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Friday, May 22, 2009

If you build it, will they come?

One of the challenges to widespread implementation of the patient-centered medical home (PCMH) is to ensure that patients understand the concept and actively seek this model of care for themselves and their families. To help explain the PCMH to patients, the Patient-Centered Primary Care Collaborative (PCPCC) has released a free, web-based multimedia program. The PCPCC is a coalition of more than 400 organizations, including the AAFP and TransforMed, that are working together to develop and advance the PCMH. Representatives of PCPCC member organizations collaborated with Emmi Solutions to develop the four-minute program, which is available to practices, employers, advocacy groups and others interested in sharing it with consumers. Check it out on the PCPCC web site. If you're new to the PCMH concept, or even if you believe you've heard it all before, watching the video might be as helpful to you as it is to your patients.

Wednesday, May 20, 2009

FPM: The Twitter Edition

With 17 million people on Twitter, we figured that there must be some family physicians, so naturally we wanted FPM to be there, too. Now there's a Twitter version of FPMFPMJournal. If you follow our feed there, you can keep up with what's in the regular issues, our e-mail newsletter and the FPM blogs. And if you're just curious to know how we can squeeze an FPM article into 140 characters, check out our new face on Twitter. And if you're an FPM reader who happens to have a Twitter life as well, drop us an @ message to let us know what you think.

That makes four ways you can get FPM: online at our web site, in our digital edition, in print (by subscription), and now through Twitter.

Tuesday, May 19, 2009

Health care isn't recession-proof, says survey

The troubled economy may be causing more patients to worry about health care costs and, in some cases, forgo needed care, according to the results of a recent AAFP survey of 505 family physicians.

Nearly 90 percent of the family physician respondents said more of their patients have expressed concerns recently about their ability to pay for their health care needs; 73 percent have seen an increase in uninsured patients in their practices; 58 percent have seen an increase in appointment cancellations; and 54 percent reported a drop in patient volume since January 2008.

Additionally, 73 percent of respondents said they have seen evidence of patients cutting prescription doses to save money, and 60 percent have seen more health problems caused by patients forgoing needed preventive care.

How are FPs responding? Two-thirds said they were taking steps such as discounting their fees, increasing charity care, providing free screenings and moving patients to generic prescriptions. Forty-four percent said they are having to cut, or consider cutting, services or staff.

AAFP members and FPM subscribers: Submit your CME quizzes online

AAFP members and paid subscribers to Family Practice Management can now take an interactive, online version of the CME quiz and submit their responses electronically for CME credit. Previously, subscribers were required to submit the paper quiz card found in their printed copy of the journal.

Readers can earn more than 18 CME credits per year via Family Practice Management's CME Quiz.

The online version of American Family Physician's CME Quiz is also now available to subscribers.

Tuesday, May 12, 2009

What we now know about the patient-centered medical home

Three years and some $8 million ago, the AAFP boldly launched TransforMed, whose primary mission was to carry out a national demonstration project (NDP) to test a model of the patient-centered medical home (PCMH) in 36 practices throughout the United States.

Yesterday, the first researchers' report, based primarily on the project's qualitative data, was published in the Annals of Family Medicine. According to the researchers, "Even though analysis of the NDP is not yet complete, we feel compelled to share early lessons ...  We have already learned enough from the NDP to identify some potentially dangerous red flags fluttering over the [PCMH] demonstrations just getting underway."

Here's what the researchers found:

1. Becoming a PCMH (as defined by the TransforMed model, now on version 2.3) requires "epic," "relentless," "practice-wide" change that will likely produce "change fatigue" among the doctors and staff.

2. The technology needed for the PCMH is not "plug and play"; instead, its implementation is "more difficult and time consuming than originally envisioned," in part because systems aren't interoperable.

3. The amount of change required to become a PCMH "takes more time than the two years allocated to the NDP."

4. Transforming to a PCMH requires tremendous costs, in terms of dollars, time and effort, and "currently available funds and reimbursements are likely to be inadequate."

As daunting as that sounds, it might actually be worth the trouble if there is evidence that the PCMH model as currently defined (with its dozens of components) makes a difference for patients. But does it? That's the million-dollar question. The research team has collected data on the patient experience and clinical outcomes for the 36 practices in the NDP, but those reports aren't slated for publication until early 2010. Judging from the tone of the researchers' first article, it's hard to believe that the coming data will be positive.

The researchers note that for practices to become PCMHs under the current model, they need more time, more money and better technology. That could be. Or is there something amiss with the PCMH model itself? Read one view on that question from the well-known researcher Barbara Starfield, MD, MPH, in an editorial for Family Practice Management.

Friday, May 8, 2009

H1N1 articles now available online

To help you respond to the current H1N1 flu outbreak and other infectious disease challenges your practice will face in the future, the AAFP journals are publishing three new articles online, prior to print publication.

The following articles are available free and in full text online; they will be printed in future issues of the journals:

American Family Physician

By Jonathan L. Temte, MD, PhD, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; AAFP Liaison to the Advisory Committee on Immunization Practices

Family Practice Management

By Charles W. Mackett III, MD, associate professor and executive vice chairman of the Department of Family Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.

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The views expressed here are those of the individual authors. They do not necessarily reflect the opinion of Family Practice Management (FPM) or the AAFP. The FPM blogs are not intended to provide medical, financial or legal advice. For more information see Terms of Use.