Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Physical symptom syndromes following war and other traumatic events have gone by an array of colorful labels over the past 150 years, and our medical and societal penchant for relabeling these syndromes continues to this day (see Table 8.1;Hyams, Wignall, & Roswell, 1996;Shorter, 1992; Schnurr & Green, chap. 1, this volume). Yet after many years of research, debate, and medical efforts, we are still far from a thorough etiologic or therapeutic understanding of these syndromes. The mainstream tradition in medicine has been to conceptualize medically unexplained (or, in the standard medical lexicon, idiopathic) symptoms as psychogenic. These This chapter was authored or coauthored by an employee of the United States government as part of official duty and is considered to be in the public domain. The views expressed in this chapter are those of the author and do not necessarily represent the official policy or position of the

A person diagnosed with arthritis is in most cases confronted with a lifelong chronic disease. Arthritis often follows an unpredictable course with an uncertain future. Patients are faced with many life changes and cannot help but respond to each new situation emotionally. Many patients claim that the mental pain and emotional turmoil caused by this chronic illness are worse than the physical pain. This article presents developmental models to enhance the health care professional's understanding of the emotional needs of the patient with arthritis.

The authors aimed to identify health care providers' and staff's perceived barriers to effective discharge planning for tracheostomy patients in a Veterans Administration hospital and suggest solutions for overcoming these barriers. The study involved a qualitative approach using a free listing technique to elicit responses to a single open-ended survey question. Salience analysis was performed, and 3 broad themes from participants (N ¼ 50) were identified as barriers. Participants discussed challenges related to care coordination (S ¼ 0.256), communication (S ¼ 0.247), and patient and family education (S ¼ 0.183). Results from the study can serve as a conceptual framework allowing practitioners to develop solutions to improve the discharge process.

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