Assessing social determinants of health in primary care: Liability or opportunity?

Health care is never boring. It changes rapidly based on political winds, financial models, novel terminology, and biomedical advances. In the past decade, there has been large-scale implementation of integrated health care, routine screening for common behavioral health conditions, and the rollout of alternative payment models in primary care. However, even before these advances have been inculcated as the standard of care, we are now witnessing the implementation of health coaches and recommendations to screen for social determinants of health. Social determinants of health (SDOHs) include nonclinical factors that impact health, such as income, education, and the social the conditions in which people are born, grow, live, work and age. While there is strong evidence that health outcomes are only marginally determined by direct clinical care and largely determined, it is unclear what "system of care" (public health vs. medical care) bears the responsibility of identifying and addressing these issues. Is this really the responsibility and role of primary care? Whether we as a health care system decide that systematically asking about and addressing SDOHs is within our job descriptions remains to be seen. Further research is needed to determine the cost and clinical impact of screening and addressing SDOHs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Integrated primary care could play a starring role in the Amazon-JP Morgan-Buffet health care enterprise.

Earlier this year, Amazon, J. P. Morgan, and Berkshire Hathaway announced plans to launch a joint health care company with more than a million covered lives. Dr. Atul Gawande, the prominent Boston-based surgeon and health care thought leader, will become the first chief executive officer of this health care venture, with a mission to get the best results at the lowest costs and remain free from profit-making incentives and constraints. In this presidential column, the author explores what this has to do with the mission in the Collaborative Family Health care Association (CFHA) and the promulgation of integrated health care. (PsycINFO Database Record

Dissolving the dichotomy in health and healthcare.

The New England Journal of Medicine Catalyst recently published an article entitled "It's Time to Treat Physical and Mental Health With Equal Intent" (Compton-Phillips & Mohta, 2018). The article describes a survey of the NEJM Catalyst Insights Council, a qualified group (n=565) of U.S. executives, clinical leaders, and clinicians who are directly involved in health care delivery. Ninety nine percent of council members responded that mental health should not only be integrated into ambulatory medical care settings but also embrace a "shared concept of mutual responsibility" (p. 11). As a long-time clinician, educator, and advocate for integrated care, Runyan was so pleased to see this dogmatic statement in a New England Journal of Medicine publication. Labeling disease as either physical or emotional has never served the individual well and may further exacerbate existing stigma and reluctance to seek the most appropriate services. Runyan argues it is time to use intentional language to avoid deconstructing physical and mental health in our discourse or be complicit when others dichotomize measurement and funding. Runyan challenges leaders and aspiring leaders in the field of integrated care to use language and advocate for measures that blur, if not dissolve, this unhelpful and artificial dichotomy. (PsycINFO Database Record

Ethical Challenges Unique to the Primary Care Behavioral Health (PCBH) Model.

The interprofessional nature of the Primary Care Behavioral Health (PCBH) model invites potential conflicts between different ethical guidelines and principles developed by separate professional disciplines. When the foundational model of care and training on which ethical principles were developed shifts, the assumptions underlying the guidance also shifts, revealing gaps and mismatches. This article reviews the extant literature in this realm, and proposes a more unifying set of ethical guidance for interprofessional, integrated primary care practice. We discuss common ethical dilemmas unique to the PCBH model through case examples, and then apply the newly proposed ethical guideline model to these cases to illustrate how the newly proposed model can be efficient and effective navigating these dilemmas.

"Joy" in practice requires workforce well-being.

In this column, the president of the Collaborative Family Healthcare Association notes that the national conversation about physician burnout has recently shifted to discussing the importance of finding joy in practice. However, she is concerned the current culture of medicine, hidden curricula in medical training, a draconian financial system, and an emotionally ill-prepared workforce may preclude sustained joy in practice. Formal curricula do not include resiliency skills, mindfulness, cognitive flexibility and reframing, conflict-resolution skills, emotional-regulation skills, or how to practice empathy and compassion without crumbling from vicarious trauma. With all the emphasis on technical proficiency, there has been insufficient emphasis on strategies for maintaining personal well-being. To the extent investment follows what we measure, the well-being of the entire health care workforce is a worthwhile data point to chase. Collaborative Family Healthcare Association membership is infused with the knowledge and skills to design and promote health care teams and systems that can foster, measure, and sustain joy. (PsycINFO Database Record

An interview with Neftali Serrano, PsyD: Collaborative family healthcare association's new executive director.

The Collaborative Family Healthcare Association (CFHA) is continually evolving along with policies, funding, and models of healthcare in the U.S. With a vision of integrated healthcare for all as the standard of care, the new executive director of CFHA describes his perspective on how we can move closer towards this vision, the remaining barriers, models of integration, and why CFHA is a unique and necessary professional organization for those with a passion for delivering whole-person comprehensive healthcare. (PsycINFO Database Record

Confronting the new epidemic: Integrated care for opioid use disorders.

The inaugural Collaborative Family Health Care (CFHA) regional conference took place March 17, 2017, in St. Louis, Missouri. The conference theme was opioid use disorders and the potential of medication-assisted treatment using team-based care to address this epidemic. The conference ended with an emphasis on the importance of and strategies for self-care among caregivers working with this population and their families. This intensive meeting was crafted as a proof in concept for CFHA; however, the content was timely with regard to its importance in health care as well as compelling in the opportunity for collaborative care to offer an effective approach. In this article, the authors highlight five impotance topics: (1) opioid use disorders should be addressed in primary care; (2) a team is essential; (3) harm reduction; (4) sustaining self through mindful practice and self-compassion; and (5) medication-assisted treatment. (PsycINFO Database Record

The future of collaborative care without the Affordable Care Act: We did it before and will do it again.

This article provides insight into the challenges we face in 2017 following the repeal of the Affordable Care Act by the newly elected Republican Congress and president. (PsycINFO Database Record

Better together: Collaborative family healthcare association and the promise of team-based care.

In this presidential column is a personal introduction of the new president of the Collaborative Family Healthcare Association (CFHA), Christine Runyan. As president she hopes to continue to support the existing organizational initiatives. CFHA remains a preeminent organization of experts to advocate for meaningful, patient-centered quality metrics and to educate, train, mentor, consult, and realize the vision we have been asserting for 25 years. (PsycINFO Database Record

A low-intensity intervention to prevent annual weight gain in active duty Air Force members.

Elevated body weight among active duty Air Force (ADAF) members is a substantial and growing problem, and typically results from gaining small amounts of weight each year over many years. We designed a strategy to prevent annual weight gain in ADAF members using self-directed behavior change booklets followed by weekly e-mails about diet and physical activity for a year. The intervention was universally offered to ADAF members meeting selection criteria at five U.S. Air Force bases (n = 3,502); members at 60 other U.S. Air Force bases served as controls (n = 65,089). The intervention was completely effective at preventing weight gain in a subgroup of men (those above the lowest three ranks, with baseline weight above maximum allowable) and in women, while controls continued to gain weight. Since the intervention did not require personalized contact, this approach has promise for large-scale population-based efforts aimed at preventing weight gain in working adults.

A novel approach for mental health disease management: the Air Force Medical Service's interdisciplinary model.

Mental health disorders are one of the most substantial public health problems affecting society today, accounting for roughly 15% of the overall burden of disease from all causes in the United States. Although primary care (PC) has the potential to be the frontline for recognition and management of behavioral health conditions, this has been a challenge historically. In order to more effectively address the broad scope of behavioral health needs, the Air Force Medical Service (AFMS) established a new model of behavioral health care. Through a series of coordinated steps, the AFMS ultimately placed trained behavioral health providers into PC clinics to serve as consultants to PC providers (PCPs). Behavioral Health Consultants (BHCs) provide focused assessments, present healthcare options to patients, and deliver brief collaborative interventions in the PC setting. BHCs see patients at the request of the PCP, in 15-30-min appointments. In the pilot study, patients averaged 1.6 visits to the BHC. Over 70% of patients fell into six categories of presenting problems: situational reactions, depressive disorders, adjustment disorders, anxiety disorders, health promotion, and obesity. Patient data (n = 76) suggest 97% of patients seen were either "satisfied" or "very satisfied" with BHC services, and 100% of the PCPs (n = 23, 68% response rate) were highly satisfied and indicated they would "definitely recommend" others use BHC services for their patients. Both the implications and the limitations of this pilot study are discussed.