Primary care
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Stigma and bias surrounding body weight is both explicit and implicit, but the most concerning impact on individuals is internalized stigma which is correlated with poor physical and mental health. Strategies to combat this public health concern include increasing awareness, education around the complex disease of obesity, proper use of communication and language surrounding weight, health, and treatment approaches, addressing equipment and practices in the clinical environment, and larger, systemic approaches to policy. Addressing stigma for a condition impacting the majority of our population is critical for the best health and well-being of our patients and ourselves.
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Primary-care settings have a unique advantage to reaching a broad range of the population and the ability to address a wide array of presenting problems, including substance-use. With high rates of substance-use in the United States and low rates of substance-use treatment utilization, the primary-care office is key in assessing and supporting patients in changing substance-use behaviors. Motivational interviewing is a conversational tool physicians can use to highlight intrinsic motivation for change and support specific changes patients want to make. Providers can also apply motivational interviewing to a variety of chronic health care behaviors.
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Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical Manual V or ICD-11 definitions. ⋯ The prevalence of this disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences. There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies.
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Mental health is a very important component of whole health because the body, mind, and spirit are woven together to create the fabric of a person's life. Many people in the United States and globally are living with mental health challenges, and it seems that much more attention has been given to anxiety-related mental health conditions in the past few years due to the coronavirus disease 2019 pandemic. The pandemic may certainly have accelerated the onset of mental health conditions for some who were already predisposed, whether it be to depression, anxiety, psychosis, or obsessive-compulsive disorder, to name a few.
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This chapter discusses the barriers related to treating substance use disorders (SUD) in primary-care building an argument that stigma is the largest health disparity left to overcome in this setting. Reviewing the history of treatment in primary-care, common medications prescribed, laws, and regulations that make this care possible in this setting. Owing to the sheer numbers of people with SUD and mental health concerns, primary-care and their related payers must recognize for many regions of the United States those community needs are related to the diagnosis and treatment of SUDs and their related behavioral and physical health problems.