Journal of the American Board of Family Medicine最新文献

{"title":"Regional Variation in Scope of Practice by Family Physicians.","authors":"Alyssa Lambert, Sarah E Fleischer, Omer Atac, Andrew Bazemore, Lars E Peterson","doi":"10.3122/jabfm.2024.240201R1","DOIUrl":"10.3122/jabfm.2024.240201R1","url":null,"abstract":"<p><strong>Introduction: </strong>Geographic variation in physician scope of practice (SOP) has been documented but the causes remain unknown. We examined whether geographic variation in family physician (FP) SOP is explained by differences in the characteristics of the FPs, their practices, practice environment, or health care market.</p><p><strong>Methods: </strong>We utilized 2 datasets from the American Board of Family Medicine (ABFM) from 2017 to 2022. The National Graduate Survey captures early career FPs while the Continuous Certification Questionnaire is administered to mid to late career FPs. We used a SOP score that ranges from 0 to 30 with a larger score reflecting a broader SOP. Bivariate analyses assessed for differences by Census division in clinician, practice, community, and health care market characteristics. A series of multilevel linear regression analyses tested if geographic differences in SOP were attenuated by the aforementioned characteristics.</p><p><strong>Results: </strong>Our analytic included 9,378 early career FPs and 28,832 mid to late career FPs in the unadjusted regression model. We found significant differences in clinician characteristics by division and cohort. In unadjusted results, SOP score differed by division and career stage within division (range 11.49 to 14.95 for later career FPs and 15.22 to 17.51 for early career FPs). Adjusting for clinician, practice, community, and health care market characteristics did not attenuate divisional variation in SOP.</p><p><strong>Discussion: </strong>Significant geographic variation in FP SOP was not explainable by adjustment for clinician, practice, community, and health care market characteristics. This suggests that health care variation is multifactorial and will require more multifaceted interventions to ameliorate.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"28-45"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789404","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":"Identifying and Addressing Social Determinants of Health with an Electronic Health Record.","authors":"Oluwatomi Ajibola, Rehab Tabchi, Karen Hepworth, Alycia Walty, Auguste Niyibizi","doi":"10.3122/jabfm.2024.240167R1","DOIUrl":"10.3122/jabfm.2024.240167R1","url":null,"abstract":"<p><strong>Objective: </strong>The benefits of Social Determinants of Health (SDoH) is well documented but several studies highlight the complexity of collecting and standardizing SDoH data in a way that makes it relevant to the standard clinical interaction. The purpose of this study is to examine how leveraging an Electronic Health Record (EHR) system can facilitate SDoH screening and its integration into Primary Care encounters, while also using the data collected to meet the identified needs.</p><p><strong>Methods: </strong>This is an observational study design. EHR and SDoH screening data from 2020 to 2023 at 3 primary care sites were gathered. The study was implemented in 3 phases to streamline and establish the screening and referral processes.</p><p><strong>Results: </strong>SDoH screening increased by 95% from 2020 to 2022 with a consequent increase in social work referrals and the allocation of resources to a targeted patient population.</p><p><strong>Conclusion: </strong>Identifying SDoH unique to a community or population can be strategically used to deliver relevant and timely services to patients. This fosters a multidisciplinary, collaborative and integrated approach to patient care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"9-14"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039821","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":"A Pilot Comparison of Clinical Data Collection Methods Using Paper, Electronic Health Record Prompt, and a Smartphone Application.","authors":"Meagan E Stabler, John M Westfall, Donald E Nease, Jennifer Raymond, Bruce Jobse, Zoe Daudier, Laurie Emanuele, Elisabeth Wilson, Maureen Boardman, Neil Korsen, Charles D MacLean, Constance van Eeghen, Paula S Hudon, Timothy E Burdick","doi":"10.3122/jabfm.2024.240199R1","DOIUrl":"10.3122/jabfm.2024.240199R1","url":null,"abstract":"<p><strong>Background: </strong>For decades, researchers have utilized paper card studies to assess primary care clinician (PCC) perceptions across various clinical and practice topics. Since 2022, cards can be completed electronically through the electronic health record (EHR) or a novel smartphone application (app). These delivery modalities have not previously been evaluated head-to-head. We report findings from a work in progress comparing paper, EHR, and app-delivered cards.</p><p><strong>Methods: </strong>The Northern New England CO-OP Practice and Community Based Research Network recruited 15 PCCs from 3 clinics to collect a total of 324 cards from unique patient visits over 4 clinical days per PCC on the topic of \"telehealth burden.\" Each clinic utilized a different data collection modality and collected approximately 100 cards. After completing the cards, we surveyed PCCs about their user experience. Our primary outcomes were PCC experience, card completion rates, and total cost of using the cards.</p><p><strong>Results: </strong>PCCs reported that data collection was easy and the card study did not disrupt clinical operations regardless of modality. Paper cards had the highest completion rate and were least expensive for a small-scale card study, but were most expensive when scaled due to the large amount of time to transcribe data manually. EHR was the most expensive modality for a small-scale card study, but EHR and app cards scaled better than paper.</p><p><strong>Conclusions: </strong>While each modality has distinct advantages and disadvantages, all 3 card study data collection methods were acceptable to PCCs and obtained a high response rate.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"46-55"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056577","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":"Maternity Care Deserts: Key Drivers of the National Maternal Health Crisis.","authors":"Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen","doi":"10.3122/jabfm.2024.240198R1","DOIUrl":"10.3122/jabfm.2024.240198R1","url":null,"abstract":"<p><p>Maternal care deserts, defined as counties where there are no hospitals offering obstetric services or birth centers and no obstetricians, gynecologists, or certified nurse midwives, have a significant adverse effect on the quality of maternity care afforded women in the United States, especially Black women and women in rural areas. The maternal mortality rate for Black women in 2022 was 2.6 times higher than the rate for White women. The rate in the most rural counties is 1.6 times higher than the rate in large metropolitan counties. Across the nation, 36% of all US counties qualify as maternal care deserts, contributing to the country's poor placement globally among high-income nations. A recent report by the March of Dimes draws attention to the crisis in maternal health care. A number of interventions have been proposed by federal government entities to address the persistent problem. Family physicians in particular have a potential role in improving the situation as they represent the broadest geographic coverage of all maternity care providers.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"165-167"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022732","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":"Empowering Family Physicians in Medical Staff Leadership to Foster Physician Well-Being.","authors":"Megan R Mahoney, Edward Damrose, Tait Shanafelt","doi":"10.3122/jabfm.2024.240136R1","DOIUrl":"10.3122/jabfm.2024.240136R1","url":null,"abstract":"<p><p>In the evolving landscape of health care, marked by increasing physician distress, the role of family physicians in leadership positions emerges as crucial for driving systemic improvements. Drawing from 9 years of collective experience as chiefs of staff, this commentary outlines a framework for family physicians serving in the Chief of Staff, Medical Staff President role or other physician executive positions aimed at improving physician well-being. Recognizing the comprehensive scope of practice and team-based orientation of family medicine, we highlight the unique capabilities of family physicians to foster organizational changes that address the root causes of physician burnout. The proposed framework emphasizes the importance of effective communication channels to ensure the medical staff's voices are heard and valued. It advocates for physician-centered approaches to credentialing and privileging processes, equitable incident reporting systems, and supportive measures for physicians facing professional challenges. By implementing a wellness-oriented framework, healthcare organizations can safeguard the future of the medical profession and create a healthcare system that prioritizes the well-being of both patients and clinicians.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"168-171"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995956","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":"Interpretating Normal Values and Reference Ranges for Laboratory Tests.","authors":"Nancy Doles, May Ye Mon, Arika Shaikh, Samantha Mitchell, Disha Patel, Dean Seehusen, Gurmukh Singh","doi":"10.3122/jabfm.2024.240224R1","DOIUrl":"10.3122/jabfm.2024.240224R1","url":null,"abstract":"<p><p>Laboratory test results drive about 70% of clinical decisions and are important in making diagnosis, prognosis, ruling out conditions, testing for propensity to disease and monitoring the course of illnesses. The requirement for releasing laboratory results to patients has altered the dynamics of doctor patient interaction. Minor variations in laboratory test results that are labeled by the laboratory as low/high/abnormal may cause unwarranted worry to the patients. The number of laboratory results that are outside the \"normal range\" far exceeds the clinically meaningful abnormal results due to the usually accepted methodology for ascertaining \"normal values\"/reference ranges, variations in methods of testing at different laboratories, variations due to age, gender, ethnicity, seasonality, and random variations. The usual process for establishing \"normal values/reference ranges\" entails testing at least 120 healthy individuals in a given age-group, gender, ethnicity, testing method and related health issues. The central 95% of the values is usually adopted as the normal range. This practice, by definition, labels 5% of healthy individuals as having abnormal laboratory results. This review addresses various issues that affect laboratory test results and interpretation of such results. It also addresses doctor and patient concerns about assessing and reporting laboratory results. In addition to reporting normal values along with patient results, it may be useful to include clinical significance of the findings, in simple terms, such as, no immediate concern, warrants discussion with doctor at the next visit, recommend contacting your doctor for further action.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"174-179"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059485","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":"To Feel Again: The Strength of a Support Community.","authors":"Angela Renee Rodgers","doi":"10.3122/jabfm.2024.240117R1","DOIUrl":"10.3122/jabfm.2024.240117R1","url":null,"abstract":"<p><p>Health care professionals are known to prioritize the health of others over themselves. The culture of medicine incentivizes this idea of putting all others first before ourselves. This habit makes physicians with chronic disease less likely to address the psychosocial aspect of how their chronic disease impacts their life. Psychosocial impact of chronic disease can include feelings such as isolation, shame, a false sense of contentment or even depression and anxiety among others. Routinely connecting with those with shared diagnoses offers validation, support, and a sense of freedom. As a woman of color with autoimmune hair loss (alopecia areata), Dr. Angela Rodgers shares her experience attending Baldie Con in 2023, a new national conference for women with various types of hair loss. She reveals how the experience unearthed truths about the relationship between physicians and their diagnoses and provides evidence-based advice on how to stay connected with community.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"172-173"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036786","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":"Hepatitis C Treatment Knowledge, Attitudes, and Practices Among Primary Care Providers-Los Angeles County, 2023.","authors":"Katherine A Loomis, Debika Bhattacharya, Raiza Amiling, Mirna Ponce-Jewel, Michael E Lazarus, Gus Chavez, Prabhu Gounder","doi":"10.3122/jabfm.2024.230354R0","DOIUrl":"10.3122/jabfm.2024.230354R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"192"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038421","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":"Insurance Instability Among Community-Based Health Center Patients with Diabetes Post-Affordable Care Act Medicaid Expansion.","authors":"Leo Lester, Dang Dinh, Annie E Larson, Andrew Suchocki, Miguel Marino, Jennifer DeVoe, Nathalie Huguet","doi":"10.3122/jabfm.2024.240186R1","DOIUrl":"10.3122/jabfm.2024.240186R1","url":null,"abstract":"<p><strong>Background: </strong>To evaluate insurance instability (churn) among adults with diabetes receiving care at community-based health centers (CHCs).</p><p><strong>Methods: </strong>Retrospective cohort study using patients' electronic health records data for 300,158 adults aged 19 to 64 with ≥3 ambulatory visits between 2014 and 2019 of which 39,542 churned out of insurance. Generalized estimating equation-based (GEE) logistic regression models were fitted to assess the odds of churning.</p><p><strong>Results: </strong>Among CHC patients, those with diabetes had 1.25 greater odds of churning than those without diabetes (aOR = 1.25; 95%CI = 1.18, 1.33). Among CHC patients with diabetes, the odds of churning were higher for those with uncontrolled diabetes, more complex medication regimens, and acute diabetes complication.</p><p><strong>Conclusions: </strong>CHC patients with diabetes are more likely to experience insurance instability than those without diabetes. Outreach efforts to reduce the impact of the postpandemic Medicaid disenrollment among patients with diabetes and lower income will be critical to reduce harmful health consequences.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"154-164"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789402","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":"Factors Influencing Changing Scopes of Practice Among Contemporary Graduates of the Nation's Largest Family Medicine Residency.","authors":"Nicholas LeFevre, Richard A Young","doi":"10.3122/jabfm.2024.240172R1","DOIUrl":"10.3122/jabfm.2024.240172R1","url":null,"abstract":"<p><strong>Background: </strong>John Peter Smith (JPS) Hospital Family Medicine Residency participated in both the P4 (Preparing the Personal Physician for Practice) and LOT (Length of Training) projects, and is known for its emphasis on preparing physicians for full-scope practice. Scope of practice outcomes among graduates of these programs are previously described, but how and why the scope of practice of these physicians change in their early career merits further exploration.</p><p><strong>Methods: </strong>A structured questionnaire was sent to all JPS graduates who matriculated as interns in the years 2007 to 2016 with information on cognitive and procedural scope of practice. Graduates were asked about their scope of practice both in their initial jobs out of residency and their current jobs. They were also asked about the forces affecting their scope of practice with both structured and open-ended questions. Responses were analyzed quantitatively and through qualitative thematic analysis.</p><p><strong>Results: </strong>A total 184 graduates provided information about practice scope. Graduates stopped providing inpatient care for children (9.2%), prenatal care (8.8%), long-acting reversible contraception (7.8%), ICU care of adults (7.8%), joint injections (7.4%), and inpatient care of adults (6.9%) at the highest rates between initial and current jobs. Scope of practice changes over time found to be statistically significant included inpatient care of children, ICU care of adults, inpatient care of adults, nursing home, substance use disorder including medication assisted therapy, and obstetric deliveries. The most common reasons for change were personal preference and work-life balance, rather than institutional and related systematic barriers.</p><p><strong>Conclusion: </strong>In the graduates of one institution, it is common for the scope of practice to change over time, both by discontinuing and adding services. Changes seem most driven by choice and work-life balance, rather than outside pressures or a feeling of inadequate preparation for practice.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"133-138"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992757","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}