Difficult patient, or something else? A review of personality disorders.

Specific behaviors or expressed thoughts may signal a need for screening. Take into account an individual's strengths and limitations when designing a Tx approach.

Alcohol use disorder: How best to screen and intervene.

The USPSTF recommends the AUDIT, the AUDIT-C, or the single-question NIAAA screen. The CAGE screening tool has low sensitivity at lower levels of alcohol intake.

Behavioral Health Consult: Targeting depression: Primary care tips and tools.

The resources provided here can help you determine if depression is to blame for your patient's symptoms. A handy antidepressant guide can inform your Tx choices.

7 tools to help patients adopt healthier behaviors.

Here's how to use the 5 As, the FRAMES protocol, and 5 other techniques to encourage patients to address issues such as diet, exercise, smoking, and substance use.

How well do physician and patient visit priorities align?

This study found that there is alignment between a patient's reason for a visit and the physician's main concern 69% of the time. Less than fully aligned priorities were associated with insurance status and the number of problems addressed.

Transitions, realignments, and focus shifts: possibilities for biopsychosocial care in the electronic health record era.

The healthcare system in the United States is currently evolving in response to a diverse range of inter-related economic and political pressures. In this article, we discuss three important macro-level transitions (volume to value, clinician-centric to patient-centered care, and individual to population) and their implications for the practice of medicine, health information technology (HIT), and clinical training. Specifically, challenges and opportunities for advancing the use of the biopsychosocial model in clinical practice and teaching in this new, electronic health record (EHR) era of medicine are highlighted. While much work needs to be done to leverage the potential of EHR/HIT systems, their potential to improve population health and patient experience while controlling the costs of care is great. As primary care clinicians and behavioral scientists navigating this changing healthcare landscape, we should continue to strive to deliver high-quality, patient-centered care. Insisting that future generations of EHR/HIT systems support a biopsychosocial approach is part of this mission.

Electronic health record functionality needed to better support primary care.

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies.