Primary care
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Seventy-five percent of health care costs can be attributed to chronic diseases, making prevention and management imperative. Collaborative patient self-management in primary care is efficacious in reducing symptoms and increasing quality of life. ⋯ Self-management interventions rest on a foundation of 5 core actions: (1) activate motivation to change, (2) apply domain-specific information from education and self-monitoring, (3) develop skills, (4) acquire environmental resources, and (5) build social support. Several delivery vehicles are described and evaluated in terms of diffusion and cost-containment goals.
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After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial.