Neighborhood-based Local Innovations to Solve Global Problems

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

2005 APA Gold Award: Improving Treatment Engagement and Integrated Care of Veterans

views and personal experiences of people who have especially contributed to the evolution of ideas in the Journal's field of interest.

The World Health Organization (WHO) is revising the ICD-10 classification of mental and behavioural disorders, under the leadership of the Department of Mental Health and Substance Abuse and within the framework of the overall revision framework as directed by the World Health Assembly. This article describes WHO's perspective and priorities for mental and behavioural disorders classification in ICD-11, based on the recommendations of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The WHO considers that the classification should be developed in consultation with stakeholders, which include WHO member countries, multidisciplinary health professionals, and users of mental health services and their families. Attention to the cultural framework must be a key element in defining future classification concepts. Uses of the ICD that must be considered include clinical applications, research, teaching and training, health statistics, and public health. The Advisory Group has determined that the current revision represents a particular opportunity to improve the classification's clinical utility, particularly in global primary care settings where there is the greatest opportunity to identify people who need mental health treatment. Based on WHO's mission and constitution, the usefulness of the classification in helping WHO member countries, particularly low- and middle-income countries, to reduce the disease burden associated with mental disorders is among the highest priorities for the revision. This article describes the foundation provided by the recommendations of the Advisory Group for the current phase of work.

Changing the health care workforce: lessons from foundation-sponsored programs.

Opportunities for prevention in primary health care are many, but healthcare systems – in particular, Australia’s fragmentation between levels of government, and fee-for-service funding base – can often frustrate even the most well-intentioned prevention efforts of primary health care practitioners, providers and funders. In this issue of Public Health Research & Practice, themed ‘Strengthening prevention in primary health care’, we focus on the links between primary health care and population health, and how they can be maximised to provide prevention at first contact for many patients with, or at risk of, chronic health conditions, particularly those associated with lifestyle factors such as obesity, smoking and alcohol. A range of perspectives are covered in this issue. There are three complementary viewpoints on the role of the new Primary Health Networks (PHNs) in prevention and public health − from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney PHN. All three agree about the potential for PHNs to integrate population health approaches with primary health care and to better address the health needs of the community in partnership with state health and other services. In a view from Liverpool in the UK, Gosling and colleagues refer to the important role that primary care has played historically in preventing poor health, and describe a range of innovations, implemented as part of a citywide plan for commissioning health and social care services. The exact role of primary health care in prevention is still being defined in Australia; however, it is clear that it is an important one. Its potential is discussed further in a paper by Harris, which identifies the need for integration and partnership between primary health care organisations and public health services and programs. In another themed article, Hyun et al. use registry data to examine the community-based care provided after hospital discharge for patients with acute coronary syndrome. They demonstrate that general practitioner (GP) follow-up is associated with lifestyle and pharmacological preventive measures, underlining the importance of GP follow-up in providing opportunity for better secondary prevention. In other articles, Milat and colleagues discuss a New South Wales (NSW) Ministry of Health guide to successful scaling up of public health interventions, and Dessaix et al. investigate factors leading to a record low in adolescent smoking. In Research, Schemann et al. find ‘poor compliance’ with a 2007 NSW Ministry of Health policy on elective or prelabour caesarean, Strengthening prevention in primary care

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

Family Physicians Sue to Shine Light on RUC Deliberations, Claim Specialists Skew Reimbursement Against Primary Care

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol

Multidisciplinary team puts the ‘home’ in hospital-to-home

Cautionary tales from the UK for the health reform in Singapore

Critical Foundations for Implementing the VA's Public Health Approach to Suicide Prevention.