Family Medicine and Community Health最新文献

{"title":"Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation","authors":"Cuiling Wei, Vincent Ka Chun Yan, Camille Maringe, Wenxin Tian, Rachel Yui Ki Chu, Wenlong Liu, Boyan Liu, Yuqi Hu, Lingyue Zhou, Celine Sze Ling Chui, Xue Li, Eric Yuk Fai Wan, Ching Lung Cheung, Esther Wai Yin Chan, William Chi Wai Wong, Ian Chi Kei Wong, Francisco Tsz Tsun Lai","doi":"10.1136/fmch-2024-002834","DOIUrl":"https://doi.org/10.1136/fmch-2024-002834","url":null,"abstract":"Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined. This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity. Design Retrospective cohort study emulating a randomised target trial using electronic health records. Setting We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. Main outcome measures Primary outcome was all-cause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. Results A total of 6183 eligible COVID-19 survivors were included in the analysis. The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group (17.1 deaths per 100 person-year) compared with non-visit group (42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI 8.1% to 14.4%). We also observed significantly better survival from respiratory diseases in the general outpatient visit group (difference in 1-year survival: 6.3%, 95% CI 3.5% to 8.9%). In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a general outpatient visit after COVID-19 discharge, the better the survival. Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being. No data are available. The data custodian has not given permission for data sharing.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of generative pre-trained transformers (GPTs) in Certification Examination of the College of Family Physicians of Canada.","authors":"Mehdi Mousavi, Shabnam Shafiee, Jason M Harley, Jackie Chi Kit Cheung, Samira Abbasgholizadeh Rahimi","doi":"10.1136/fmch-2023-002626","DOIUrl":"10.1136/fmch-2023-002626","url":null,"abstract":"<p><strong>Introduction: </strong>The application of large language models such as generative pre-trained transformers (GPTs) has been promising in medical education, and its performance has been tested for different medical exams. This study aims to assess the performance of GPTs in responding to a set of sample questions of short-answer management problems (SAMPs) from the certification exam of the College of Family Physicians of Canada (CFPC).</p><p><strong>Method: </strong>Between August 8th and 25th, 2023, we used GPT-3.5 and GPT-4 in five rounds to answer a sample of 77 SAMPs questions from the CFPC website. Two independent certified family physician reviewers scored AI-generated responses twice: first, according to the CFPC answer key (ie, CFPC score), and second, based on their knowledge and other references (ie, Reviews' score). An ordinal logistic generalised estimating equations (GEE) model was applied to analyse repeated measures across the five rounds.</p><p><strong>Result: </strong>According to the CFPC answer key, 607 (73.6%) lines of answers by GPT-3.5 and 691 (81%) by GPT-4 were deemed accurate. Reviewer's scoring suggested that about 84% of the lines of answers provided by GPT-3.5 and 93% of GPT-4 were correct. The GEE analysis confirmed that over five rounds, the likelihood of achieving a higher CFPC Score Percentage for GPT-4 was 2.31 times more than GPT-3.5 (OR: 2.31; 95% CI: 1.53 to 3.47; p<0.001). Similarly, the Reviewers' Score percentage for responses provided by GPT-4 over 5 rounds were 2.23 times more likely to exceed those of GPT-3.5 (OR: 2.23; 95% CI: 1.22 to 4.06; p=0.009). Running the GPTs after a one week interval, regeneration of the prompt or using or not using the prompt did not significantly change the CFPC score percentage.</p><p><strong>Conclusion: </strong>In our study, we used GPT-3.5 and GPT-4 to answer complex, open-ended sample questions of the CFPC exam and showed that more than 70% of the answers were accurate, and GPT-4 outperformed GPT-3.5 in responding to the questions. Large language models such as GPTs seem promising for assisting candidates of the CFPC exam by providing potential answers. However, their use for family medicine education and exam preparation needs further studies.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing innovation to help meet the needs of elders: field testing an electronic tool to streamline geriatric assessments across healthcare settings.","authors":"Limor Adler, Zorian Radomyslsky, Miri Mizrahi Reuveni, Eduardo Schejter, Ilan Yehoshua, Yakov Segal, Sara Kivity, Etti Naimi, Mor Saban","doi":"10.1136/fmch-2024-002729","DOIUrl":"10.1136/fmch-2024-002729","url":null,"abstract":"<p><strong>Background: </strong>As populations age globally, effectively managing geriatric health poses challenges for primary care. Comprehensive geriatric assessments (CGAs) aim to address these challenges through multidisciplinary screening and coordinated care planning. However, most CGA tools and workflows have not been optimised for routine primary care delivery.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of a computerised CGA tool, called the Golden Age Visit, implemented in primary care in Israel.</p><p><strong>Methods: </strong>This study employed a quasiexperimental mixed-methods design to evaluate outcomes associated with the Golden Age electronic health assessment tool. Quantitative analysis used electronic medical records data from Maccabi Healthcare Services, the second largest health management organisation (HMO) in Israel. Patients aged 75 and older were included in analyses from January 2017 to December 2019 and January 2021 to December 2022. For patients, data were also collected on controls who did not participate in the Golden Age Visit programme during the same time period, to allow for comparison of outcomes. For physicians, qualitative data were collected via surveys and interviews with primary care physicians who used the Golden Age Visit SMARTEST e-assessment tool.</p><p><strong>Results: </strong>A total of 9022 community-dwelling adults aged 75 and older were included in the study: 1421 patients received a Golden Age Visit CGA (intervention group), and 7601 patients did not receive the assessment (control group). After CGAs, diagnosis rates increased significantly for neuropsychiatric conditions and falls. Referrals to physiotherapy, occupational therapy, dietetics and geriatric outpatient clinics also rose substantially. However, no differences were found in rates of hip fracture or relocation to long-term care between groups. Surveys among physicians (n=151) found high satisfaction with the programme.</p><p><strong>Conclusion: </strong>Implementation of a large-scale primary care CGA programme was associated with improved diagnosis and management of geriatric conditions. Physicians were also satisfied, suggesting good uptake and feasibility within usual care. Further high-quality studies are still needed but these results provide real-world support for proactively addressing geriatric health needs through structured screening models.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine IV: perspectives on practice—lenses of appreciation","authors":"W. Ventres, Leslie A Stone, Radeeb Akhtar, Jeffrey M Ring, Lucy M Candib, Erick Messias, Ronald M Epstein, Marc Tunzi, Amy L Lee, Christopher P. Morley, Carina M Brown, David Slawson, Jill Konkin, David G Campbell, I. Couper, Susan Williams, Robert Brooks, Lucie Walters","doi":"10.1136/fmch-2024-002791","DOIUrl":"https://doi.org/10.1136/fmch-2024-002791","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘IV: perspectives on practice—lenses of appreciation’, authors address the following themes: ‘Relational connections in the doctor–patient partnership’, ‘Feminism and family medicine’, ‘Positive family medicine’, ‘Mindful practice’, ‘The new, old ethics of family medicine’, ‘Public health, prevention and populations’, ‘Information mastery in family medicine’ and ‘Clinical courage.’ May readers nurture their curiosity through these essays.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine IX: people and places—diverse populations and locations of care","authors":"W. Ventres, Leslie A Stone, Emad R Abou-Arab, Julio Meza, David S Buck, Jerome W Crowder, J. Edgoose, Alexander Brown, Ellen J Plumb, Amber K Norris, Jay J Allen, Lauren E Giammar, John E Wood, Scott M. Dickson, G. A. Brown","doi":"10.1136/fmch-2024-002826","DOIUrl":"https://doi.org/10.1136/fmch-2024-002826","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘IX: people and places—diverse populations and locations of care’, authors address the following themes: ‘LGBTQIA+health in family medicine’, ‘A family medicine approach to substance use disorders’, ‘Shameless medicine for people experiencing homelessness’, ‘‘‘Difficult” encounters—finding the person behind the patient’, ‘Attending to patients with medically unexplained symptoms’, ‘Making house calls and home visits’, ‘Family physicians in the procedure room’, ‘Robust rural family medicine’ and ‘Full-spectrum family medicine’. May readers appreciate the breadth of family medicine in these essays.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussing menstrual health in family medicine","authors":"Allison R Casola, Alice Renaud, Ashwini Kamath Mulki","doi":"10.1136/fmch-2023-002149","DOIUrl":"https://doi.org/10.1136/fmch-2023-002149","url":null,"abstract":"Menstrual health is a general biological marker for many cisgender women, transgender men and non-binary people. Despite more than half of the population being people who menstruate, stigma, lack of conversation and pressing social needs around menstrual health persists throughout medicine.[1][1]","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine XII: family medicine and the healthcare system","authors":"W. Ventres, Leslie A Stone, J. South-Paul, Kendall M Campbell, Aerial R Petty, Hima Ekanadham, Kurt C Stange, Rebecca S. Etz, William L Miller, Robert L Ferrer, Marianna Kong, Thomas Bodenheimer, Roger Strasser, Sharon C M Reece, Joshua Freeman, John M Westfall","doi":"10.1136/fmch-2024-002829","DOIUrl":"https://doi.org/10.1136/fmch-2024-002829","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘XII: Family medicine and the future of the healthcare system’, authors address the following themes: ‘Leadership in family medicine’, ‘Becoming an academic family physician’, ‘Advocare—our call to act’, ‘The paradox of primary care and three simple rules’, ‘The quadruple aim—melding the patient and the health system’, ‘Fit-for-purpose medical workforce’, ‘Universal healthcare—coverage for all’, ‘The futures of family medicine’ and ‘The 100th essay.’ May readers of these essays feel empowered to be part of family medicine’s exciting future.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine II: foundational building blocks—context, community and health","authors":"W. Ventres, Leslie A Stone, Rupal Shah, Tamala Carter, Geoffrey M Gusoff, Winston R. Liaw, Bich-May Nguyen, Joanna V Rachelson, Mary Alice Scott, Teresa L Schiff-Elfalan, Seiji Yamada, R. Like, Kathleen Zoppi, A. P. Catinella, Richard M Frankel, Shailendra Prasad","doi":"10.1136/fmch-2024-002789","DOIUrl":"https://doi.org/10.1136/fmch-2024-002789","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘II: foundational building blocks—context, community and health’, authors address the following themes: ‘Context—grounding family medicine in time, place and being’, ‘Recentring community’, ‘Community-oriented primary care’, ‘Embeddedness in practice’, ‘The meaning of health’, ‘Disease, illness and sickness—core concepts’, ‘The biopsychosocial model’, ‘The biopsychosocial approach’ and ‘Family medicine as social medicine.’ May readers grasp new implications for medical education and practice in these essays.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India","authors":"Amritesh Grewal, Bhavik Bansal, Chetanya Mittal, Hardik Gupta, A. Sasi, Prasanth Ganesan, Aashima Dabas, Puneet Sahi, Lakshmi Ramamoorthy, H. T. Lalthanthuami, J. Ramamoorthy, Arwachi Sindhu, Suyash Arora, Anumeha Bhukya, Muthumani Hepzibah, Kanchana Devi, Karthick Krishnamurthy, S. K. Rai, Nikhil Mehta, Komal Antil, S. Bakhshi, S. Ganguly","doi":"10.1136/fmch-2023-002618","DOIUrl":"https://doi.org/10.1136/fmch-2023-002618","url":null,"abstract":"Background The proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers (primary care physicians (PCPs)), especially in LMICs, are often not equipped to handle survivorship care. This study aimed to assess knowledge, and attitude among trainee healthcare providers concerning major issues of paediatric survivorship care. Methods A multi-centre, cross-sectional, questionnaire-based study was conducted among nursing and medical undergraduate students, and postgraduate medical residents across three tertiary-care teaching hospitals in India—All India Institute of Medical Sciences, New Delhi; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry; and Maulana Azad Medical College, New Delhi. A questionnaire with total of 24 questions (14 knowledge-based and 10 attitude-based) was finalised after validation by expert review and piloting. The major domains covered in the questionnaire included knowledge and attitude regarding long-term adverse effects and psychosocial, employment-related issues faced by the survivors. It was administered to the study participants electronically. The knowledge-based questions had true/false responses (scored as 0 or 1 if incorrect or correct, respectively). Attitude-based questions were scored as 5-point Likert scale. Results Total 898 responses were collected (median age: 21 years, 64% (576/898) female). Among the respondents, 44% were undergraduate medical students, 42% were nursing students and 14% were postgraduate medical residents. The mean (SD) of knowledge score was 8.72 (2.04) (out of 14). On multivariable analysis, only discipline of training predicted knowledge scores regarding survivorship care. Postgraduate medical residents (9.08) as well as undergraduate medical students (8.85), had significantly higher mean knowledge scores than nursing students (8.47) (p=0.004). Two questions were answered incorrectly by the majority; children and siblings of CCS need additional genetic screening (79% incorrectly answered true), and CCS face intimacy issues in relation to normal sexual functioning (59% incorrectly answered false). Nearly half (48%) of respondents believed that their knowledge of cancer survivorship issues was inadequate. Majority of respondents (84%) suggested that oncologists should handle long-term survivorship care rather than PCPs. Conclusion Trainee healthcare providers in India reported inadequate knowledge regarding survivorship care. Improving awareness by incorporating survivorship in teaching curriculum is imperative to equip future PCPs to provide survivorship care across the country.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine V: ways of thinking—honing the therapeutic self","authors":"W. Ventres, Leslie A Stone, Johanna F Shapiro, Cynthia Haq, Jéssica R B Leão, Donald E. Nease, Liz Grant, Stewart W Mercer, John Gillies, P. G. Blasco, M. D. de Benedetto, G. Moreto, M. Levites, J. DeVoe, William R. Phillips, Jane M Uygur, T. R. Egnew, Colette S Stanley","doi":"10.1136/fmch-2024-002792","DOIUrl":"https://doi.org/10.1136/fmch-2024-002792","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘V: ways of thinking—honing the therapeutic self’, authors present the following sections: ‘Reflective practice in action’, ‘The doctor as drug—Balint groups’, ‘Cultivating compassion’, ‘Towards a humanistic approach to doctoring’, ‘Intimacy in family medicine’, ‘The many faces of suffering’, ‘Transcending suffering’ and ‘The power of listening to stories.’ May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}