Contributions of medical family therapy to the changing health care system.

Medical family therapy is a form of professional practice that uses a biopsychosocial approach and systemic family therapy principles in the collaborative treatment of individuals and families dealing with medical problems. It emerged out of the experience of family therapists working in primary medical care settings in the 1980s and 1990s. This article describes how contemporary medical family therapy can contribute to a transformed health care system in four areas: the patient experience of health care, the health of the population, the containment of health care costs, and enhanced practice environments.

Using the communication assessment tool in family medicine residency programs.

BACKGROUND AND OBJECTIVES: The Communication Assessment Tool (CAT), developed by Makoul et al assesses patient perceptions of physicians' interpersonal and communication skills. The objective of this study was to gather initial benchmarking data for the use of the CAT in family medicine residency programs. METHODS: Data were collected from patients seeing 127 residents from six family medicine residency programs. A total of 1,931 patients completed the paper and pencil version of the CAT following an appointment with a resident; 1,880 of the CAT forms met the inclusion criteria for analysis. RESULTS: The overall mean percentage of items from which residents were rated as excellent was 69.7%. Significant differences were found in the overall percentage of items rated as excellent based on training year, with PGY-1 (77.0%) residents being rated significantly higher than PGY-2 (69.5%) and PGY-3 (68.1%) residents. There were no significant differences found in the overall percentage of items rated as excellent based on the native language or gender of the residents. CONCLUSIONS: This initial benchmarking data can allow family medicine residency programs to compare the performance of their residents with the performance of residents from other programs. We recommend that the results of the CAT be used as both an evaluative and learning tool.

Improving pediatric asthma control among minority children participating in medicaid: providing practice redesign support to deliver a chronic care model.

BACKGROUND: Asthma, a leading chronic disease of children, currently affects about 6.2 million (8.5%) children in the United States. Despite advances in asthma research and availability of increasingly effective therapy, many children do not receive appropriate medications to control the disease, have over-reliance on reliever medication, and lack systematic follow-up care. The situation is even worse for poor inner-city and minority children who have significantly worse asthma rates, severity, and outcomes. National Asthma Education and Prevention Program Guidelines recommend a multimodal, chronic care approach. OBJECTIVE: The authors assessed the effectiveness of practice redesign and computerized provider feedback in improving both practitioner adherence to National Asthma Education and Prevention Program Guidelines (NAEPP), and patient outcomes in 295 poor minority children across four Federally Qualified Health Centers (FQHC). METHODS: In a nonrandomized, two-group (intervention versus comparison), two-phase trial, all sites were provided redesign support to provide quarterly well-asthma visits using structured visit forms, community health workers for outreach and follow-up, a Web-based disease registry for tracking and scheduling, and a provider education package. Intervention sites were given an additional Web-based, computerized patient-specific provider feedback system that produced a guideline-driven medication assessment prompt. RESULTS: Logistic regression results showed that providers at intervention sites were more than twice as likely on average to prescribe guideline-appropriate medications after exposure to our feedback system during the Phase I enrollment period than providers at comparison sites (exp(B) = 2.351, confidence interval [CI] = 1.315-4.204). In Phase II (the post-enrollment visit period), hierarchical linear models (HLMs) and latent growth curves were used to show that asthma control improved significantly by .19 (SE = .05) on average for each of the remaining four visits (about 11% of a standard deviation), and improved even more for patients at intervention sites. These results show that implementation of practice redesign support guided by a pediatric chronic care model can improve provider adherence to treatment guidelines as well as patients' asthma control. CONCLUSIONS: The addition of patient-specific feedback for providers results in quicker adoption of guideline recommendations and potentially greater improvements in asthma control compared to the basic practice redesign support alone.

Family interviewing: a review of the literature in primary care.

BACKGROUND: Interviewing families is an essential skill for family physicians, but there is little research on the process or outcomes of family interviewing in primary care. METHODS: We conducted a search of MEDLINE and PsychINFO using a wide range of terms related to family interviewing. The studies obtained were grouped into one of four categories: physicians' family orientation or level of family involvement, family genograms, family members who accompany patients to routine visits, and family conferences. RESULTS: Family history and other family information are commonly collected, and family issues are often discussed in office visits. Genograms can be reliably and accurately obtained during brief visits, but they are not commonly used, and their impact is uncertain. Family members frequently accompany patients to office visits and serve various roles. The potential benefits and risks of these visits are not fully understood. Family conferences are infrequently used but are well accepted by patients and may be a cost-effective method for reducing unnecessary health care utilization. CONCLUSIONS: Physicians use a wide range of family interviewing approaches with individual patients, with family members who accompany patients to office visits, and in family conferences. More research is needed to examine the process and outcome of these different types of family interviewing.