Implementing Whole Person Primary Care: Results from a Year-Long Learning Collaborative.

PURPOSE: The National Academies of Medicine report on Implementing High-Quality Primary Care calls for a transformation of the primary care to a "whole person" model that is person-centered, relationship-based and takes into account the social, spiritual, emotional and behavioral aspects of health. However, our current delivery tools, such as the SOAP Note, do not sufficiently capture and organize the delivery of these elements in practice. To explore how to remedy this, an Integrative Health Learning Collaborative (IHLC) was established to implement and test new tools for changing primary care practices toward whole person care. METHODS: The IHLC comprised primary care practices committed to changing to a whole person care model of care along with a panel of experts in integrative health and change management. The IHLC met virtually monthly. Representatives from each practice and an assigned expert met to strategize and adapt the tools to their environment and practice. The practices used previously developed tools (the HOPE Note toolkit), change management tools, and quality improvement techniques to introduce, implement, and evaluate the changes. RESULTS: Sixteen clinics completed the process after 1 year. Overall, practices used the HOPE Note tools in 942 patients. Participants reported changes on the effectiveness of the collaborative (1) on clinical practice, (2) on the skills and attitudes of participants; and (3) the support in change management. CONCLUSIONS: This online learning collaborative supported practices implementing a whole person care model in primary care and improved the understanding, skills, and delivery ability of whole person care in all clinics completing the program.

What should physicians know about hypertension? The implicit knowledge requirements in the maintenance of certification self-assessment module.

BACKGROUND AND OBJECTIVES: The American Board of Family Medicine (ABFM) Maintenance of Certification process requires family physicians to have a core knowledge base in key areas such as hypertension and diabetes care but does not define this knowledge in specific terms. We developed a method of content analysis to evaluate what type of knowledge is assessed on the ABFM's Hypertension Self-assessment Module (SAM) to better understand what the implied knowledge of a family physician should be. METHODS: In this qualitative descriptive analysis, we categorized the 60 questions comprising the knowledge assessment portion of the Hypertension SAM, version 2.20.03, into diagnosis, treatment, or etiology/general knowledge questions. Diagnosis and treatment questions were graded for relevance to typical family practice. Diagnosis questions were coded regarding importance. Treatment questions were subdivided into drug or nondrug treatments. Drug treatment items were categorized as testing knowledge of safety/tolerability issues, effectiveness issues, or cost considerations. RESULTS: The 60 questions represented 213 specific items of knowledge. Most (71%) of the items on the SAM focused on therapy, with the remainder evaluating knowledge of diagnosis issues or general knowledge. Of the therapy-related items, the items were evenly split between knowledge of safety/tolerability and knowledge of effectiveness (47.1% each). The remaining items required knowledge of nondrug therapy. No items evaluated knowledge of the relative cost of treatment or cost-effectiveness. With regard to the relevance of the tested information, only 70% of the items test knowledge that would be commonly needed in the practice of family medicine. CONCLUSIONS: There is currently no consensus on the discrete set of skills and knowledge that should be held by a competent family physician. In the absence of a comprehensive set of goals and objectives, the knowledge content being assessed in the SAMs can at least inform teaching programs about what their learners will be required to know to maintain certification. For the content area of hypertension, most of the knowledge required was regarding drug treatment. Interestingly, 30% of the knowledge content being assessed was found to be neither important nor commonly needed in the care of patients. We recommend that more work be done to define the specific knowledge and skills required for a competent family physician and that future maintenance of certification modules be written to assess mastery of these core requirements.

Saw palmetto for prostate disorders.

Saw palmetto is an herbal product used in the treatment of symptoms related to benign prostatic hyperplasia. The active component is found in the fruit of the American dwarf palm tree. Studies have demonstrated the effectiveness of saw palmetto in reducing symptoms associated with benign prostatic hyperplasia. Saw palmetto appears to have efficacy similar to that of medications like finasteride, but it is better tolerated and less expensive. There are no known drug interactions with saw palmetto, and reported side effects are minor and rare. No data on its long-term usage are available. The herbal product also has been used to treat chronic prostatitis, but currently there is no evidence of its efficacy.