To fully implement health care reform in the United States, primary care physicians need more training in team-building and treating mental illness in their practices, a new joint report from the Carter Center and the American College of Physicians suggests.

Titled "Five Prescriptions for Ensuring the Future of Primary Care," the report is an outgrowth of the Health Education Summit at the Carter Center in Atlanta, where leaders from many disciplines converged last October to discuss educational and training gaps in primary care, behavioral health care and health promotion.

"The paper is certainly the initiative of a strategic process," said Dr. John Bartlett, summit co-chairman and senior adviser for the Carter Center's Primary Care Initiative and Mental Health Program. "It's pretty clear there's a whole new set of challenges that will be required, particularly for primary care teams. We're not looking for any sudden changes, but it is an attempt to introduce new concepts into the dialogue."

That includes the five prescriptions featured in the title:

• Teaching young health professionals and students about the structure, financing and workforce issues inherent in health care, as well as new models of technology-enabled care
• Providing more training in team-oriented settings, which mirrors a common approach in other disciplines
• Integrating mental and behavioral care diagnosis and treatment into the primary care setting
• Using existing funds and programs and creating new incentives to promote primary care careers to young health professionals
• Stimulating a broader research agenda to influence primary care practices and future health care training

Because mental health conditions affect about a fourth of the U.S. population, primary care doctors must be able to recognize and treat these disorders among their patients, Bartlett said. Behavioral conditions also include such issues as obesity and smoking, he noted, and so are exceedingly common.

"They are far more prevalent and common than we'd like to admit," said Dr. Michael S. Barr, ACP's senior vice president for medical practice, professionalism and quality and co-chairman of the summit. "And the interplay [between mental health and other conditions] is pretty complex. We want to integrate behavioral health at the point of care."

Bartlett cited corporations' team-building efforts -- on which millions of dollars are spent -- as an example of how members of the medical community can work together to integrate care instead of treating each physician as a separate entity.

"Health care is a team-based practice," he said. "That's not second-best care. To my mind, teamwork is actually the best care."

To carry out the recommendations, Bartlett and Barr have formed five work groups -- each to tackle one "prescription" -- that will review the specific goals and devise tactics to advance them. The process should take 12 to 24 months, Bartlett said.

And though the co-chairmen are clear-eyed about the challenges of bringing the recommendations to fruition, they don't see a choice if primary care is to keep up with the ever-changing health care culture.

"We can't continue to do what we're doing and expect different results," Barr said. We have to develop systems and train health professionals in those systems. It starts with describing the best model of care we can envision."

"I'm optimistic, but realistic too," he added. "It will be a challenge."

More information

The full report, Five Prescriptions for Ensuring the Future of Primary Care, is available on the ACP website.