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From page 385... ... Index Read the entire page →
From page 387... ... , 123, 190 American Society of Internal Medicine (ASIM) , 122, 183 Asian Americans, 157, 195 Association of American Medical Colleges (AAMC) Read the entire page →
From page 388... ... programs, 161-162 Clinical trials, 236-237 for mental health treatment, 287 Clinicians, 5, 148-149 communication skills, 47, 82 core competencies, 9, 188-194, 258, 314 in primary care definition, 29, 33, 36, 44-45, 148 salaried, 115, 116 INDEX 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) Read the entire page →
From page 389... ... , 109, 196, 221 Depression, 295, 297, 298, 302 Diagnosis, see Clinical decisionmaking; Early detection Diagnostic and Statistical Manual for Mental Disorders (DSMJ, 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 Early detection, 41, 58-59; see also Preventive care Educational levels, 71 Read the entire page →
From page 390... ... , 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, 124126, 165 Lor-profit ownership, 22, 108 G Gatekeepers, 20, 39, 125 in mental health services, 302 General practitioners, 19, 41n, 63, 64, 68, 190 Geographic distribution of managed care programs, 106-107 of physicians, 64, 67, 158 of primary care workforce, 10, 171173, 257 Global capitation, 114-116 Graduate medical education (GME) , 157, 185-187 financing, 196-203 Medicare support, 196, 197-198, 202203, 259 as a public good, 200-201 H Health Care Financing Administration (HCFA) Read the entire page →
From page 391... ... , 139 Hispanic Americans, 157 Hospital-based care, 13 excess capacity, 21 preventable, 66, 67 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, 355356, 361 networks, 38, 365 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- 108 391 Integrated services in community context, 352-372 comprehensiveness, 32, 38-41 continuity in, 32, 43-44 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) Read the entire page →
From page 392... ... , 117 Medicare, 20, 22, 64, 116 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 comorbidity, 292-293, 295 and insurance reimbursement, 87, 297, 299 prevalence of disorders, 289 relation to physical health, 3, 86-87, 237, 286-288, 299 research, 237, 306 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 parallel systems, 135, 304 research, 306-307 Mexican Americans, 86, 157 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 INDEX N National Ambulatory Medical Care Survey (NAMCS) Read the entire page →
From page 393... ... , 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, 348352 Primary care consortium, 7, 12, 141, 250252, 261 Primary care definition, 1, 2-3, 8, 31-34, 104, 119-120, 252-253, 313 development of, 29-31 early definitions, 19, 27-29 Primary care teams, 2, 8, 42, 110, 120121, 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 specialists as, 41, 123-124 Productivity, see Efficiency and productivity Professional societies, 193. See also under names of individual societies Read the entire page →
From page 394... ... , 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, 129130, 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 Screening programs, 87, 125 Self-care, 76, 86 Self-declaration, 208, 209 Self-efficacy, 81 Self-referral, 39, 70 Social functioning, 37-38 Social sciences, 3, 81-82 Society, see Communities; Culture and social norms Society of Teachers of Family Medicine (STEM) , 190 Socioeconomic conditions, 71 Southeast Asians, 195 Specialists and specialty care, 12, 13-14, 24, 68, 106, 123, 153 accessibility of, 13, 65-66 clinical decision-making, 83-84 cost issues, 13, 63-65 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 Read the entire page →
From page 395... ... INDEX 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, 317319, 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 Telecommunication, 46, 88 Title VII funds, 157, 196, 198-200 Title VIII funds, 200 Traditional healers, 36, 126 Triage functions, 28, 118 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, 126130, 255 Underuse of care, 47, 49 Undifferentiated problems, 40n Uninsured population, 22-23, 65, 66, 104, 113 in managed care markets, 107, 128 395 United States Medical Licensing Examination, 185 Universal coverage, 8, 21, 368 financing, 113-114, 253-254 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, 5456 links with community and family, 53, 59-61 for preventive care and health promotion, 53, 58-59 quality issues, 3, 66-70 as route to appropriate care, 53-54 Vertical integration, 107 W Workforce, 4-5, 9-10 and care accessibility, 9, 20, 168, 169 estimation methods, 165- 167 geographic maldistribution, 10, 171173, 257 imbalances in supply, 5, 169 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 Read the entire page →

From page 385...

... Index

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From page 387...

... , 123, 190 American Society of Internal Medicine (ASIM) , 122, 183 Asian Americans, 157, 195 Association of American Medical Colleges (AAMC)

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From page 388...

... programs, 161-162 Clinical trials, 236-237 for mental health treatment, 287 Clinicians, 5, 148-149 communication skills, 47, 82 core competencies, 9, 188-194, 258, 314 in primary care definition, 29, 33, 36, 44-45, 148 salaried, 115, 116 INDEX 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)

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From page 389...

... , 109, 196, 221 Depression, 295, 297, 298, 302 Diagnosis, see Clinical decisionmaking; Early detection Diagnostic and Statistical Manual for Mental Disorders (DSMJ, 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 Early detection, 41, 58-59; see also Preventive care Educational levels, 71

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From page 390...

... , 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, 124126, 165 Lor-profit ownership, 22, 108 G Gatekeepers, 20, 39, 125 in mental health services, 302 General practitioners, 19, 41n, 63, 64, 68, 190 Geographic distribution of managed care programs, 106-107 of physicians, 64, 67, 158 of primary care workforce, 10, 171173, 257 Global capitation, 114-116 Graduate medical education (GME) , 157, 185-187 financing, 196-203 Medicare support, 196, 197-198, 202203, 259 as a public good, 200-201 H Health Care Financing Administration (HCFA)

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From page 391...

... , 139 Hispanic Americans, 157 Hospital-based care, 13 excess capacity, 21 preventable, 66, 67 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, 355356, 361 networks, 38, 365 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- 108 391 Integrated services in community context, 352-372 comprehensiveness, 32, 38-41 continuity in, 32, 43-44 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)

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From page 392...

... , 117 Medicare, 20, 22, 64, 116 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 comorbidity, 292-293, 295 and insurance reimbursement, 87, 297, 299 prevalence of disorders, 289 relation to physical health, 3, 86-87, 237, 286-288, 299 research, 237, 306 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 parallel systems, 135, 304 research, 306-307 Mexican Americans, 86, 157 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 INDEX N National Ambulatory Medical Care Survey (NAMCS)

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From page 393...

... , 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, 348352 Primary care consortium, 7, 12, 141, 250252, 261 Primary care definition, 1, 2-3, 8, 31-34, 104, 119-120, 252-253, 313 development of, 29-31 early definitions, 19, 27-29 Primary care teams, 2, 8, 42, 110, 120121, 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 specialists as, 41, 123-124 Productivity, see Efficiency and productivity Professional societies, 193. See also under names of individual societies

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From page 394...

... , 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, 129130, 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 Screening programs, 87, 125 Self-care, 76, 86 Self-declaration, 208, 209 Self-efficacy, 81 Self-referral, 39, 70 Social functioning, 37-38 Social sciences, 3, 81-82 Society, see Communities; Culture and social norms Society of Teachers of Family Medicine (STEM) , 190 Socioeconomic conditions, 71 Southeast Asians, 195 Specialists and specialty care, 12, 13-14, 24, 68, 106, 123, 153 accessibility of, 13, 65-66 clinical decision-making, 83-84 cost issues, 13, 63-65 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

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From page 395...

... INDEX 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, 317319, 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 Telecommunication, 46, 88 Title VII funds, 157, 196, 198-200 Title VIII funds, 200 Traditional healers, 36, 126 Triage functions, 28, 118 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, 126130, 255 Underuse of care, 47, 49 Undifferentiated problems, 40n Uninsured population, 22-23, 65, 66, 104, 113 in managed care markets, 107, 128 395 United States Medical Licensing Examination, 185 Universal coverage, 8, 21, 368 financing, 113-114, 253-254 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, 5456 links with community and family, 53, 59-61 for preventive care and health promotion, 53, 58-59 quality issues, 3, 66-70 as route to appropriate care, 53-54 Vertical integration, 107 W Workforce, 4-5, 9-10 and care accessibility, 9, 20, 168, 169 estimation methods, 165- 167 geographic maldistribution, 10, 171173, 257 imbalances in supply, 5, 169 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

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Index Pages 385-395

Index
Pages 385-395