioral science faculty. Participants completed a web-based survey (N = 60) on roles and a semistructured interview (N = 24) about the responsibilities on inpatient medicine teaching service.
Results
Results suggest that behavioral science faculty assume the roles of educator, patient care supporter, evaluator, mentor/advisor, and scholar/researcher and perform multiple responsibilities.
Conclusions
Implications for this research inform the hiring process and training for behavioral science faculty and resident education.
Introduction: A growing recognition of the need for specialized training to prepare health care providers to work in integrated care (IC) settings requires innovative methods to educate learners. ...There is an opportunity to provide IC trainees with relevant experiential opportunities to practice these techniques using simulation-based learning, a well-established training approach in medical education. Method: This pilot study sought to examine the feasibility of using simulation-based learning in the interprofessional training of Marital and Family Therapy (MFT) and Family Nursing Practitioner (FNP) trainees in relevant integrated care competencies. Participants included 26 learners (21 MFT and five FNP). The case simulation event involved students completing a video telehealth clinical encounter involving a warm handoff. Clinical faculty observed trainees, completed a checklist designed specifically for the event, and provided feedback directly after the event. Results: Trainees reported high satisfaction with the use of simulation-based learning. Observational coding revealed that trainees successfully implemented many elements of a warm handoff, however, aspects involving interprofessional communication, brief intervention, and follow-up planning appeared more challenging. Discussion: Increased utilization of interprofessional case simulation training in masters and doctoral level behavioral health programs could help accelerate the development of a competent integrated care workforce.
Public Significance Statement
Interprofessional simulation-based learning can aid preservice learners in developing core competencies in integrated behavioral health.
Research suggests that National Collegiate Athletic Association (NCAA) Division I student-athletes have higher levels of stress and other behavioral health issues, including substance use, than ...nonathletes. For several reasons, student-athletes may be less likely to admit to behavioral health issues and seek mental health care. Integrated care is a model of care that integrates behavioral health into a medical practice. This article explores the newly released NCAA Best Mental Health Practice guidelines and the application of integrated care to a Division I athletic training room setting using the three-worldview framework for successful integration, incorporating clinical outcomes, operational reliability, and financial stability.
Background:
There is a growing awareness of the importance of mental health care in National Collegiate Athletic Association (NCAA) student-athletes; however, there is a lack of literature on mental ...health resources in collegiate settings. Identifying current practices can set the stage to improve the delivery of care.
Hypothesis:
There is great variability in resources and current practices and no “standard of care” exists.
Study Design:
Observational, quantitative.
Level of Evidence:
Level 5.
Methods:
One hundred twenty-seven (36% response rate) head athletic trainers at Division I NCAA member colleges completed a web-based survey. Questions assessed several aspects of mental health clinicians, perception of care coordination, and screening.
Results:
Seventy-two percent of respondents noted that counseling took place in a counseling center, and 20.5% of respondents indicated that they had a mental health provider who worked in the athletic training room. Mental health clinician credentials included marriage and family therapist, psychologist, clinical social worker, and psychiatrist. The majority of athletic trainers (ATCs) noted that they are satisfied with the feedback from the mental health provider about the student-athletes’ mental health (57.3%) and believe that they would be able to provide better care to student-athletes if mental health services occurred onsite in the training room (46.4%). Fewer than half (43%) indicated that they use screening instruments to assess for mental health disorders.
Conclusion:
There is wide variability on how mental health services are provided to NCAA Division 1 student-athletes. Some mental health care providers are located offsite, while some provide care in the training room setting. Also, there are inconsistencies in the use of standardized screening tools for mental health evaluation. There is no standard collaborative or integrated care delivery model for student-athletes.
Clinical Relevance:
Opportunities exist for standardization through integrated care models and increased use of validated screening tools to deliver comprehensive care to student-athletes.
In order to investigate the patient experience of integrated behavioral health care in primary care settings, we implemented a patient cohort model from a combined site sample (N = 727) consisting of ...a family practice clinic and a Federally Qualified Health Center. Patient experience was measured using 12 questions from a validated measure, the Agency for Healthcare Research and Quality’s Consumer Assessment of Health Care Providers and Systems (CAHPS®), Home and Community Based Services version, and six additional questions about interactions with an integrated behavioral health care team. We assessed bivariate relationships between satisfaction with integration and the clinic practice and self-reported physical health or self-reported mental/emotional health. We also utilized multiple regression to evaluate this relationship. Our analyses showed a statistically significant and small to moderate direct correlation between patients’ self-reported health (both physical and mental/emotional health) and their ratings of the practice as a whole (p = .0003), such that patients who rated their physical and/or mental/emotional health as better were more likely to rate their overall satisfaction with the practice higher. The results of this study suggest that primary care patients with only mild to moderate health conditions (physical and/or mental/emotional) may experience greater satisfaction with integrated behavioral health care than patients with multiple and/or severe health conditions. In contrast, patients with multiple and/or severe health conditions may experience lower satisfaction with integrated behavioral health care and may be better served through higher levels of care.
Training for Teamwork: A Case Study Sudano, Laura E.; Patterson, Jo Ellen; Lister, Zephon D.
Families systems & health,
09/2015, Volume:
33, Issue:
3
Journal Article
Peer reviewed
As the field of collaborative care, or integrated behavioral health, continues to develop, lessons are learned from attempts to establish such programs (Sieber et al., 2012; Unützer, 2014). Part of ...the success of collaborative care programs is the function of an interdisciplinary team. In this article, faculty from University of San Diego (USD) and University of California, San Diego (UCSD) share changes needed to curriculum and career development to support leadership and teamwork skills essential to program development, implementation, and sustainability for integrated behavioral health. This article uses Unützer's (2014) 4 factors of creating a successful collaborative care program (i.e., shared vision, leadership, staffing, and financial sustainability) to discuss implications for effective collaboration between 2 universities and the training of primary care providers in teamwork and leadership skills for overcoming barriers and pitfalls to expand collaborative care beyond their initial training.
Introduction: A growing recognition of the need for specialized training to prepare health care providers to work in integrated care (IC) settings requires innovative methods to educate learners. ...There is an opportunity to provide IC trainees with relevant experiential opportunities to practice these techniques using simulation-based learning, a well-established training approach in medical education. Method: This pilot study sought to examine the feasibility of using simulation-based learning in the interprofessional training of Marital and Family Therapy (MFT) and Family Nursing Practitioner (FNP) trainees in relevant integrated care competencies. Participants included 26 learners (21 MFT and five FNP). The case simulation event involved students completing a video telehealth clinical encounter involving a warm handoff. Clinical faculty observed trainees, completed a checklist designed specifically for the event, and provided feedback directly after the event. Results: Trainees reported high satisfaction with the use of simulation-based learning. Observational coding revealed that trainees successfully implemented many elements of a warm handoff, however, aspects involving interprofessional communication, brief intervention, and follow-up planning appeared more challenging. Discussion: Increased utilization of interprofessional case simulation training in masters and doctoral level behavioral health programs could help accelerate the development of a competent integrated care workforce.
Due to the importance of the human factor for an effective control of soil erosion, the FAO (1985) suggested to put emphasis on social, cultural, economical and institutional factors involved in the ...problem. In this context, in 1991, an investigation in Coatlinchan, Mex. was carried out to explore the local farmers knowledge about soil erosion and its control. A survey was applied to 22 % of ejidal population. It was found that people have agricultural knowledge regarding erosion and soil conservation practices. Nevertless, the little individual land holding and the strong unequality of the income in agricultural activities in relation to the other production sectors, have provoked that people relegate conservation practices to a secondary level.
Debido a la importancia del factor humano para un efectivo control de la erosion, en 1985 la FAO sugirio poner enfasis en aspectos sociales, culturales, economicos e institucionales, relacionados con dicho problema. En este contexto, en 1991 se desarrollo el presente trabajo en Coatlinchan, Mex., y se exploro el conocimiento que tienen los agricultores locales de la erosion y de las practicas para su control. Con este objetivo se aplico una encuesta a 22 % de la poblacion ejidal, y se encontro en ella tradicion por la agricultura, asi como conocimiento de la erosion y de varias practicas para su control; sin embargo, el pequeno tamano de la dotacion individual, y la amplia desigualdad en los ingresos de la agricultura con los otros sectores de la produccion, han provocado que esta, e incluso el cuidado de la tierra, sea relegada a un plano secundario.
Sex differences in arterial hypertension Gerdts, Eva; Sudano, Isabella; Brouwers, Sofie ...
European heart journal,
12/2022, Volume:
43, Issue:
46
Journal Article
Peer reviewed
Open access
There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females ...and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.
Abstract
Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality ...studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient’s global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.
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