Full Continuum Of Care Research Articles

Patterns of Service Utilization across the Full Continuum of Care: Using Patient Journeys to Assess Disparities in Access to Health Services

Healthcare organizations have a contractual obligation to the public to address population-level inequities to health services access and shed light on them. Various studies have focused on achieving equitable access to healthcare services for vulnerable patients. However, these studies do not provide a nuanced perspective based on the local reality across the full continuum of care. In previous work, graph topology was used to provide visual depictions of the dynamics of patients’ movement across a complex healthcare system. Using patients’ encounters data represented as a graph, this study expands on previous work and proposes a methodology to identify and quantify cohort-specific disparities in accessing healthcare services across the continuum of care. The result has demonstrated that a more nuanced approach to assessing access-to-care disparity is doable using patients’ patterns of service utilization from a longitudinal cross-continuum healthcare dataset. The proposed method can be used as part of a toolkit to support healthcare organizations that wish to structure their services to provide better care to their vulnerable populations based on the local realities. This provides a first step in addressing inequities for vulnerable patients in accessing healthcare services. However, additional steps need to be considered to fully address these inequities.

APA’s Government, Policy, and Advocacy Update (August 2022)

APA’s Government, Policy, and Advocacy Update (August 2022)

Integrating the experience: Principles for digital transformation across the patient journey

As medical science advances and the population ages, the prevalence of chronic conditions has also grown. The traditional model of care, with its focus on acute and episodic issues within the office visit, is not designed to meaningfully address long-term patient needs. With COVID-19 has come unprecedented digital adoption, bringing health care delivery to a critical juncture. While digital tools and technologies present vast opportunities for democratizing and decentralizing care experiences, their piecemeal application to the existing “sick care” model and its information technology infrastructure will not only limit their value, but will inevitably add cost, inefficiency, and burden to care teams. In order to build upon this momentum and reap the full benefits of practice digitization, care model transformation must occur. This entails holistically reexamining how every component of the health care experience, from the digital tools to visit interactions, synchronizes to address the full continuum of patient needs throughout the journey. By doing this, care shifts away from one-size-fits-all, fragmented strings of visits, toward seamless experiences that adapt to patients’ needs in real-time while integrating within their daily lives. Rather than acting as a substitute for care, technology instead is vital to promoting and amplifying the impact of all those involved. To achieve this, this paper outlines 10 principles for restructuring care to incorporate digital health capabilities. Each describes how all care model components work as a system that aligns with patient needs. By doing this, technology is now an integral in supporting relationships across the full continuum of care.

Empowerment dimensions and their relationship with continuum care for maternal health in Bangladesh

One of the most important approaches to improving the health of mothers and newborns has been the continuum of care (CoC) for maternal health. Women's lack of empowerment may be an obstacle to accessing CoC in male-dominated societies. However, research often defines empowerment narrowly, despite the fact that multiple components of empowerment can play a role. The aim of this study was to look at the relationship between CoC for maternal health and measures of empowerment among Bangladeshi women. The data for this analysis came from the Bangladesh Demographic and Health Survey 2017–2018. The research centered on a subset of 4942 married women of reproductive age who had at least one live birth in the 3 years preceding the survey. Women's empowerment was measured using SWPER Global, a validated measure of women's empowerment for low- and middle-income countries. CoC for maternal health was measured at three stages of pregnancy, pregnancy, delivery, and the postpartum period. To estimate adjusted odds ratios, we specified three-level logistic regression models for our three binary response variables after descriptive analysis. Just 30.5% of mothers completed all phases of the CoC (ANC 4+, SBA, and PNC). After adjusting for individual, household, and community level variables, women with high social independence (adjusted odds ratio [AOR] 1.97; 95% confidence interval [CI] 1.58–2.47) had 97% more ANC 4+ visits, 176% higher retention in SBA (AOR 2.76; 95% CI 1.94–3.94), and 137% higher completion of full CoC (AOR 2.37; 95% CI 1.16–4.88) than women with low social independence. Frequency of reading newspapers or magazines, woman's education, age at first cohabitation, and age of the woman at first birth were significant predictors of CoC at all three stages, namely pregnancy, delivery, and postpartum, among the various indicators of social independence domain. Moreover, the intraclass correlation showed that about 16.20%, 8.49%, and 25.04%, of the total variation remained unexplained even after adjustments of individual, household and community level variables for models that predicted ANC 4+ visits, CoC from pregnancy to SBA, and CoC from delivery to the early postnatal period. The low completion rate of complete CoC for maternal health imply that women in Bangladesh are not getting the full health benefit from existing health services. Health promotion programs should target mothers with low levels of education, mothers who are not exposed to print media, and mothers who are younger at the time of birth and their first cohabitation to raise the rate of completing all levels of CoC for maternal health.

Moving Beyond Simple Risk Prediction: Segmenting Patient Populations Using Consumer Data.

There has been growing interest among health systems in population health (1, 2). Population health aims to improve the overall health of a population across the full continuum of care by more targeted, effective and coordinated health services (3). Given the rising trend of aging population and chronic disease burden, managing population health becomes more important for health systems trying to control cost (4). In order to improve outcomes and efficiency, health systems need to customize care and interventions based on identified risks and costs (5). One of the systematic approaches in the literature for targeting interventions to subgroups of patients with different needs is population segmentation or risk-stratification (referred as patient segmentation in the remainder of this paper). Population segmentation that divides a population into groups with related service needs is an important foundation for effective and sustainable care delivery (6–8). Segmentation divides patients into distinct groups with specific needs, characteristics or behaviors and allows for health services to be organized around patients with similar needs (7). Patient segmentation models are becoming essential element of healthcare management due to the increase in the number of programs that incentivize value-based care (9). Although patient segmentation models can help design interventions targeting subgroups of patients, they are often based on International Classification of Diseases (ICD) codes found in electronic health records (EHRs) and/or insurance claims data and lack important social risk factors that are essential for designing interventions. World Health Organization defines social determinants of health (SDOH) as the conditions in which people are born, grow, work, live, and age (10). These factors include economic policies and systems, development agendas, social norms, social policies and political systems (10). There are numerous studies demonstrating social factors acting as powerful determinants on multiple health outcomes including coronary heart disease (11), breast cancer (12), childhood obesity (13) and end-stage renal failure (14). Literature suggests that high utilizers of healthcare resources among Medicaid and uninsured population often have multiple chronic conditions (15, 16) and programs targeting this population collectively argue that social risk factors including but not limited to language, health literacy, unemployment, substance abuse and housing are important drivers of healthcare utilization (17, 18). Most of the current patient segmentation models use administrative billing data because insurance claims data provides a nearly complete view of patients' interactions with health care delivery system; therefore, it is a reliable source to extract utilization outcomes (19). Majority of the EHRs on the other hand contain data from clinical encounters occurring between individuals and providers within a single health system and hence miss out of network events (19). On the positive side of EHRs is that they offer more extensive data including family history, lab results, vital signs and symptoms which could help improve the population segmentation model (20). One drawback of reliance on insurance claims data and EHRs is that they miss social and behavioral factors that complicate care (21). Although, there is a subset of ICD-10-CM codes, the Z codes, for documenting SDOH in EHRs, these codes are underutilized (22, 23). As such, SDOH Z codes may not reflect the actual burden of social needs experienced by patients. To address this gap, this paper presents the complementary benefit of consumer data when it is linked to EHRs or insurance claims data. The consumer marketing data include individual-level SDOH (including income, education, lifestyle variables, language spoken, household size, smoking status, life events, shopping activity) that are not available in the insurance claims data or majority of EHR data. The combined data provides 360-degree view of patients and can help predict the risk of repeat emergency room visits or hospital admissions (24). Inclusion of SDOH is essential to improve population health as medical interventions without addressing social determinants are not sustainable and effective. This unprecedented view into the lives of patients has significant potential to improve upon segmentation approaches relying exclusively on health plan or EHR data that lack measures or even decent proxies for fitness, diet and other SDOH which can profoundly alter the course of chronic diseases. A number of commercial companies provide marketing data that is well-utilized by organizations that subscribe to their services. Experian's ConsumerViewSM U.S. database is one of the world's largest consumer database on more than 300 million individuals and 126 million households (25). ConsumerViewSM U.S. database is compiled from hundreds of resources. For example, property and mortgage data are compiled from public records and county deeds while lifestyle and interest data are compiled from consumers who have completed self-reported surveys (25). Marketing companies match and mange patient identity across the healthcare ecosystems enabling the linkage of datasets across channels and silos (26, 27). According to Acxiom, two-thirds of hospitals actively use or want third-party consumer and lifestyle data to improve patient care (24).

Paths to Successful Translation of New Therapies for Severe Traumatic Brain Injury in the Golden Age of Traumatic Brain Injury Research: A Pittsburgh Vision.

New neuroprotective therapies for severe traumatic brain injury (TBI) have not translated from pre-clinical to clinical success. Numerous explanations have been suggested in both the pre-clinical and clinical arenas. Coverage of TBI in the lay press has reinvigorated interest, creating a golden age of TBI research with innovative strategies to circumvent roadblocks. We discuss the need for more robust therapies. We present concepts for traditional and novel approaches to defining therapeutic targets. We review lessons learned from the ongoing work of the pre-clinical drug and biomarker screening consortium Operation Brain Trauma Therapy and suggest ways to further enhance pre-clinical consortia. Biomarkers have emerged that empower choice and assessment of target engagement by candidate therapies. Drug combinations may be needed, and it may require moving beyond conventional drug therapies. Precision medicine may also link the right therapy to the right patient, including new approaches to TBI classification beyond the Glasgow Coma Scale or anatomical phenotyping-incorporating new genetic and physiologic approaches. Therapeutic breakthroughs may also come from alternative approaches in clinical investigation (comparative effectiveness, adaptive trial design, use of the electronic medical record, and big data). The full continuum of care must also be represented in translational studies, given the important clinical role of pre-hospital events, extracerebral insults in the intensive care unit, and rehabilitation. TBI research from concussion to coma can cross-pollinate and further advancement of new therapies. Misconceptions can stifle/misdirect TBI research and deserve special attention. Finally, we synthesize an approach to deliver therapeutic breakthroughs in this golden age of TBI research.

White Paper AGA: An Episode-of-Care Framework for the Management of Obesity-Moving Toward High Value, High Quality Care: A Report From the American Gastroenterological Association Institute Obesity Episode of Care and Bundle Initiative Work Group.

The American Gastroenterological Association acknowledges the need for gastroenterologists to participate in and provide value-based care for both cognitive and procedural conditions. Episodes of care are designed to engage specialists in the movement toward fee for value, while facilitating improved outcomes and patient experience and a reduction in unnecessary services and overall costs. The episode of care model puts the patient at the center of all activity related to their particular diagnosis, procedure, or health care event, rather than on a physician's specific services. It encourages and incents communication, collaboration, and coordination across the full continuum of care and creates accountability for the patient's entireexperience and outcome. This paper outlines a collaborative approach involving multiple stakeholders for gastrointestinal practices to assess their ability to participate in and implement an episode of care for obesity and understand the essentials of coding and billing for these services.

KVC's Bridging the Way Home: An innovative approach to the application of Trauma Systems Therapy in child welfare

This article presents implementation study findings from a large-scale evaluation of an intervention model for children in foster care, aimed to improve care within the services system. This Bridging the Way Home Initiative, funded by the Anne E. Casey Foundation, and conducted under the auspices of KVC Kansas (KVC) in Kansas created processes by which a defined trauma-informed intervention model (Trauma Systems Therapy-TST) could inform the work of all those involved in the care of a foster child (i.e., clinical and non-clinical providers, and foster parents). This study focuses on how effectively TST was integrated into the full continuum of care at KVC, an organization that provides out-of-home care to children served by the Kansas Department for Children and Families in the Kansas City Metropolitan and East Kansas regions. The implementation study helps explain findings from a complementary outcomes study—covered in a separate article also submitted for review. We found the process of implementing and expanding TST demanding, iterative and complex, yet ultimately TST was implemented across levels. The majority of staff and foster parents completed training in TST, and fidelity measures showed progress in TST use over time. KVC's implementation of TST provided both the knowledge and the tools necessary for foster parents to better care for the children in their homes. KVC's efforts show it is possible to infuse trauma-informed care into a large child welfare organization across all levels of care.

Abstract 27: The Georgia Stroke Curriculum (GSC): Provides Free Stroke Education to Healthcare Professionals

Background: In 2015 the Georgia Stroke Professional Alliance (GA-SPA) supported the launch of a free educational platform, the Georgia Stroke Curriculum (GSC). This up-to date, evidence based, peer reviewed stroke education is an alternative to other more costly options. Statewide provider and instructor classes were developed. GSC is a four module, didactic, interactive course focused on the full continuum of care of the acute stroke patient. GSC is peer reviewed by stroke content experts Purpose: To expand free state-wide education to all health care professionals committed to improving the quality of stroke care through evidence based stroke education provided by clinical experts, who are trained and provided the latest evidence in stroke care Methods: GSC was developed by experienced stroke professionals with an extensive background in neuroscience and stroke care. The three different programs are advanced, core and instructor classes. Modules are peer reviewed by a consortium of stroke content experts, including stroke neurologists, physiatrist, emergency room, neurology, flight and rehabilitation nurses, case managers, stroke coordinators, quality specialists, and paramedics. The initial course was proctored by a stroke neurologist and stroke coordinators. Additional pilot classes were completed at comprehensive, primary, and remote treatment stroke centers Results: GSC is an expanding educational platform for free professional stroke education for healthcare professionals that is evidenced based, cutting edge with a regional approach, inclusive of feedback from providers, hospitals and healthcare systems. As of August 2016 nearly 70 GSC instructors were trained statewide along with over 500 healthcare professionals. The education has improved professional stroke knowledge as evidenced by an average score of 60% on the pretest to 90% on the posttest Conclusion: GSC serves as a free subject matter resource on stroke education to healthcare professionals with a focus on the full continuum of stroke care. The state-wide initiative has improved the knowledge for healthcare professionals in the region. GSC expands the reach of a free, current, evidenced based program as an effective method to enhance stroke education throughout the state

Information Sharing: Best Practices That Support Transitions in Care.

Care coordination that improves patient care and patient outcomes is becoming increasingly necessary as bundled payment programs are developed. Rather than looking at each aspect of the patient's care, the entire care continuum from preoperative preparation through completion of the episode will become the norm. The length of the episode of care may be 30 days or as long as 90 days. The transition to different care providers during that episode requires information sharing. This is best accomplished by a technology platform that allows for real-time information sharing. This article describes one organizations experience with managing the full continuum of care.

Maternity-care: measuring women's perceptions.

Achieving maternity-care outcomes that align with women's needs, preferences and expectations is important but theoretically driven measures of women's satisfaction with their entire maternity-care experience do not appear to exist. The purpose of this paper is to outline the development of an instrument to assess women's perception of their entire maternity-care experience. A questionnaire was developed on the basis of previous research and informed by a framework of standard service quality categories covering the spectrum of typical consumer concerns. A pilot survey with a sample of 195 women who had recent experience of birth was undertaken to establish valid and reliable scales pertaining to different stages of maternity care. Exploratory factor analysis was used to interpret scales and convergent validity was assessed using a modified version of the Client Satisfaction Questionnaire. Nine theoretically informed, reliable and valid stand-alone scales measuring the achievement of different dimensions of women's expectancies of public maternity care were developed. The study scales are intended for use in identifying some potential areas of focus for quality improvement in the delivery of maternity care. Reliable and valid tools for monitoring the extent to which services respond to women's expectations of their entire maternity care form part of the broader toolkit required to adequately manage health-care quality. This study offers guidance on the make-up of such tools. The scales produced from this research offer a means to assess maternity care across the full continuum of care and are brief and easy to use.

Maternal and household characteristics as determinants of maternal health seeking along the continuum of care in rural Tanzania

Four antenatal care (ANC) visits, delivery in a health facility, and three postnatal care (PNC) visits are the global recommendations for mothers to optimize maternal health outcomes.[i] While these are each vital to maternal health, most existing studies analyze health seeking behavior for each level separately (ANC, health facility delivery, and PNC), without assessing health seeking along the full continuum of care. This study aims to characterize what determines a mother’s achievement of the recommended maternal health visits in three districts of rural Tanzania to illuminate strategic programmatic interventions to improve maternal health. [i] WHO. (1998). Postpartum care of the mother and newborn: a practical guide. Geneva: World Health Organization, Maternal and Newborn Health/Safe Motherhood Unit Data for this study were extracted from a cross-sectional household survey conducted between May and July 2011 by the Connect Project—a randomized cluster trail implemented by Columbia University and Ifakara Health Institute in Rufiji, Ulanga, and Kilombero districts of Tanzania to test the impact of paid community health workers on maternal and child health. 2,183 households yielded 915 women who were eligible for analysis since they had given birth within two years preceding the survey. Univariate, bivariate, and multivariate multinomial logistic regression analyses were utilized to assess relationships between maternal and householdlevel characteristics and maternal health seeking behavior. The outcome of interest was defined into three categories: highest (recommended): 4+ ANC visits and delivery in health facility and 1+ PNC; lowest: 0-3 ANC and delivery outside of health facility and 0-1 PNC; middle: all other care patterns. Preliminary findings indicate that 19.1% of women achieved the highest level, 67.9% achieved the middle level, and 13.0% achieved the lowest level. Multivariate analysis revealed parity as a significant predictor of care-seeking with women in their first pregnancy being 5.73 times (95% CI: 1.99-15.96; p < 0.001) more likely to achieve the recommended level of care and 3.49 times (95% CI: 1.37-9.38; p < 0.01) more likely to achieve the middle level of care than the lowest level. Wealth Index was also a significant predictor of health seeking behavior with those in the highest wealth index being 4.11 times (95% CI: 1.86-9.11; p < 0.000) more likely to achieve the recommended level of care and 3.13 times (95% CI: 1.57-6.25; p < 0.001) more likely to achieve the middle level than the lowest level. By determining differences between mothers achieving the full recommended maternal health visits versus those achieving less optimal levels, we recommend that maternal health interventions target multigravida and low-income mothers to achieve the greatest impact in increasing achievement of all recommended maternal health visits along the continuum of care in rural Tanzania.

Evaluating the confluence of oncology market trends and key levers to drive payment and delivery reform for treatment of multiple myeloma.

45 Background: A multi-factorial focus on treatment costs and the incremental improvement in outcomes has accelerated interest in payment and delivery reform in oncology, specifically a shift from fee-for-service to fee-for-value. As the landscape continues to evolve, there are key levers that will accelerate reform for specific cancer types. Our objective was to examine how broad oncology market trends and key levers for multiple myeloma (MM) intersect to drive payment and delivery reform. Methods: We evaluated 18 oncology market trends, classified the pervasiveness of each as nascent, emerging, or widespread, and assessed trends for specificity to MM compared to other cancers. We then evaluated six key levers that, within the context of each trend, may ripen MM for payment and delivery reform. Levers included 1) national guidelines; 2) quality measures; 3) prevalence/incidence relative to other cancer types; 4) advanced imaging or other high-cost treatment expenditures; 5) drug/biologic contribution toward treatment costs; and 6) approved companion diagnostic(s). Results: While some guidelines exist to address treatment of MM, there are gaps in recommendations that do not address the full continuum of care to guide physician decision making, giving this lever low influence to drive reform. One measure for quality improvement has been used at a broad national level, giving this lever moderate influence on reform. Today, characteristics of MM that trigger key levers make MM an unlikely focus for widespread reform initiatives. Conclusions: Most oncology market trends are cancer-type agnostic, but trend pervasiveness and their confluence with key levers will dictate the shape of alternative payment models for changes to treatment delivery and reimbursement. By developing additional quality measures and addressing guideline gaps, stakeholders may further trigger two key levers to ripen MM for payment and delivery reform. Reform initiatives may be expedited as additional treatment options are introduced to the market, and as stakeholders work to influence key levers and evaluate the feasibility for and implementation new payment and delivery models for MM.

Understanding and Supporting the Resilience of a New Generation of Combat-Exposed Military Families and Their Children

Taking our nation to war has exposed a generation of military families and children to combat and its consequences. Every dollar spent on bullets, trucks, fuel, and food carried a future 'tax' in the form of consequences for psychological and physical health and family relationships. In this commentary, I focus on several themes that emerge from the special collection or articles. For example, I consider how best to define the ecological niche(s) occupied by military-connected children and families. Not surprisingly given significant gaps in our knowledge, evidence regarding the well-being of military-connected children is mixed. I also consider the multi-layered environments within which individuals and families function, recognizing both the challenges and opportunities they provide. The need to respond rapidly to the evolving needs of military families has highlighted the value of both prevention science and implementation science. Public health models emphasizing a full continuum of care that emphasizes not only treatment but also universal, selective, and indicated prevention also are appealing given the uneven density, uncertain locations, and unknown identities of military families in civilian communities (Beardslee 2013; Murphy and Fairbank 2013). Finally, it is important to recognize that we are at the beginning, not the end, of the post-war lifetimes for the new generation of veterans and their families.

Buprenorphine from detox and beyond: preliminary evaluation of a pilot program to increase heroin dependent individuals' engagement in a full continuum of care

Absence of successful transition to post-detoxification treatment leads to high rates of relapse among detoxified heroin users. The present study evaluated a pilot buprenorphine treatment program (BTP). Heroin dependent individuals were inducted onto buprenorphine/naloxone in detox, maintained while transitioning through an intensive inpatient program (IIP), and gradually tapered off medication over 5months of outpatient (OP) treatment. Compared to programmatic indicators of treatment engagement in the year prior to BTP implementation, referrals from detox to IIP, entry into and completion of IIP and subsequent OP, and days in OP treatment increased substantially. BTP completers, compared to non-completers, viewed abstinence as more difficult and as requiring more assistance to achieve, were less likely to be current cocaine and alcohol users or to have relapsed during the course of treatment. Although preliminary and in need of replication, initial adjunctive use of buprenorphine in an abstinence-based continuum of care may improve post-detoxification treatment entry, engagement, and completion.

Practicing Anthropology in an Academic Community Hospital: Lessons from the Field

Practicing anthropology at an academic community hospital involves collaborations across the full continuum of care, from hospital, to doctor's office, to the medical education classroom and into the community. Through these collaborations, the anthropologist learns about hospital culture through many different lenses and is, in turn, able to provide valuable insights into organizational culture and patient care from a variety of vantage points.

The Alberta hip and knee replacement project: A model for health technology assessment based on comparative effectiveness of clinical pathways

The Alberta Hip and Knee Replacement Project developed a new evidence-based clinical pathway (NCP) for total hip (THR) and knee (TKR) replacement. The aim was to facilitate the delivery of services in a timely and cost-effective manner while achieving the highest quality of care for the patient across the full continuum of care from patient referral to an orthopedic surgeon through surgery, recovery, and rehabilitation. The purpose of this article is to provide an overview of the study design, rationale, and execution of this project as a model for health technology assessment based on comparative effectiveness of alternative clinical pathways. A pragmatic randomized controlled trial study design was used to evaluate the NCP compared with the standard of care (SOC) for these procedures. The pragmatic study design was selected as a rigorous approach to produce high quality evidence suitable for informing decisions between relevant interventions in real clinical practice. The NCP was evaluated in three of the nine regional health authorities (RHAs) in Alberta with dedicated central intake clinics offering multidisciplinary care teams, constituting 80 percent of THR and TKR surgeries performed annually in Alberta. Patients were identified in the offices of twenty orthopedic surgeons who routinely performed THR or TKR surgeries. Evaluation outcome measures were based on the six dimensions of the Alberta Quality Matrix for Health (AQMH): acceptability, accessibility, appropriateness, effectiveness, efficiency and safety. Data were collected prospectively through patient self-completed questionnaires at baseline and 3 and 12 months after surgery, ambulatory and inpatient chart reviews, and electronic administrative data. The trial design was successful in establishing similar groups for rigorous evaluation. Of the 4,985 patients invited to participate, 69 percent of patients consented. A total of 3,434 patients were randomized: 1,712 to SOC and 1,722 to the NCP. The baseline characteristics of patients in the two study arms, including demographics, comorbidity as measured by CDS and exposure to pain medications, and health-related quality of life, as measured by Western Ontario and McMaster Universities Osteoarthritis Index and Short Form-36, were similar. The Alberta Hip and Knee Replacement Project demonstrates the feasibility and advantages of applying a pragmatic randomized controlled trial to ascertain comparative effectiveness. This is a model for health technology assessment that incorporates how clinical pathways can be effectively evaluated.

AMA Calls for Remedies for Psychiatric-Bed Shortage

AMA Calls for Remedies for Psychiatric-Bed Shortage

Nursing Programs Could Sharpen LTC Focus

Nursing Programs Could Sharpen LTC Focus

The andrologist from medicine of reproduction to sexual medicine: the Italian experience

The main andrological areas of interest, male reproductive and - more recently - sexual dysfunctions are most appropriately viewed as symptoms of the couple with medical, psychological and behavioural components that cannot be treated in a mechanical, purely medicinal manner (sexual medicine). The patient and his sexual partner must be active participants in a full continuum of care (medical sexology), the new challenge for the renewed and enriched field of andrology. In this field, the cooperation between basic researchers (such as geneticists, neurophysiologists, pharmacologists, ethologists) and a wide group of clinicians (such as endocrinologists, psychologists and psycho-sexologists, psychiatrists, urologists and gynaecologists) is of paramount importance for the andrologist at the dawn of the new field of medical sexology, which will be full of scientific gratification in the years to come.