Family Medicine Update

Value and the medical home: effects of transformed primary care.

Am J Manag Care. 2010 Aug;16(8):607-14

Authors: Gilfillan RJ, Tomcavage J, Rosenthal MB, Davis DE, Graham J, Roy JA, Pierdon SB, Bloom FJ, Graf TR, Goldman R, Weikel KM, Hamory BH, Paulus RA, Steele GD

BACKGROUND: The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 different primary care practices. The goals were to improve the quality, efficiency, and patient experience of care. OBJECTIVE: To evaluate the ability of a medical home model to improve the efficiency of care for Medicare beneficiaries. STUDY DESIGN: Observational study using regression modeling based on preintervention and postintervention data and a propensity-selected control cohort. METHODS: Four years of claims data for Medicare patients at 11 intervention sites and 75 control groups were analyzed to compute hospital admission and readmission rates, and the total cost of care. Regression modeling was used to establish predicted rates and costs in the absence of the intervention. Actual results were compared with predicted results to compute changes attributable to the PHN model. RESULTS: ProvenHealth Navigator was associated with an 18% (P < .01) cumulative reduction in inpatient admissions and a 36% (P = .02) cumulative reduction in readmissions across the total population over the study period. CONCLUSIONS: Investing in the capabilities of primary care practices to serve as medical homes may increase healthcare value by improving the efficiency of care. This study demonstrates that the PHN model is capable of significantly reducing admissions and readmissions for Medicare Advantage members.

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– Value and the medical home: effects of transformed primary care.

The pharmacological treatment of bipolar disorder in primary care.

Med J Aust. 2010 Aug 16;193(4):S24-30

Authors: Malhi GS, Adams D, Berk M

OBJECTIVE: To provide a practical overview of the pharmacological management of adults with bipolar disorder in primary care and the role of general practitioners in the pharmacotherapy of this complex disorder. DATA SOURCES: Published guidelines for the treatment of bipolar disorder, plus Cochrane reviews, meta-analyses, review articles and reports from randomised controlled trials that were published up to May 2009. STUDY SELECTION: Over 500 articles on the treatment of bipolar disorder were reviewed, with an emphasis on meta-analyses and systematic reviews of randomised controlled trials. Where evidence was more limited, open trials and non-controlled data were also reviewed. DATA EXTRACTION: Key recommendations relevant to GPs were synthesised and rated according to National Health and Medical Research Council levels of evidence. DATA SYNTHESIS: Lithium, valproate and atypical antipsychotics are first-line treatment options for acute mania, and monotherapy is ideal if it produces an adequate response. For depressive episodes, recommendations are less definitive and the use of antidepressants is controversial. Most patients require maintenance treatment, during which pharmacotherapy should be used to prevent relapse, and psychological and social interventions should be considered. CONCLUSIONS: Bipolar disorder is a lifelong episodic illness that affects 1%-2% of the population, many of whom are principally managed by their GPs. Pharmacological treatment with mood-stabilising agents is the primary form of management, although this is ideally provided in conjunction with psychosocial interventions.

20712557

– The pharmacological treatment of bipolar disorder in primary care.

Complementary and alternative medicine use among military family medicine patients in Hawaii.

Mil Med. 2010 Jul;175(7):534-8

Authors: Kent JB, Oh RC

Complementary and alternative medicine (CAM) is a growing component of medicine within the U.S. civilian and military populations. Tripler Army Medical Center (TAMC) Family Medicine Clinic represents an overseas medical facility stationed among a diverse ethnic population. The impact that local cultures have on CAM utilization in the military population in overseas medical facilities is unknown. METHODS: Cross-sectional survey. The authors surveyed all volunteer soldiers, family members, and retirees 18 years old or greater enrolled at TAMC Family Medicine Clinic with appointments between September 1 and September 25, 2008. RESULTS: 503 volunteers were surveyed with a response rate of 73% (n = 369). A total of 50.7% reported using at least one CAM therapy within the last year. CAM use was significantly higher among women, Caucasians, and a college level education or greater. CONCLUSION: Prevalence of CAM use is higher within a military family medicine clinic in Hawaii than the prevalence among mainland civilian or other military populations.

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– Complementary and alternative medicine use among military family medicine patients in Hawaii.