CONTEXT: Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). OBJECTIVE: To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. DESIGN, SETTING, AND PARTICIPANTS: Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. RESULTS: Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. CONCLUSIONS: Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring the current primary care model and offering convenient, individualized, non-biased educational options may aid success.

This paper argues the importance of establishing integrated systems to meet the needs of forensic investigations as well as the needs of families of the missing in post-conflict situations. Meeting the psychosocial needs of families to resolve uncertainty and to recover the remains of their loved ones must be part of a multidisciplinary team approach to a transparent and standardised scientific investigative protocol. The authors present several case studies from the former Yugoslavia illustrating community-based interventions combining education projects and participation in antemortem data collection as well as providing a support network for families of the missing. The participation of the scientific investigators (pathologists, anthropologists, crime scene investigators, etc), many of whom are unprepared for the presence of family members at the scene, is critical to the success of the integrated process. Providing for and sustaining a long term follow-up programme with families, who may require ongoing mental health and social support, is also essential.

This article presents a case that illustrates the vital role that social workers and other mental health and public health workers provided to support families following the 1999 conflict between Serb forces and Kosovar Albanians in Kosovo. A public health and social work team from Boston-based Physicians for Human Rights responded to an emergency postconflict situation by planning and implementing a community-based intervention that mobilized local mental health providers and established collaboration among national and international agencies, including the International War Crimes Tribunal for the Former Yugoslavia, to provide a support network for families with missing family members. The intervention included assessment of local resources, training, fieldwork, professional development of local staff, and the establishment of long-term local responsibility and autonomy.

OBJECTIVE: It is widely recognized that interdisciplinary team care is essential for effective management of complex patients such as the frail elderly. Physicians need to understand the operational mechanisms that drive the team care model. While such concepts should be an integral part of medical education, teaching such a model of care that demonstrates effective provider communication, coordination of multiple services, and the provision of cost-effective health care can be difficult. The Program of All-inclusive Care of the Elderly (PACE) is a well-established, high-quality program that has been replicated nationally and can serve as an effective teaching model. Achieving the goals of the PACE program requires strong team leadership and communication, clear patient-oriented goal definition, an understanding and appreciation of roles among various disciplines, skillful negotiation, and shared responsibility for the patient. The PACE model offers medical and family practice residents a non-traditional clinical setting with educational opportunities not available in most hospital or ambulatory settings. DESCRIPTION: For several years the Fallon Healthcare System Elder Service Plan (ESP), one of 25 national PACE programs, has provided an educational setting for medical and family practice residents as a component of their clinical rotations in geriatrics. This training experience has been expanded to include additional residents in on-site interactive seminars that focus on effective communication using an interdisciplinary team approach to care. The ESP program provides comprehensive medical and social services to a frail, non-institutionalized nursing-home-eligible population. The aim of the program is to preserve the health and independence of its participants for as long as possible. The ESP team consists of physicians, nurse practitioners, nurses, nurse's aides, home health workers, social workers, therapists, nutritionists, and pharmacists. The seminar includes a slide and video presentation led by members of the ESP team using selected scenarios that portray both effective and poor team dynamics and communication. Definitions of a team, the process of establishing patient- and family-oriented goals, interdisciplinary role appreciation and responsibility, and the basics of financing a comprehensive health care delivery system for the frail elderly are discussed. Approximately half of each session is devoted to interactive discussion and critiquing of the scenarios by the residents and faculty, which is derived from the ESP team. DISCUSSION: For most of the medical and family practice residents, this experience represents their first exposures to this model of coordinated team care for the elderly. Preliminary evaluation results indicate that residents have generally been unaware of the services available to the elderly and of the opportunities for coordinated care using the expertise of multiple disciplines. There is a lack of knowledge of key non-physician professional roles. The expanded use of PACE models as training sites could be beneficial in preparing future health care professionals for interdisciplinary team care of the growing numbers of frail elderly.