Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training.

BACKGROUND AND OBJECTIVES: The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. METHODS: Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates >3 years from program completion. RESULTS: Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were >3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. CONCLUSIONS: This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.

The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak: Lessons for Future Infection Surveillance and Response.

Federally Qualified Health Centers (FQHCs) have been essential in response to COVID-19 outbreaks among vulnerable populations. Our rural FQHC had a primary role in early detection of and response to a poultry plant-related outbreak at the outset of the pandemic that disproportionately and gravely affected the local Hispanic community. The health center activated a rapid local response that included the community's first mass testing event and first acute respiratory treatment clinic, both of which were central to abatement. Lessons learned from this experience provide important guidance for the potential role of FQHCs in infection outbreak preparedness in marginalized communities.

The design and methods of the OPTIMUM study: A multisite pragmatic randomized clinical trial of a telehealth group mindfulness program for persons with chronic low back pain.

Mindfulness-based stress reduction (MBSR) is an evidence-based non-pharmacological approach for chronic low back pain (cLBP), yet it is not readily available or reimbursable within primary care clinics. Primary care providers (PCPs) who wish to avoid prescribing opioids and other medications typically have few options for their cLBP patients. We present the protocol of a pragmatic clinical trial entitled OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness). OPTIMUM is offered online via telehealth and includes medical group visits (MGV) with a PCP and a mindfulness meditation intervention modeled on MBSR for persons with cLBP. In diverse health-care settings in the US, such as a safety net hospital, federally qualified health centers, and a large academic health system, 450 patients will be assigned randomly to the MGV + MBSR or to usual PCP care alone. Participants will complete self-report surveys at baseline, following the 8-week program, and at 6- and 12-month follow-up. Health care utilization data will be obtained through electronic health records and via brief monthly surveys completed by participants. The primary outcome measure is the PEG (Pain, enjoyment, and general activity) at the 6-month follow-up. Additionally, we will assess psychological function, healthcare resource use, and opioid prescriptions. This trial, which is part of the NIH HEAL Initiative, has the potential to enhance primary care treatment of cLBP by combining PCP visits with a non-pharmacological treatment modeled on MBSR. Because it is offered online and integrated into primary care, it is expected to be scalable and accessible to underserved patients. Clinical Trials.gov: NCT04129450.

Teach students, Empower patients, Act collaboratively and Meet health goals: an early interprofessional clinical experience in transformed care.

PURPOSE: Transformation of care teaching is often didactic and conceptual instead of practical and operational. Clinical environments, slow to transform, limit student exposure to key experiences that characterize transformed care. We describe the design and implementation of TEAM Clinic (Teach students, Empower patients, Act collaboratively, Meet health goals) - an early clinical learning experience to address this gap. METHODS: The TEAM Clinic curriculum was based on a review of existing curricula and best practice recommendations for the transformation of care. Three key elements were selected as the focus for a low-volume, high-service clinic: patient centeredness, interprofessional collaboration and team-based care. Learners and medically and socially complex patients were recruited for voluntary participation and completed anonymous surveys about the experience during and afterward. RESULTS: Nine first-year medical students, two first-year social work students and one pharmacy resident were integrated into the interprofessional team. Students were assigned roles adapted to their level and skill set; deliberate interprofessional pairing was assigned to broaden perspectives on scope and role of team members. Upon completion of this two-semester experience, 11 of the 12 learners returned surveys; all rated the experience as positive (strongly agree or agree) on the Authentic Clinical Interprofessional Experience - Evaluation of Interprofessional Site tool. Patient surveys indicated satisfaction with multiple aspects of the visit. CONCLUSION: TEAM Clinic provided a practical example of transformation of care teaching in a not-yet-transformed environment. Logistical barriers included space, schedule and staffing. Facilitators included alignment with the goals of core curricula and faculty. Limitations included that this description of these curricula and this pilot come early in our longitudinal development of TEAM Clinic, constraining our ability to measure behavioral changes around interprofessional education, teamwork or patient centeredness. Next steps would examine the trajectory to these outcomes in the preclinical student group.

Psicanálise aplicada ao contexto hospitalar: intervenções em tempos de pandemia Covid-19 / Psychanalyse appliquée em contexte hospitalier: interventions em période de pandémie de Covid-19 / Applied psychoanalysis in the hospital context: interventions in times of Covid-19 pandemics

Este artigo apresenta o relato de experiência de psicólogas clínicas de hospitais privados, localizados na cidade do Rio de Janeiro,durante a pandemia do novo coronavírus. Essa prática é alicerçada nos princípios teórico-clínicos da psicanálise aplicada às práticas em instituições hospitalares. Há mais de uma década faz parte dos projetos de psicanálise aplicada do Instituto Sephora de Ensino e Pesquisa de Orientação Lacaniana. Essa experiência aqui relatada é inédita pois, pela primeira vez, foi necessário efetuar o acompanhamento psicanalítico através de recursos virtuais. A potência do dispositivo analítico, ancorado no campo da fala e da linguagem, precisou ser reinventada para alcançar pacientes com Covid-19 e seus familiares. Através de vinhetas clínicas serão apresentadas algumas das dificuldades encontradas nesta nova prática em tempos de pandemia. Esperamos dar testemunho de que zelamos para que a ética e o desejo do analista nos orientassem para fazer bom uso do novo dispositivo

Cet article présente le rapport d'expérience de psychologues cliniciens des hôpitaux privés, principes théorico-cliniques de la psychanalyse et fait partie des projets de psychanalyse appliquée de l'Institut Sephora pour l'Enseignement et la Recherche d'Orientation Lacanienne,depuis plus d'une décennie. A travers des vignettes cliniques seront présentées quelques impasses face à et comment, en temps de pandémie, l'éthique et le désir de l'analyste ont été maintenus

This article reports on the experience of clinical psychologists in private hospitals located in the city of Rio de Janeiro during the covid-19 pandemic. This practice is based on the theoretical-clinical principles of psychoanalysis and has been incorporated into the applied psychoanalysis projects of the Instituto Sephora de Ensino e Pesquisa de Orientação Lacaniana (ISEPOL) for over a decade. Through clinical vignettes, the article will present the impasses faced, in times of pandemic, and how the psychoanalyst's ethics and desires were preserved