Exploring end-of-residency transitions in a VA Patient Aligned Care Team.

BACKGROUND: End-of-residency transitions create disruptions in primary care continuity. The national implementation of Patient Aligned Care Teams (PACT) in Veterans Health Administration (VA) primary care clinics creates an opportunity to mitigate this discontinuity through the provision of team-based care. OBJECTIVES: To identify team-based solutions to end-of-residency transitions in a resident PACT continuity clinic by assessing the knowledge, attitudes, and perceptions of non-physician PACT members and resident PACT physicians. DESIGN AND PARTICIPANTS: Cross-sectional survey of 27 resident physicians and 24 non-physician PACT members in the Internal Medicine Clinic at the Audie L. Murphy VA Hospital in the South Texas Veterans Health Care System. RESULTS: Twenty-seven residents and 24 non-physician PACT members completed the survey, with response rates of 90 % and 100 %, respectively. All residents and 96 % of non-physician PACT members agreed or strongly agreed that the residents were responsible for informing patients about end-of-residency transitions. Only 38 % of non-physician PACT members versus 52 % of residents indicated that non-physician PACT members should be responsible for this transition. Approximately 80 % of resident physicians and non-physician PACT members agreed there should be a formalized approach to these transitions; 67 % of non-physician PACT members were willing to support this transition. Potential barriers to team-based care transitions were identified. Major themes of write-in suggestions for improving the transition focused on communication and relationships between the patient and PACT and among the PACT members. CONCLUSIONS: PACT implementation changes the roles and relationship structures among all team members. While end-of-residency transitions create a disruption in the relationship system, the remainder of the PACT may bridge this transition. Our results demonstrate the importance of a team-based solution that engages all PACT members by improving communication and fostering effective team relationships.

The status of complementary and alternative medicine education in U.S. physician assistant programs.

BACKGROUND: Many Americans use complementary and alternative medicine (CAM). Medical educators have responded by incorporating CAM education into their curricula. Research has reported on the number and types of CAM therapies included in physician assistant (PA) curricula, but information on the purposes, methods, and practice of CAM education is lacking. PURPOSE: This study was designed to identify the content, methods, purpose, and orientation to CAM education in PA curricula. METHODS: An online survey of all accredited physician assistant programs in the United States addressing content, teaching methods, instructor qualifications, and core competencies was administered. RESULTS: Response rate was 68%: 77% of PA programs included CAM education in their curriculum; 93% stated it was required. The median number of CAM therapies included in the curriculum was 10. Reasons for including CAM were increased use by patients (79%), complementary medicine in the medical literature (66%), and faculty interest or request (62%). For most PA programs, CAM is taught as a component of other courses through lectures and written exams. Core competencies are consistent with recommendations of the PA profession, as well as other professional medical associations. CONCLUSIONS: Most PA programs have incorporated CAM instruction into their curricula. Content is typically limited to those CAM therapies most commonly encountered in medical practice. The means and methods of teaching CAM are largely the same as for traditional medical content. The most common objectives of CAM education are learning to assess for CAM use, educating patients, and recognizing indications and contraindications while respecting patients' health beliefs and choices.

Dental services for migrant and seasonal farmworkers in US community/migrant health centers.

CONTEXT: Migrant and seasonal farmworkers are recognized as a medically underserved population, yet little information on need, access, and services is available-particularly with regard to oral health care. PURPOSE: This study describes the facilities, services, staffing, and patient characteristics of US dental clinics serving migrant and seasonal farmworkers, and identifies trends and issues that may impede or improve dental care access and service. METHODS: National databases were used to identify community and migrant health centers providing oral health care to migrant and seasonal farmworkers. Mailed surveys collected information on clinic history, operational details, services provided, patient demographics, employment and resource needs, and perceived barriers to care. FINDINGS: Among the 81 respondents (response rate 41%), hours of operation varied from 1 evening a week to more than 40 hours a week; 52% had no evening hours. Almost all the clinics offered preventive, diagnostic, and basic restorative dental services, and roughly two thirds also offered complex restorative services. Patients most frequently sought emergency dental care (44%) followed by basic restorative services (32%) and preventive services (26%). The dentist position was the most difficult to fill, and new funding sources were cited as the most important resource need. Respondents perceived cost of services, lack of transportation, and limited clinic hours as primary barriers to care. CONCLUSIONS: While some barriers to care have been almost universally addressed (eg, language), there is evidence that some impediments remain and may present significant obstacles to a broad improvement in oral health care for migrant and seasonal farmworkers.

Dental decay in southern Illinois migrant and seasonal farmworkers: an analysis of clinical data.

CONTEXT: Migrant and seasonal farmworkers are a population at risk for oral health problems. Data on the oral health conditions of migrant and seasonal farmworkers' permanent teeth are particularly lacking. PURPOSE: To document the relative rates of treated and untreated dental decay in a sample of southern Illinois migrant and seasonal farmworkers who had sought care at a farmworker health center dental clinic. METHODS: Existing migrant health dental clinic records from 1995-2002 were reviewed. Final sample size was 650. Data for decayed, missing, and filled tooth surfaces were recorded using both anatomical recording and treatment notes. FINDINGS: Sixty-nine percent of migrant farmworkers had at least 1 decayed (untreated) tooth surface, and more than half had 3 or more decayed surfaces. CONCLUSIONS: Results indicate that untreated dental decay is significant among migrant and seasonal farmworkers who seek care at this dental clinic. Recommendations include addressing barriers to care, improved monitoring of dental health conditions, and further research to better document the treatment needs of this population.