All physicians are in a unique position to influence their patients risk of coronary artery disease (CAD). The physician must first assess the degree of CAD risk, and then, collaborating with the patient, develop a CAD risk reduction strategy that is tailored to the patient's needs and likely to succeed. Prevention-oriented primary care (POPC) is a host/environment office-based model that can be used in primary care practices to accomplish this goal. This article describes a patient-physician interactive model that can be used as an office-based approach to CAD risk reduction. This model can guide the physician and patient through a collaborative approach to healthcare aimed at preventing CAD. It is based on the recognition that a clear systematic interchange between physician and patient that is evidence based and patient centered is the key to successful risk factor modification. The efficacy of this evidence-based model is currently being studied. It uses a computer software product our team developed called the ERIS/St. Joseph health risk appraisal. This article describes eight important elements of this CAD risk reduction model: 1) physician-patient interviewing/communication styles; 2) defined physician and patient roles; 3) a computerized, prevention-oriented patient history and health-risk appraisal; 4) the patient's list of his or her health priorities; 5) the physician's list of medical priorities for CAD risk reduction; 6) a shared patient-physician priority list; 7) specific intervention plans, with target goals, and critical pathways/strategies for reaching the goals; and 8) planned follow-up care with measurable and targeted outcome goals.
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[Show abstract][Hide abstract] ABSTRACT: Health practitioners use various models for facilitating health or lifestyle change, which entails either stopping an unhealthy behavior or promoting a new healthy behavior. Four models offer evidence-based, systematic, and integrative approaches to lifestyle change. They are: the Transtheoretical Model or Stages of Change; Brief Motivational Interviewing; Prevention Oriented Primary Care; and the ECBIS Psychotherapy Model (Emotion, Cognition, Behavioral, Interpersonal, and System). This article reviews each model and features a case illustration to demonstrate how these models can be integrated and applied clinically to help a patient change multiple health behaviors.
[Show abstract][Hide abstract] ABSTRACT: There are many psychological risk factors for cardiovascular disease, and the ability to reduce mortality depends on an ability to integrate care of these risk factors with traditional Framingham cardiovascular risk, and utilize them both in routine practice. The aim of this article is to provide an update of all the major emotional and behavioral cardiovascular risk factors along with a practical treatment model for implementation. First, we provide a review of major emotional and behavioral cardiovascular risk factors, the associated primary effect, and proposed mechanism of action. Second, we provide an office-based approach to cardiovascular risk factor reduction and methods of reducing barriers to implementation, called Prevention Oriented Primary Care - Abridged. The approach integrates several forms of detection, assessment utilizing the 3A's (ask, assess, assist), and Stages of Change approaches, and subsequent efficient and targeted treatment with either Motivational Interviewing or further office intervention. A case example is provided to help illustrate this process.
Cardiology in review 03/2013; 21(5). DOI:10.1097/CRD.0b013e3182918f57 · 2.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND/OBJECTIVE Guided by ACGME's requirements, psychiatric residency training in psychotherapy currently focuses on teaching school-specific forms of psychotherapy (i.e., cognitive-behavioral, supportive, and psychodynamic psychotherapy). On the basis of a literature review of common factors affecting psychotherapy outcomes and experience with empirically supported and traditional psychotherapies, the authors aimed to develop an advanced contemporary and pragmatic approach to psychotherapy training for eight residents (two per PGY year) enrolled in a specialized Psychotherapy Scholars' Track within an adult general-residency program. METHOD The authors developed core principles and clinical practices, and drafted year-by-year educational goals and objectives to teach the psychotherapy scholars. Based on experiential learning principles, we also developed an individualized form of psychotherapy training, which we call "The Apprenticeship Model." RESULTS The Psychotherapy Scholars' Track, and "Apprenticeship Model" of training are now in their third year. To date, authors report that scholars are highly satisfied with the structure and curriculum in the track. Trainees appreciate the protected time for self-directed study, mentored scholarship, and psychotherapy rotations. Patients and the Psychotherapy Scholars experience the "Apprenticeship Model" of psychotherapy training as authentic and compatible with their needs and resources. CONCLUSION The Psychotherapy Scholars' Track developed and piloted in our general psychiatry residency is based on common factors, empirically-supported treatments, and use of experiential learning principles. Whether the Psychotherapy Scholars' Track and "Apprenticeship Model" will ultimately increase residents' psychotherapy skills and positively affect their ability to sustain postgraduate psychotherapy practice in varied settings requires long-term evaluation. The developers welcome empirical testing of the comparative effectiveness of this psychotherapy teaching approach relative to others.