A Call for Action on Primary Care and Public Health Integration

Scientific Education and Professional Development Program Office, Office of Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia 30333, USA.
American journal of preventive medicine (Impact Factor: 4.53). 06/2012; 42(6 Suppl 2):S89-91. DOI: 10.1016/j.amepre.2012.04.011
Source: PubMed
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    • "Although speculative, it is possible that it was difficult for these clinics to effectively coordinate and incorporate these community resources into their patients’ chronic illness care, especially if patients had difficulty finding transportation or lacked insurance. Due to increasing interest in linking primary care with community resources [26,27], this finding deserves further exploration in future research. "
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    ABSTRACT: Little is known as to whether primary care teams' perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients' own experience of chronic illness care. We examined the extent to which practice members' perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients' perceptions of the chronic illness care they have received. Analysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice "members" (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire. Two sets of hierarchical linear regression models accounting for nesting of practice members (N = 283) and patients (N = 1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients' perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales [Self-management Support (p < 0.05); Community Linkages (p < 0.02), Delivery System Design (p < 0.02), and Organizational Support (p < 0.02)] were consistently associated with PACIC summary score and the majority of PACIC subscale scores after controlling for patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak. The ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care.Trial registration: NCT00482768.
    Full-text · Article · Mar 2014 · BMC Family Practice

  • No preview · Article · Dec 2013 · American journal of preventive medicine
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    ABSTRACT: Numerous studies show that many primary care physicians (PCPs) do not discuss preventive health behaviors related to diet and exercise with their overweight patients. To investigate whether certain counseling approaches by PCPs in their clinical encounters with patients are associated with improvements in care and resource utilization. A total of 2205 patients in a large HMO were surveyed, during November and December 2010, about their health behaviors and perceptions of their interactions with their PCPs. Survey responses from each patient were matched with 48 months of patient-specific medical claims data, from October 2008 through September 2012, capturing the frequency and monetary costs of health care utilization. A series of regression analyses, completed in June 2013, focused on four dependent variables: patients' intentions to improve diet and activity, patients' satisfaction with their physicians, visits to healthcare providers, and health plan spending on treatment. For each finding, the degree of physician-patient discussion of preventive health behaviors was strengthened when (1) physicians expressed confidence in patients' ability to improve diet and exercise and (2) patients had confidence that their physician could facilitate improvement of these behaviors. The associations between physician counseling and subsequent key improvements for overweight patients are strengthened by the physician's confidence in the patient's ability to engage in preventive health behaviors and the patient's confidence in the physician's ability to help in implementing these behaviors. Cultivating such mutual confidence is instrumental in optimizing physicians' influence on overweight patients' health behaviors.
    No preview · Article · Mar 2014 · American journal of preventive medicine
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