The experience of Patient Aligned Care Team (PACT) members.

BACKGROUND: In April 2010, the Veterans Health Administration (VHA) launched the Patient Aligned Care Team (PACT) initiative to implement a patient-centered medical home (PCMH) model. Few evaluations have addressed the effects of PCMH on health care professionals' experiences. PURPOSES: The aim of this study was to contribute to evaluation of the PACT initiative and the broader literature on PCMH by assessing respondents' experiences of implementing a PCMH model and becoming a teamlet. METHODOLOGY/APPROACH: A retrospective qualitative analysis of open-text responses in a survey fielded to all VHA Primary Care personnel (VHA Primary Care physicians, nurse practitioners, physician assistants, nurse care managers, clinical associates, and administrative clerks) in May and June 2012 (approximately 2 years into the 5-year planned implementation of PACT) using deductive and inductive content analysis. The main measures were two open-response fields: "Is there anything else you would like us to relay to the VA leadership in Central Office?" and "Do you have any other comments or feedback on PACT?" The data consisted of free text responses of 3,868 survey participants who provided text for one or both of the open-response fields. FINDINGS: Although respondents viewed PACT positively as a model and reported it improved relationships with patients and increased patient satisfaction, they described multiple barriers to achieving functioning teamlets and unintended consequences, including reduced time with patients, increased participant burnout, and decreased team efficacy because of low-performing team members. A central theme related to staffing being insufficient for the new model. PRACTICE IMPLICATIONS: Insufficient staffing of PCMH teams is a critical barrier to realizing the benefits of the new model. Frontline staff have concrete recommendations for other problems, such as using back-up teams to cover during absences, but that will require providing more opportunities for feedback from staff to be heard.

Complex Relationships Among Masculine Norms and Health/Well-Being Outcomes: Correlation Patterns of the Conformity to Masculine Norms Inventory Subscales.

The Conformity to Masculine Norms Inventory (CMNI) is a widely used multidimensional scale. Studies using the CMNI most often report only total scale scores, which are predominantly associated with negative outcomes. Various studies since the CMNI's inception in 2003 using subscales have reported both positive and negative outcomes. The current content analysis examined studies ( N = 17) correlating the 11 subscales with 63 criterion variables across 7 categories. Most findings were consistent with past research using total scale scores that reported negative outcomes. For example, conformity to masculine norms has been inversely related to help-seeking and positively correlated with concerning health variables, such as substance use. Nonetheless, past reliance on total scores has obscured the complexity of associations with the CMNI in that 30% of the findings in the present study reflected positive outcomes, particularly for health promotion. Subscales differed in their relationships with various outcomes: for one subscale they were predominantly positive, but six others were mostly negative. The situational and contextual implications of conformity to masculine norms and their relationships to positive and negative outcomes are discussed.