| This page in the original is blank. |
| This page in the original is blank. |
Index
A
Academic health centers, 188, 206, 207
interdisciplinary team training, 11
mission of, in primary care, 9, 24, 144, 257
role in primary care delivery, 111-112, 143-144, 173
Accessibility of services, 44, 47, 65-66, 240, 329
in primary care definition, 2, 31, 32, 33, 45-46
and workforce supply, 9, 20, 168, 169
Accountability
in clinician-patient partnership, 57-58
for efficient use of resources, 33, 49
for patient satisfaction, 33, 48-49
of patients, 49-50
in primary care definition, 2, 31, 33, 46-50
for quality of care, 33, 46-48, 242-243
research, 242-243
Accreditation organizations, 141, 193
and primary care curriculum, 10, 186, 194
Acute care, 40-41
Advanced care planning, 85
Advocacy skills, 192
Agency for Health Care Policy and Research (AHCPR), 218, 220, 221, 223-224
All-payer system
for graduate medical education, 11, 202, 259
for primary care training, 6, 10, 201-202, 258-259
for research funding, 233
Alternative medicine, 126
American Academy of Family Physicians (AAFP), 190, 199
American Academy of Pediatrics, 199
American Board of Family Practice (ABFP), 208
American College of Obstetricians and Gynecologists (ACOG), 123, 190
American Society of Internal Medicine (ASIM), 122, 183
B
Behavioral sciences, 81-82
Biomedical sciences, 3, 81, 191
Bureau of Health Professions (BHP), 198, 199, 220
C
CALPERS (California Public Employees Retirement System), 139
Capitation payments, 114-116
and mental health services, 115, 300-302
and withholding of services, 327
and workforce composition, 315
Catastrophic health insurance, 117
Centers for Disease Control and Prevention (CDC), 221
Certification and licensure, 10, 47
after physician retraining, 11, 210-211
examinations, 185
of nurse practitioners, 159-160, 316
Classification, see Diagnostic classification and coding
Clerkships, 182-184
Clinical decisionmaking, 3, 39, 83-84, 355
importance of continuity of care, 57
and mental disorders, 86-87, 288, 293-298, 299
by nonphysician clinicians, 320
patient participation, 85-86
theoretical bases, 81-83
Clinical nurse specialist (CNS) programs, 161-162
Clinical trials, 236-237 for mental health treatment, 287
core competencies, 9, 188-194, 258, 314
in primary care definition, 29, 33, 36, 44-45, 148
see also Education and training;
Nurse practitioners;
Partnership with patients;
Physician assistants;
Physicians;
Specialists and specialty care;
Workforce
Coding, see Diagnostic classification and coding
Collaborative care, 71-72
in mental health, 9, 136-137, 304-305, 307
see also Primary care teams
Communication and interpersonal relations, 47, 82
training in, 10, 191, 194-195, 258, 307
Communities
coordination of services within, 36, 43, 71-72, 127
in primary care definition, 3, 31, 32, 33, 35-36
research on, 243
Community-Based Public Health Initiative, 196
Community health information networks (CHINs), 365
Community-oriented primary care (COPC), 28, 30, 71, 133, 351-352, 357, 369
with mental disorders, 292-293, 295
Competencies, see Core competencies
and care outcomes, 68-69
integrated services, 32, 38-41
Computer-based patient records, 44, 57, 69-70, 88, 125, 126, 142
Computer networks, 38
Consolidated Omnibus Budget Reconciliation Act, 197
Consortia, see Primary care consortium
Consultation/liaison (C/L) psychiatry, 305
Continuing medical education (CME), 142, 192, 207
Continuity of care, 28, 29, 44, 69, 117-118
and clinician-patient partnership, 56-57
and mental health care, 302
research, 241
Coordination of services, 32, 41-43, 55-56, 69-70, 88, 126
research, 240-241
specialty referrals and other services, 41, 55, 109-110, 124-126, 130-139, 131-132, 356
Core competencies, 9, 188-194, 258, 314
for nurse practitioners, 192-193
training, 5, 10, 183-184, 186-187, 188-194, 258
Costs and cost control, 14, 21, 64, 347-348
and technological innovation, 24
Council on Graduate Medical Education (COGME), 14, 170-171 202, 367
Cultural sensitivity, 36, 85-86
training in, 10, 191, 194-196, 258
Culture and social norms, 35, 85-86, 329
Curricula, see Core competencies;
Education and training
D
Data sources, 222-229
development of national data set, 11, 224-225, 228-229, 260
patient interviews and surveys, 48-49
patient records as, 48, 57-58, 227
population-based surveys, 218, 223-224, 229n
on workforce issues, 10, 170-171, 172, 257
see also Medical Outcomes Study;
Medicare Current Beneficiary Survey;
National Ambulatory Medical Care Survey;
National Health and Nutrition Examination Survey;
National Health Interview Survey;
National Medical Expenditures Survey;
Netherlands Transition Project
Data standards, 12, 233-234, 261, 355-356
Definitions, see Primary care definition
Delivery of primary care
academic health centers' role in, 9, 24, 111-112, 143-144, 173, 257
coordination with other services, 109-110, 124-126, 130-139, 356
organizational arrangements, 4, 108, 118-119
professional roles in, 110, 119-126
specialists' role in, 12, 41, 44, 110, 122-124, 238-239, 261
to underserved populations, 4, 8, 111, 126-130, 255
see also Financing of primary care;
Infrastructure development;
Integrated delivery systems;
Managed care
Demand for clinicials, 156, 165-166, 167-168
monitoring of, 5, 10, 170-171, 257
see also Geographic distribution;
Underserved population;
Workforce
Dentists and dentistry, 44, 109, 125, 165
Department of Defense (DOD), 196, 221
Department of Health and Human Services (DHHS), 11, 12, 218, 219, 220, 223
Department of Veterans Affairs (VA), 109, 196, 221
Depression, 295, 297, 298, 302
Diagnosis, see Clinical decisionmaking;
Early detection
Diagnostic and Statistical Manual for Mental Disorders (DSM), 79, 294, 295-296
Diagnostic classification and coding, 12, 228, 233, 234, 235, 261
international systems, 79, 90, 218, 294, 296
Diagnostic tests, 84
Disease prevention, see Preventive care
E
see also Preventive care
Educational levels, 71
Education and training, 5-6, 19, 167-170, 179-180, 307-308
in ambulatory care settings, 10, 202-203, 258
community contexts, 191-192
continuing medical education (CME), 142, 207
in core competencies, 5, 10, 186-187, 188-194, 258
funding of, 5-6, 157-158, 166, 179, 181, 196-203, 257
interdisciplinary approaches, 6, 11, 203-206, 259-260
minority participation, 157, 169-170
of nurse practitioners, 20, 159, 160-162, 200, 206, 316
of physician assistants, 157, 196-200
of physicians, 150, 156-158, 180-187
see also Graduate medical education;
Retraining of physicians;
Undergraduate medical education
Efficiency and productivity, 15, 61-62, 115
of nonphysician clinicians, 317-319, 321, 332
Elderly persons, 2, 18, 20, 60, 137, 138
Emergency care, 45, 65-66, 67, 111
Epidemiological studies, 82-83
comparison of U.S. and Dutch data sets, 89-101
as unit of assessment, 48, 79-80, 226-228
Ethics and ethical behavior, 82, 192 accountability for, 33, 49
Evidence-based medicine, 82-83
F
Faculty reimbursement, 197-198
Family members and relationships, 81, 191
in primary care definition, 3, 31, 32, 33, 35
research on, 243
Family practice, 19, 63, 64, 77, 192
Federated Council of Internal Medicine Curriculum Task Force (FCIMCTF), 189-190
Fee-for-service (FFS), 8, 114, 115, 116, 254, 314
HMO payments to clinicians, 315n
and mental health services, 300
Financing of primary care, 113-118
impact on quality of care, 327-332, 355
payment methods and mechanisms, 8, 115-118, 254
universal coverage, 113-114, 253-254
see also All-payer system;
Capitation payments;
Fee-for-service
First-contact care, 27, 28, 29, 38-39
by non-medical professionals, 124-126, 165
G
in mental health services, 302
General practitioners, 19, 41n, 63, 64, 68, 190
Geographic distribution
of managed care programs, 106-107
of primary care workforce, 10, 171-173, 257
Global capitation, 114-116
Graduate medical education (GME), 157, 185-187
financing, 196-203
Medicare support, 196, 197-198, 202-203, 259
as a public good, 200-201
H
Health Care Financing Administration (HCFA), 128, 197, 221, 223, 224, 254
Health care reform, 7, 21, 113
Health care services, in primary care definition, 2, 31, 32-33, 37 -38
Health Maintenance Organization Act, 20
Health maintenance organizations (HMOs), 20, 22, 63, 106, 107, 351
payments to clinicians, 115
staffing patterns, 322-327
Health promotion, 2, 3, 18, 58, 87-88, 132, 134
Health services research, 236
HEDIS (Health Plan Employer Data and Information Set), 139
Hispanic Americans, 157
Hospital-based care, 13
excess capacity, 21
Households, see Family members and relationships
Humanities, 81
I
ICD, see International Classification of Diseases
Inappropriate care, 47
Income levels, 71
Information management, 3, 88, 142, 192
and accessibility of services, 46
in community contexts, 36, 44, 355-356, 361
patient records, 43-44, 57-58, 69-70
Informed consent, 85
Infrastructure development, 141-143
for research, 11, 218-219, 235
Insurance, 116
mental health care coverage, 87, 297, 299
primary care disincentives, 116, 117, 136, 137
see also Universal coverage
Integrated delivery systems, 2, 18, 32-33, 35, 38, 143
accessibility, 45-46
and clinician training, 206-207
organization of, 22, 31, 107-108
Integrated services
in community context, 352-372
coordination in, 32, 41-43, 126
for mental health care, 303, 304-305, 357-358
in primary care definition, 2, 29, 31, 32, 33, 38-44, 314
research, 240-241
Interdisciplinary teams, see Primary care teams
Internal medicine and internists, 19, 20, 77, 122, 156
training, 186-187, 192, 194, 199-200, 209
International Classification of Primary Care (ICPC), 80, 90, 218
International Classification of Diseases (ICD), 79, 90
and mental disorders, 294, 296
International medical graduates (IMGs), 149
J
Judgment, see Clinical decisionmaking
K
Kaiser Permanente, 107, 320-321
Kellogg, W. K., Foundation, 134, 179, 196, 222, 352
Korean Americans, 86
L
Latino populations, 195
Life-cycle curriculum, 191
Long-term care, 9, 60, 109, 114, 137-139, 256
M
geographic distribution, 106-107
and information management, 355
and mental health services, 300-301, 302
and public health, 132-133, 134-135, 355
and underserved populations, 111, 118, 119, 127-128, 172-173, 327-328
workforce impacts, 106, 313-327
Medicaid, 20, 22, 130, 167-168, 196
cost-of-care studies, 64
managed care arrangements, 22, 106, 127-128, 132
Medical Outcomes Study (MOS), 63, 68
Medical savings accounts (MSAs), 117
graduate medical education support, 196, 197-198, 202-203, 259
managed care arrangements, 22, 106, 128
nursing education support, 200
Medicare Current Beneficiary Survey (MCBS), 224
Mental health
and insurance reimbursement, 87, 297, 299
prevalence of disorders, 289
relation to physical health, 3, 86-87, 237, 286-288, 299
Mental health ''carve-outs," 109, 135, 136, 302-303
Mental health services, 9, 109, 135-137, 255-256, 285-308
collaborative care models, 9, 136-137, 304-305, 307
financing of, 87, 135-136, 300-304
research, 306-307
Minority groups, 85-86
medical education and training, 157, 169-170
see also Cultural sensitivity;
Culture and social norms
Misuse of health services, 47
Mixed practices, 122
N
National Ambulatory Medical Care Survey (NAMCS), 77, 91-92, 97-101, 223
National Board of Medical Examiners (NBME), 185
National Center for Health Statistics (NCHS), 218, 223, 228-229
National Committee for Quality Assurance (NCQA), 139
National Health and Nutrition Examination Survey (NHANES), 223
National Health Interview Survey (NHIS), 91-92, 97-101, 223
National Health Service Corps, 171-172
National Hospital Ambulatory Medical Care (NHAMC) survey, 223
National Institute for Mental Health, 305-306
National Institutes of Health, 126, 221
National Medical Expenditures Survey (NMES), 223-224, 226-227, 228
National Organization of Nurse Practitioner Faculties (NONPF), 192
Native Americans, 157
Navajo, 85
Netherlands Transition Project, 80, 89, 90-91, 93-97
Nonphysician clinicians, see Nurse practitioners;
Physician assistants
Nurse practitioners (NPs)
core competencies, 192-193
education and training, 20, 159, 160-162, 200, 206, 316
in managed care settings, 320-321, 322-323
as physician substitutes, 315, 317-319, 322-323, 332
quality of care, 319-320, 333-334
responsibilities, 110, 162, 316
O
Obstetrics and gynecology, 77, 110, 122, 123, 154, 209
Omnibus Budget Reconciliation Act, 197
Optometry and vision services, 109, 125
Orthopedists, 77
Outcomes of care, 67-70
P
Partnership with patients, 2, 3, 18, 44, 49-50, 53, 56-58, 61-62, 84-86, 329
in primary care definition, 3, 31-32, 33, 36-37
research, 241-242
theoretical bases for, 81-82
Patient education materials, 142
Patient records
in accountability systems, 48, 57-58
as research data sources, 48, 57-58, 227
Patient satisfaction, 33, 44, 48-49
with nonphysician clinicians, 319
Patients, in primary care definition, 31, 33, 34
Pediatrics and pediatricians, 19, 20, 77, 156, 192
Performance monitoring, 114, 139-141, 256
measurement, 9, 24, 47-48, 140, 141
Personal health care needs, 18, 53-54
diagnostic clusters, 53-54, 77-78
in primary care definition, 3, 31, 33, 37, 40
research, 239-240
Pew Charitable Trusts, 134, 179, 221
Pew Health Professions Commission, 202, 204, 209
Pharmacy services, 109, 125-126
Physician assistants (PAs), 110, 162-163
education and training, 20, 163-164, 198, 206, 316
in managed care settings, 320-321, 322-323
as physician substitutes, 315, 317-319, 322-323, 332
quality of care, 319-320, 333-334
scope of practice, 10, 173-175, 258, 314-315, 332-333
Physicians
demand and supply issues, 110, 149-153, 313, 315, 322-323
education and training, 150, 156-158, 180-187
geographic distribution, 64, 67, 158
primary care supply and shortages, 19, 20, 154-158
principal providers, 28, 41, 42, 123-124
and public health professionals, 353-354
retraining, 6, 11, 208-211, 260
substitution with nonphysicians, 241, 315, 317-319, 322-323, 332, 334
see also Specialists and specialty care
Pike Street Clinic Project, 303
Practice-based research networks, 12, 230-233, 260
Preferred provider organizations (PPOs), 106
Preventive care, 2, 3, 18, 41, 58-59, 70, 87-88, 132, 134, 192, 345
actual practice of, 298
in community context, 35-36, 71, 348-352
Primary care consortium, 7, 12, 141, 250-252, 261
Primary care definition, 1, 2-3, 8, 31-34, 104, 119-120, 252-253, 313
development of, 29-31
Primary care teams, 2, 8, 42, 110, 120-121, 254-255, 313n
as care coordinators, 55-56, 138
in managed care, 327-332, 334-335
training, 11, 203-206, 259-260
Principal physicians, 28, 41n, 42, 123-124
Productivity, see Efficiency and productivity
Professional societies, 193.
See also under names of individual societies
Providers, see Clinicians
Psychiatry, 305
Public health, 29-30
linkage to primary care, 9, 30, 60-61, 88, 109, 131-135, 243-244, 255, 342-372
research on, 243-244
Public health nurses, 19
Public Health Service Act
Title VII funds, 157, 196, 198-200
Title VIII funds, 200
Puerto Ricans, 157
Q
Quality assessment, 47-48, 242
improvement programs, 107-108, 256
and nonphysician clinicians, 319-320, 321-322
performance measurement, 9, 24, 47-48, 140, 141
R
Randomized clinical trials (RCTs), 236-237
coordination of, 41, 55, 131-132
incentives against, 115
to mental health professionals, 86, 135, 287, 302-303
Registered nurses (RNs), 158-159, 160
Relationships, see Collaborative care;
Partnership with patients;
Primary care teams
Requirements for clinicians, see Demand for clinicians
and clinical trials, 236-237
on core concepts, 239-244
data sources, 222-229
data standards, 12, 233-234, 261, 355-356
lead agency for, 11, 219-222, 260
on mental health, 237
on specialty care, 238-239
see also Practice-based research networks
Residency, 5, 11, 186-187, 197
Residency review committees, 186
Resource-Based Relative Value Scale (RBVRS), 116, 254
Retraining of physicians, 6, 11, 208-211, 260
Robert Wood Johnson Foundation, 20, 134, 179, 199, 221
Rural settings, 20, 111, 171-172
demands on practice in, 129, 298
managed care in, 106, 111, 127, 129-130, 172-173
S
Satisfaction, see Patient satisfaction
School outreach, 59-60
Scope of care, 40-41
Scope of practice, 5, 10, 23, 173-175, 258, 314-315, 332-333
Self-efficacy, 81
Social functioning, 37-38
Society, see Communities;
Culture and social norms
Society of Teachers of Family Medicine (STFM), 190
Socioeconomic conditions, 71
Southeast Asians, 195
Specialists and specialty care, 12, 13-14, 24, 68, 106, 123, 153
clinical decision-making, 83-84
imbalance in supply, 19, 20, 23, 122, 155-156, 169
quality issues, 66-70
research on, 238-239
role in primary care, 12, 41, 44, 110, 122-124, 238-239, 261
Special-needs populations, 128-129, 255
State scope of practice laws, 5, 10, 23, 174-175, 258
Stroke, 295
Substance abuse services, 109, 135
Substitution for physicians, 241, 315, 317-319, 322-323, 332, 334
Supply of professionals, see Workforce
Surveys, see under Data sources
T
Team care, see Primary care teams
Technical quality, 47
Technological innovations, 24
Title VII funds, 157, 196, 198-200
Title VIII funds, 200
U
Undergraduate medical education, 180-185
competencies, 183-184
curricular reforms, 182-183
examinations, 185
faculty, 185
training in primary care settings, 5, 181-184
Underserved populations, 171-172n
and managed care programs, 111, 118, 119, 127-128, 172-173, 327-328
primary care delivery, 4, 8, 111, 126-130, 255
Undifferentiated problems, 40n
Uninsured population, 22-23, 65, 66, 104, 113
in managed care markets, 107, 128
United States Medical Licensing Examination, 185
Universal coverage, 8, 21, 368
Unnecessary care, 47
Urban poor, 20, 111, 130, 171-173
V
Value of primary care, 2, 3, 14, 18, 52
accessibility of services, 65-66
for clinician-patient partnership, 53, 56-58
cost impacts, 63-65
as guide through health system, 53, 54-56
links with community and family, 53, 59-61
for preventive care and health promotion, 53, 58-59
as route to appropriate care, 53-54
Vertical integration, 107
W
and care accessibility, 9, 20, 168, 169
estimation methods, 165-167
geographic maldistribution, 10, 171-173, 257
monitoring and data collection, 10, 170-171, 172, 257
nonphysician clinicians, 160-162, 171, 316
primary care physicians, 19, 20, 154-158
specialists, 19, 20, 23, 122, 155-156, 169
see also Education and training
