Families, systems & health : the journal of collaborative family healthcare最新文献

{"title":"Treatment barriers in PANS/PANDAS: Observations from eleven health care provider families.","authors":"Angela W Tang,&nbsp;Heidi J Appel,&nbsp;Stacie C Bennett,&nbsp;Leighann H Forsyth,&nbsp;Susan K Glasser,&nbsp;Maura A Jarka,&nbsp;Pierre D Kory,&nbsp;Amy N Malik,&nbsp;Andrea I Martonoffy,&nbsp;Lena K Wahlin,&nbsp;Tricia T Williams,&nbsp;Nate A Woodin,&nbsp;Lien C Woodin,&nbsp;Ian K T Miller,&nbsp;Loren G Miller","doi":"10.1037/fsh0000602","DOIUrl":"https://doi.org/10.1037/fsh0000602","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) are severe but highly treatable postinfectious inflammatory brain conditions. Despite published diagnostic and treatment guidelines for this condition, there are long delays in obtaining appropriate care. The reasons for these delays are poorly understood. We sought to identify health care system barriers to timely treatment by examining cases of PANDAS/PANS occurring in children of health care professionals.</p><p><strong>Method: </strong>We recruited families via e-mail request through the PANDAS Physicians Network. Participating parents completed a structured questionnaire and provided a written case description.</p><p><strong>Results: </strong>Eleven families completed data collection, representing a broad spectrum of disease (child disease onset age 4-15, 7 males/4 females, mild to severe). Parents included 11 physicians, 2 mental health professionals, 2 nurses, and a PharmD. Nine cases (82%) had \"very delayed\" diagnosis and treatment (>4 weeks after onset). The most commonly encountered causes for treatment delay were clinician lack of awareness (82%), clinician skepticism (82%), overdependence on diagnostic testing (91%), and out-of-pocket expenses >$100 US (82%). Other common challenges included difficulties finding a provider to spearhead care (64%), psychological misdiagnosis (55%), and children's suppression of behaviors during assessments (55%).</p><p><strong>Conclusions: </strong>We found numerous barriers to treatment of PANDAS/PANS among children of health care providers. Our findings suggest that even among the medically sophisticated, PANDAS/PANS diagnosis and treatment remains challenging. Improvement in PANDAS/PANS education of clinicians who may encounter children with this disorder is 1 key step toward addressing our identified barriers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).</p>","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":" ","pages":"477-487"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39493646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout among behavioral health providers in integrated care settings.","authors":"Max Zubatsky, Christine N Runyan, S. Gulotta, Jeanna R. Knight, J. Pettinelli","doi":"10.1037/fsh0000456","DOIUrl":"https://doi.org/10.1037/fsh0000456","url":null,"abstract":"INTRODUCTION\u0000Burnout in health care, especially among physicians, is a growing concern. It is now well accepted that physician burnout leads to increased depersonalization of patients, lower personal accomplishment, employee turnover, and worse patient outcomes. What is not known, however, is to what extent behavioral health providers (BHPs) in medical settings experience burnout and its associated sequela.\u0000\u0000\u0000METHOD\u0000Participants (n = 230) from a variety of practice settings and levels of integrated care completed practice and burnout questions via an online survey. Practice-related questions and a modified version of the Maslach Burnout Inventory was administered to BHPs who work in different levels of collaboration with other medical providers.\u0000\u0000\u0000RESULTS\u0000Overall, BHPs who work primarily in fully integrated care settings reported higher rates of personal accomplishment in their everyday job (B = 1.49; 95% confidence interval [CI] = 0.40, 2.58). Additionally, those who have worked more than 10 years in these types of settings reported both higher personal accomplishment (B = 1.58; 95% CI = 0.68, 2.49) and lower rates of depersonalization (B = -1.32; 95% CI = -2.28, -0.36).\u0000\u0000\u0000DISCUSSION\u0000In contrast to high rates of burnout among many clinicians in the United States, this is the first study to document relatively low rates of reported burnout among integrated care BHPs. The relationships between lower burnout, working in a fully integrated care practice, and experience as a BHP is important to understand when creating and sustaining team-based primary care jobs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129690089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A conversation with my personal oncologist.","authors":"H. Applebaum, M. Applebaum","doi":"10.1037/fsh0000445","DOIUrl":"https://doi.org/10.1037/fsh0000445","url":null,"abstract":"This article describes a conversation between a father diagnosed with cancer and his son, who is an oncologist. The father has turned to his son for medical advice and the son subsequently becomes his father's \"personal oncologist.\" (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124387986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The middle of patience.","authors":"Amanda J Zavodnick","doi":"10.1037/fsh0000430","DOIUrl":"https://doi.org/10.1037/fsh0000430","url":null,"abstract":"We often think that either we are being patient or we have completely lost it. Whether we are at the kitchen table, in the office, or stuck in traffic, it's hard to appreciate that there is often a sweet spot directly in between, a fleeting moment in which we can choose a direction, as long as we are present to notice the signs. This essay shares my personal experience with rediscovering patience and living in the moment as a mother to a young boy with severe attention-deficit/hyperactivity disorder and sensory challenges. It mixes my clinical experience as a therapist with my parenting world and all the \"stuff\" in between. I hope it offers some tips to readers and clinicians on how to pause and take it all in-in order to capture and live in the moment. It helps us find humor in the frustration and love in all the distractions that are thrown our way. Maybe this is exactly the place where we can find the middle ground of patience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116846727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement in a complex world.","authors":"A. Valeras","doi":"10.1037/fsh0000454","DOIUrl":"https://doi.org/10.1037/fsh0000454","url":null,"abstract":"In this column the author presents his thoughts on quality improvement (QI) as it relates to health care. Although the story of QI, combined with a drastic urgency for change, may have created the current state in its misapplication in health care, it is the QI tenets put forth by Deming that can redeem its promise. In this way, QI is a fractal, similar in makeup and application on various scales. This speaks to the universality of Deming's four tenets; the same tenets used for a successful QI project need to be employed in building the QI capacity of an organization (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130354101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pictures.","authors":"Jeffrey H. Millstein","doi":"10.1037/fsh0000432","DOIUrl":"https://doi.org/10.1037/fsh0000432","url":null,"abstract":"This article talks about an elderly patient named June and how her photos gave the author, a physician, a newfound insight. They remind him of the essential humanity in all patients, which sometimes just lies beneath a tarnished exterior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128886071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bathroom.","authors":"P. Rousseau","doi":"10.1037/fsh0000441","DOIUrl":"https://doi.org/10.1037/fsh0000441","url":null,"abstract":"This article details the hospitalization experience of a homeless man diagnosed with cancer. Recounted are the man's desire to enter a hospice program and his need for a safe space. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125783583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhode Island's investment in primary care transformation: A case study.","authors":"Debra Hurwitz, Pano Yeracaris, S. Campbell, Mardia Coleman","doi":"10.1037/fsh0000450","DOIUrl":"https://doi.org/10.1037/fsh0000450","url":null,"abstract":"INTRODUCTION\u0000Rhode Island has received national recognition as a leader in statewide, multipayer, multistakeholder initiatives that focus on investments in primary care as a strategy to build a strong delivery system foundation that delivers high-quality, affordable health care.\u0000\u0000\u0000METHOD\u0000For this case study we summarize key structural, process and outcomes factors and lessons learned from internal and external evaluations and project based and stakeholder-engaged quality improvement efforts that helped Rhode Island become the most improved U.S. health system over the past 5 years.\u0000\u0000\u0000RESULTS\u0000Rhode Island's Office of the Insurance Commissioner through a collaborative process contractually established per-member, per-month payments to practices that engaged in the statewide transformation program to the patient-centered medical home model of care and paid incentives for achieving quality, patient experience, and hospital utilization targets.\u0000\u0000\u0000DISCUSSION\u0000Critical lessons learned include the importance of engaging stakeholders in systems change, measuring and monitoring primary care spending, and continuous learning and best-practice sharing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"37 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130889774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental illness: Is there an app for that?","authors":"D. Gratzer, G. Strudwick, Anthony Yeung","doi":"10.1037/fsh0000451","DOIUrl":"https://doi.org/10.1037/fsh0000451","url":null,"abstract":"The aim of this commentary is to consider the advantages and disadvantages of incorporating apps into clinical care and provide a few rules of thumb for clinicians who are helping their patients select the most useful app or apps. We then use this guidance to review three popular health-related apps. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133094181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passerby.","authors":"Rebecca Hamburger","doi":"10.1037/fsh0000438","DOIUrl":"https://doi.org/10.1037/fsh0000438","url":null,"abstract":"The abject (the down and out), a visual tax on passersby and an economic tax on society, are easy and convenient to ignore. Homelessness, often, escapes the attention of institutions designed to address it. It is the duty of health providers to help society and policymakers to acknowledge the context and factors that beget ill health. These 55 words are a criticism of the indifference shown toward this important health issue. (PsycINFO Database Record (c) 2019 APA, all rights reserved).","PeriodicalId":358476,"journal":{"name":"Families, systems & health : the journal of collaborative family healthcare","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131249985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}