The 4 Health Aims
My name is Adriana Linares. I am a Colombian family physician who has worked in Washington state for the last five years. I have been involved with the WA Portal and I moderate this blog as part of the transformation efforts of our team.
We are going to write about the four aims, or pillars, of health care. We are a team of four people but would like to involve as many as possible. We would like feedback, comments, criticisms, and especially solutions to some of the topics we will discuss.
We decided to start with the fourth aim.
To be able to excel on our work, we as health care workers need to be satisfied.
I attended the American Academy of Family Physicians FMX (Experience) meeting in San Antonio, and came back motivated and ready to continue my efforts for excellence in health care. You know what helped me? The American Academy of Family Physicians presented a new portal: Physician Health First. It provides great resources, strategies and evaluations to enhance physician wellbeing. The Academy has heard its members and is working on trying to alleviate some of the problems associated with health care in the United States that burden the practice of medicine in our country.
I invite all of you to review the resources available on the WA Portal related to well being. We have included also resources related to staff wellness and providers in different areas of medicine.
Please let us know what you think. Send your comments -- what would you like for us to cover? How can we improve our blog?
Talk to you soon.
Adriana C. Linares, MD
Family Medicine with OB
Collaborative Care Model for Behavioral Health Integration
My clinical work includes working as a consulting psychiatrist in two ways in primary care clinics – one as a direct consultant using telehealth technology to see patients, and the other as an indirect consultant in a population based model of care called collaborative care. The Portal includes resources on both models of care. The Telepsychiatry Toolkit from the American Psychiatric Association provides background information on telepsychiatry, along with clinical training, reimbursement, and technical considerations. Telepsychiatry is one way to distribute specialist physician visits to areas with fewer specialists such as psychiatrists. Reimbursement for telehealth is expanding under MACRA, and 49 states cover telepsychiatry under Medicaid. Collaborative care is team based care involving the primary care clinician, a care manager, and a psychiatric consultant. Resources from the AIMS Center at the University of Washington are included in the Portal and are standard tools for clinics to use in deciding whether or how to implement collaborative care. One recent example is the Financial Modeling Workbook that can help organizations understand associated costs and revenues. Is your site working on new strategies for telehealth or on implementing a population based model of care such as collaborative care? Check out the Portal for resources.
Social determinants of health are central to health care
Early this week I had an encounter with a relatively new patient to me, which made me pause. She was desperately upset, saying she had been told by an ED physician that she “has lung cancer.” The physician had been evaluating her for possible pneumonia. I reviewed the discharge materials she had been given and found there was no mention of any sign of abnormalities in the range of imaging that was done. It turned out that this 50-year-old Washington native had dropped out of school early and was illiterate, which contributed to her misunderstanding the comments of the ED doc (probably related to them doing some smoking cessation counseling). Unsurprisingly, she and her family faced additional obstacles to health care involving lack of employment, housing, and insurance.
While sociologists, educators, and economists have pointed to the role of social factors in health and well being for decades it has only been in recent years there has been increasing awareness of the crucial role that social determinants of health (e.g., education and income), have on health throughout the lifecourse. As described in a recent article about screening for social determinants in primary care pediatrics, health care delivery sites can make a big difference in connecting patients to community services. These linkages improve the effectiveness of the health care delivery as well and lead to better health outcomes. The accountable communities of health (ACHs), throughout the state of Washington have made connection of community resources to the health care delivery systems a priority. WA Portal
Find out more about the opportunities to link community services to the work of care delivery sites by searching “social determinants” on the WA Portal resource library.