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Annals Journal Club Selection:
Sep/Oct 2007
The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.
The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1Articles for Discussion
- Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med. 2007;5(5):457-461.
- Zweifler J. The missing link: improving quality with a chronic disease management intervention for the primary care office. Ann Fam Med. 2007;5(5):453-456.
Discussion Tips
Consider these articles in the context of your own practice, of calls for practice reform, and of calls for payment reform. Because these are essays rather than research articles, it is not easy to critique the methods. It is important, however, to consider the logic of their arguments and the degree to which they are grounded in both current reality and future possibility.Discussion Questions
- What are the questions addressed by these essays? Why do the questions matter?
- What changes do each propose?
- How might these changes be feasibly implemented in your practice?
- What would be the intended consequences of these changes in practice organization?
- What are the potential unintended consequences?
- What health care system changes would be needed to enable these changes?
- How could patients be engaged?
- What other changes do these proposals stimulate you to envision?
- How do these ideas relate to the Future of Family Medicine2 proposal for a New Model practice?3
- How do they relate to the idea of the Patient-Centered Medical Home recently endorsed by 4 professional organizations?4
- Do such initiatives as the TransforMED National Demonstration Project and Preparing the Personal Physician for Practice (P4)5 or the Prescription for Health6 project make such changes seem more feasible?
Reference
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. Available at: http://annfammed.org/cgi/content/full/4/3/196.
- Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2(Suppl 1):S3-S32.
- Task Force 1 Writing Group, Green LA, Graham R, et al. Task Force 1. Report of the Task Force on Patient Expectations, Core Values, Reintegration, and the New Model of family medicine. Ann Fam Med. 2004;2(Suppl 1):S33-S50.
- American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). Joint Principles of the Patient-Centered Medical Home. March, 2007. http://www.medicalhomeinfo.org/Joint%20Statement.pdf. Accessed August 30, 2007.
- TransforMED. http://www.transformed.com/. Accessed August 30, 2007.
- Prescription for Health. http://www.prescriptionforhealth.org/. Accessed August 30, 2007.
The Article in Brief
The Teamlet Model of Primary Care
Thomas Bodenheimer, MD , and colleagues
Background The 15-minute doctor visit must be eliminated as the standard in primary care, according to this essay. The authors propose that it be replaced by a teamlet (little team) model, which has 2 main features: (1) the patient visit involves 2 caregivers--a clinician (doctor, nurse-practitioner, or physician�s assistant) and a health coach--rather than only the clinician; and (2) the 15-minute visit is expanded to include a previsit by the coach, a visit by the clinician together with the coach, a postvisit by the coach, and between-visit care by the coach. According to the authors, the teamlet model is a blueprint for addressing some of the serious problems facing primary care: inadequate visit time to provide all recommended acute, chronic, and preventive care; doctor and patient dissatisfaction with the rushed atmosphere of many visits; and inadequate quality of care that may be provided by stressed primary care practices. Pilot projects are underway to test whether this model of care is practical.
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