Jennifer L. White

Neuropsychological and socio-emotional correlates of specific-arithmetic disability ☆

Neuropsychological and socio-emotional factors associated with specific-arithmetic disability were investigated in an unselected sample of New Zealand children. Subjects were 17 specific-arithmetic disabled, 27 specific-reading disabled, 63 generally disabled, and 50 nondisabled 13 year olds. Evidence was sought for an association between specific-arithmetic disability and the neuropsychological and socio-emotional correlates of Nonverbal Learning Disability syndrome (NLD). NLD is characterized by a pattern of nonverbal and verbal neuropsychological strengths and weaknesses, and appears to place individuals at greater risk for internalizing psychopathology, than other learning disabilities. Only specific-arithmetic disabled subjects were found to show a neuropsychological profile reminiscent of NLD. Evidence of poor socio-emotional adjustment was found across all three learning-disabled groups, and was greatest among generally disabled subjects. We found that the specific-arithmetic-disabled subjects exhibited the greatest degree of overlap between internalizing psychopathology and a NLD neuropsychological profile. The results are interpreted as providing some support for the idea that specific-arithmetic-disabled individuals may be at greater risk for the NLD syndrome than either generally disabled or specific-reading-disabled individuals.

Panel Workload Assessment in US Primary Care: Accounting for Non–Face-to-Face Panel Management Activities

Purpose: An. understanding of primary care provider (PCP) workload is an important consideration in establishing optimal PCP panel size. However, no widely acceptable measure of PCP workload exists that incorporates the effort involved with both non–face-to-face patient care activities and face-to-face encounters. Accounting for this gap is critical given the increase in non–face-to-face PCP activities that has accompanied electronic health records (EHRs) (eg, electronic messaging). Our goal was to provide a comprehensive assessment of perceived PCP workload, accounting for aspects of both face-to-face and non–face-to-face encounters. Methods: Internal medicine, family medicine, and pediatric PCPs completed a self-administered survey about the perceived workload involved with face-to-face and non–face-to-face panel management activities as well as the perceived challenge associated with caring for patients with particular biomedical, demographic, and psychosocial characteristics (n = 185). Survey results were combined with EHR data at the individual patient and PCP service levels to assess PCP panel workload, accounting for face-to-face and non–face-to-face utilization. Results: Of the multiple face-to-face and non–face-to-face activities associated with routine primary care, PCPs considered hospital admissions, obstetric care, hospital discharges, and new patient preventive health visits to be greater workload than non–face-to-face activities such as telephone calls, electronic communication, generating letters, and medication refills. Total workload within PCP panels at the individual patient level varied by overall health status, and the total workload of non–face-to-face panel management activities associated with routine primary care was greater than the total workload associated with face-to-face encounters regardless of health status. Conclusions: We used PCP survey results coupled with EHR data to assess PCP workload associated with both face-to-face as well as non–face-to-face panel management activities in primary care. The non–face-to-face workload was an important contributor to overall PCP workload for all patients regardless of overall health status. This is an important consideration for PCP workload assessment given the changing nature of primary care that requires more non–face-to-face effort, resulting in an overall increase in PCP workload.