SO PLEASE DON’T EVER CHANGE

         The Institute of Medicine:  Last year the Institute of Medicine (IOM) issued its report Informing the Future: Critical Issues in Health.  Released prior to the final enactment of President Obama's landmark health care reform legislation, the Patient Protection and Affordable Care Act [PPACA], the IOM foresaw the changes coming.  "Increasing effectiveness and efficiency of the health care system.  By all accounts, the nation's current health care system is flawed, marked by rising costs, lack of evidence about the effectiveness of even the most widespread medical procedures, and a growing number of people who are uninsured.  Among suggested changes, HHS should work with Congress to establish a capability for assessing the comparative value – including clinical and cost effectiveness – of medical interventions and procedures, preventive and treatment technologies, and methods of organizing and delivering care.  This effort will require expanded information sharing, both within the department as well as with external organizations, in order to better evaluate and inform the health care system."

The IOM called for the federal government to: * Define a 21^st century vision for how to provide the greatest value in protecting and improving health in today's climate of varied, complex, and sometimes changing health needs.  * Strengthen the health care workforce.  Serious shortages exist across the health care spectrum of professionals with the right backgrounds, training, and skills.  There is an aging workforce, new health challenges requiring new skills, an imbalance between primary care providers and specialists, and an underrepresentation of minority groups.  And, * Assessing what works in health care.  Many studies have documented spending on ineffective care and significant variations in how multiple health care providers treat the same condition.  At the same time, health plans face the need to constantly learn how their beneficiaries might benefit from – or be harmed by – newly available health services.  Rigorous standards for creating clinical practice guidelines which could help clinicians and patients make informed decisions about appropriate health care for specific clinical conditions should be developed and promoted.  Evidence-based health care is critical as we enter the 21^st century.  And yet, it is unquestionably an evolving and highly complex process.

            APA – Getting Ahead of the Curve:  During the past year, President Carol Goodheart's APA Presidential Task Force on Advancing Practice, on which Hawaii's Darryl Salvador and long time colleague Jeff Zimmerman serve, addressed their basic mission of identifying educational and other resources needed by practicing psychologists and prioritizing and advancing the development and dissemination of such resources.  The ultimate objective is to create an outcomes framework and a clinical resources framework in order to integrate practice and science in useful ways that support practitioner efforts to develop quality services.  "In this era of ever increasing demands for accountability, the best way for psychologists to demonstrate the effectiveness of services is to measure outcomes."

            Jeff's report: "So, you're sitting in your office and have a question about practice (clinical issues, practice management, insurance, etc.) or you are involved in research and want to float some ideas, or you are searching for information about outcome measures.  What do you do?  Well typically we use one of the common search engines, pose a question and get millions of hits to sort through.  While search engines can offer a great diversity of hits, we are often unsure how to better pinpoint what we need and we can be unsure of the quality of information obtained.  Similarly, on the many list serves we may be on, we have to sort through countless e-mails or digests to find pertinent information.  Now members of APA have another choice – PsycLINK.

            "If you go to my.apa.org and click under Tools, you will be taken to APA's new wiki platform PsycLINK.  There you will find the beginnings of a new initiative started by the APA Task Force appointed by Carol and chaired by Karen Zager.  Thanks to the work of the task force, which included APA members and Practice Directorate Executive Director Katherine Nordal and her staff Lynn Bufka and Joan Freund, PsycLINK is a platform that is continuing to develop and is a community built by psychologists for psychologists.  As it grows, the breadth and depth of information will grow as well.  Searches will be more comprehensive and to the point, as many results of the public search engines will be screened out.  Additionally, the diversity of input from colleagues in different Divisions and professional roles can be more easily realized, when compared to a more singular listserv hosted by one professional subgroup.

            "PsychLINK is not e-mail intensive in the slightest.  You can set it to send you one e-mail a day of all the titles of the postings, or you can check it when you care to.  To post comments or start new posts you have to register – again, a very simple process.  So, check it out.  Ask a question, post something you think may be of use, or comment on a posting to lend a hand to a colleague.  This isour virtual community.  Let's help it grow."

            A Highly Complex Process:  Another IOM report focused upon Policy Issues in the Development of Personalized Medicine in Oncology and noted that personalized cancer medicine is defined as medical care based on the particular biological characteristics of the disease process in individual patients.  In oncology, personalized medicine has the potential to be especially influential in patient treatment because of the complexity and heterogeneity of each form of cancer.  However, the current classifications of cancer are not as useful as they need to be for making treatment decisions.  Treatment needs to evolve toward a focus on targeted treatments based on individual characterizations of the disease.  Although this underlying concept has great promise, a number of policy issues must be clarified and resolved before personalized medicine can reach its full potential.  These include technological, regulatory, and reimbursement hurdles.  Addressing the reimbursement possibilities, the report noted that while some Medicare coverage decisions are made at the national (CMS) level, approximately 85 to 90 percent of coverage decisions are actually made by local contractors.  That is, local contractors can increase national coverage and reimburse additional procedures and tests, if deemed to be "reasonable and necessary" in order to improve clinically meaningful health outcomes.  Evidence is assessed using standard principles of evidence-based medicine.

            Women Veterans:  With the significant number of active duty personal, veterans, and called up national guard troops in Hawaii, another IOM report should be of particular interest.  That document recommended that DoD and VA quantify the number and distribution of mental health professionals needed to provide treatment to the full population of returning service members, veterans, and their families who might suffer from mental health disorders such as PTSD, major depression, and substance abuse, so that they can readjust to life outside of theater.  The committee also recommended that DoD and VA continue to implement programs for the recruitment and retention of mental health professionals, particularly to serve those in hard-to-reach areas.  Women now constitute 14% of deployed forces in the U.S. military, and although technically they are barred from serving in combat, a growing and unprecedented number of female soldiers are deployed to combat areas where their lives are at risk.  All service members are exposed to high levels of workplace stress; however, women in the military were found to face some unique stressors, such as sexual harassment and trauma exposure that may affect their mental health and emotional well-being.  Female veterans report a higher burden of medical illnesses, worse quality-of-life outcomes, and earlier psychologic morbidity than do men who are exposed to the same levels of trauma.  Both the military and family life requires commitment and loyalty, and servicewomen who have families may experience intense conflict between the demands of their military roles and their family roles.  Deployment involves being separated from children and families for months at a time and leaving children behind with spouses or alternative caregivers.  Single mothers confront special challenges.  Interestingly, deployment appears to affect the marital stability of male and female soldiers differently.  It has been found that deployment led to a large, statistically significant increase in divorce rates in women in the military, but not men.  Psychologists Margarita Alegria, John Corrigan, and Janice Krupnick served on this IOM committee.  I KIND OF LIKE YOU JUST THE WAY YOU ARE (Beatles, 1963).  Yet, fundamental change is definitely coming.  Aloha,

 

Pat DeLeon, former APA President – Hawaii Psychological Association – December, 2010