International Journal of Psychiatry in Medicine, Jul 19, 2023
Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians... more Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health and as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME’s recently revised statement on the training mission of family medicine residencies and with their most recent update of the Milestones which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular experiences in family medicine residency programs.
Does providing opiate maintenance therapy during incarceration increase participation in communit... more Does providing opiate maintenance therapy during incarceration increase participation in community treatment programs after release? Ahmad Abdl-Haleem, DO PGY 3 Resident, Northwestern McGaw Family Medicine at Humboldt Park Objective: A question was posed on the Family Practice Inquiry Network "Does providing opiate maintenance therapy during incarceration increase participation in community treatment programs after release?" Methods: A literature search was performed using the research support of Northwestern Galter Library staff. Results: A 2017 meta-analysis of 8 RCTs, 5 secondary-analyses of RCTs, and 11 quasi-experimental studies evaluated the efficacy of MAT within prisons on patient oriented outcomes, specifically focusing on whether opiate maintenance therapy during incarceration increased participation in community treatment programs after release. Through this meta-analysis, it was demonstrated that incarcerated individuals treated with methadone were significantly more likely to participate in community treatment compared to those without treatment (4 trials, n=407. [OR] = 9.0; 95% CI = 2.5-31, Q = 6.3, I 2 = 68%). Conclusions: Opiate MAT during incarceration does increase participation in community substance use treatment programs following release (SOR: A, meta-analysis of RCTs and quasi-RCTs).
Background and Objectives: Many residency programs are developing resident wellness curricula to ... more Background and Objectives: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum. Methods: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses. Results: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated wit...
An integrative approach to individuals with mood, emotional or mental health concerns involves a ... more An integrative approach to individuals with mood, emotional or mental health concerns involves a comprehensive model of care that is person-centered. Integrative medicine builds on a patient's personal meaning and goals (spiritual aspects) and includes herbal therapies, nutritional support, movement and physical manipulative therapies, mindfulness, relaxation strategies, and psychotherapies.
The purpose of this study was to explore how adults with prediabetes perceive their risk of devel... more The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with inten...
Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship... more Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved.
The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to bet... more The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.
International Journal of Psychiatry in Medicine, Jul 19, 2023
Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians... more Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health and as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME’s recently revised statement on the training mission of family medicine residencies and with their most recent update of the Milestones which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular experiences in family medicine residency programs.
Does providing opiate maintenance therapy during incarceration increase participation in communit... more Does providing opiate maintenance therapy during incarceration increase participation in community treatment programs after release? Ahmad Abdl-Haleem, DO PGY 3 Resident, Northwestern McGaw Family Medicine at Humboldt Park Objective: A question was posed on the Family Practice Inquiry Network "Does providing opiate maintenance therapy during incarceration increase participation in community treatment programs after release?" Methods: A literature search was performed using the research support of Northwestern Galter Library staff. Results: A 2017 meta-analysis of 8 RCTs, 5 secondary-analyses of RCTs, and 11 quasi-experimental studies evaluated the efficacy of MAT within prisons on patient oriented outcomes, specifically focusing on whether opiate maintenance therapy during incarceration increased participation in community treatment programs after release. Through this meta-analysis, it was demonstrated that incarcerated individuals treated with methadone were significantly more likely to participate in community treatment compared to those without treatment (4 trials, n=407. [OR] = 9.0; 95% CI = 2.5-31, Q = 6.3, I 2 = 68%). Conclusions: Opiate MAT during incarceration does increase participation in community substance use treatment programs following release (SOR: A, meta-analysis of RCTs and quasi-RCTs).
Background and Objectives: Many residency programs are developing resident wellness curricula to ... more Background and Objectives: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum. Methods: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses. Results: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated wit...
An integrative approach to individuals with mood, emotional or mental health concerns involves a ... more An integrative approach to individuals with mood, emotional or mental health concerns involves a comprehensive model of care that is person-centered. Integrative medicine builds on a patient's personal meaning and goals (spiritual aspects) and includes herbal therapies, nutritional support, movement and physical manipulative therapies, mindfulness, relaxation strategies, and psychotherapies.
The purpose of this study was to explore how adults with prediabetes perceive their risk of devel... more The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with inten...
Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship... more Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved.
The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to bet... more The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.
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Papers by Mary Talen