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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Adverse Childhood Experiences and Social Risks Screening in Adult Primary Care.","authors":"India Gill, Ariana Thompson-Lastad, Denise Ruvalcaba, Laura M Gottlieb, Danielle Hessler Jones","doi":"10.3122/jabfm.2024.240170R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240170R1","url":null,"abstract":"<p><strong>Background: </strong>In 2020, the state of California started financially incentivizing primary care practices to screen for adverse childhood events (ACEs). In its current Medicaid 1115 waiver, the state also has encouraged health care teams to screen for social risks (SR) - (eg, food, housing, and transportation insecurity). In this qualitative study, we explore community health center (CHC) staff and patient perspectives about opportunities and barriers to integrating adult screening for ACEs and SR.</p><p><strong>Methods: </strong>We identified eligible California CHCs through Medicaid claims data on ACEs screening and/or participation in ACEs or SR-related learning collaboratives. Staff and/or patients in 12 clinics participated in semistructured interviews exploring opportunities and barriers to integrated ACEs and SR screening. Interviews were analyzed using a rapid qualitative data analysis approach.</p><p><strong>Results: </strong>Thirty-nine clinic staff (including clinic leaders, allied health professionals, licensed clinicians) and 10 patients participated. While staff and patients often conceptually endorsed integrated ACEs and SR screening, they identified substantial practical barriers to integration. Barriers primarily related to different screening frequencies and workflows. Other barriers reflected broader primary care time constraints and workforce shortages. Participants shared multiple recommendations to improve screening programs, including strategies for combining ACEs and SR screening.</p><p><strong>Discussion: </strong>California CHC staff and patients described several conceptual benefits of integrating ACEs and SR screening, but longstanding primary care challenges make it complicated to integrate these activities. Standardizing the integration of ACEs and SR screening will require institutional and structural shifts to overcome common barriers to providing whole person care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789403","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":"Clusters of Health-Related Social Needs Among Adult Primary Care Patients.","authors":"Joshua R Vest, Wei Wu, Kyaien Conner","doi":"10.3122/jabfm.2024.240173R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240173R1","url":null,"abstract":"<p><strong>Introduction: </strong>Patients frequently report multiple health-related social needs (HRSNs) at the same time. This study aimed to identify clusters of co-occurring HRSNs in an adult primary care population.</p><p><strong>Methods: </strong>We surveyed 1252 adult (>=18) primary care patients in Indianapolis, IN. Subjects completed surveys in person at 1 of 3 sites operated by 2 different health systems. Data collection was offered in both English and Spanish. Surveys comprised previously published and validated instruments covering housing instability, financial strain, food insecurity, transportation barriers, unemployment, and legal problems.</p><p><strong>Results: </strong>We identified 4 underlying clusters of HRSNs within the patient population using Complete-Linkage Agglomerative Hierarchical Clustering: \"low HRSNs\" (38.6%), \"high HRSNs\" (29.6%), \"housing dominant\" (23.2%), and \"food dominant\" (8.6%). The high HRSNs cluster had higher average comorbidity scores (<i>P</i> < .001), number of inpatient admissions (<i>P</i> = .004), number of ED visits (<i>P</i> < .001), and number of primary care visits (<i>P</i> < .001).</p><p><strong>Discussion: </strong>As health care organizations increasingly focus on HRSNs as an approach to reducing costs and improving health of patients, these findings indicate that organizational strategies and actions should consider the interrelated and co-occurring nature of HRSNs. To support a large number of patients, strategies should support multiple HRSNs.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789401","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":"Associations Between Modifiable Preconception Care Indicators and Pregnancy Outcomes.","authors":"Ashwini Kamath Mulki, Melanie B Johnson, Nicole M Burgess, Kyle Shaak, Katie Nisbett, Katarzyna Jabbour, Roya Hamadani, Beth Careyva","doi":"10.3122/jabfm.2024.240133R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240133R1","url":null,"abstract":"<p><strong>Purpose: </strong>This study explored gaps and opportunities in preconception care with a focus on determining whether modifiable preconception care indicators are associated with preterm births.</p><p><strong>Methods: </strong>This retrospective case-control study explored prepregnancy data of patients ≥18 years old who delivered preterm (cases) versus full term (controls) between June 1, 2018, and May 31, 2019, at a health care network in Pennsylvania. Cases were matched 1:2 with controls based on age, parity, and history of preterm delivery. A literature review yielded 11 key indicators of quality preconception care. Documentation of counseling on these indicators were extracted from patient charts from their most recent primary care visit before pregnancy (preconception care) and their pregnancy intake visit (prenatal care). Bivariate analyses were used to assess whether any of the 11 preconception indicators were associated with preterm birth. All analyses were conducted using SPSS statistical software.</p><p><strong>Results: </strong>Our sample included 663 patient charts: 221 preterm births and 442 term births. Elevated blood pressure (>120/80) in the preconception period (Odds Ratio [OR] = 1.84) and at the prenatal intake visit (OR = 1.68) was significantly associated with preterm birth. In addition, patients with Body Mass Index (BMI) ≤18 or ≥30 at their prenatal visit were nearly twice as likely (OR = 1.85) to have pregnancies resulting in preterm birth.</p><p><strong>Conclusions: </strong>Our study highlights BMI and Blood Pressure (BP) as key focus points for preconception counseling. Additional studies are needed to determine whether pregnancy outcomes other than preterm birth may be influenced by these and other preconception care indicators.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789400","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":"Answering the \"100 Most Important Family Medicine Research Questions\" from the 1985 Hames Consortium.","authors":"Christy J W Ledford, Jacqueline B Britz, Melinda L McKew, Mia V von Gal, Neha Balachandran, L A Middleton, Dean A Seehusen","doi":"10.3122/jabfm.2024.240130R1","DOIUrl":"10.3122/jabfm.2024.240130R1","url":null,"abstract":"<p><strong>Introduction: </strong>The 1985 Hames Consortium convened family medicine researchers to identify outstanding questions in their practice.</p><p><strong>Method: </strong>In this descriptive review, we collected, codified, and analyzed available literature to describe the availability of evidence to answer these questions.</p><p><strong>Results: </strong>Of 136 total questions, researchers rated 33 questions as not at all answered (24.2%), 49 questions as somewhat answered (36.0%), 37 as mostly answered (27.2%), and 17 as fully answered - will implement in practice (12.5%). Notably, 2 of the categories with the highest number of total questions, community oriented primary care and the value of comprehensive care, had the highest percentage of unanswered questions.</p><p><strong>Discussion: </strong>The Hames 100 questions and categories themselves demonstrate the values and purpose of family medicine research and can serve as a powerful tool to discuss the future of family medicine research. The varied questions illustrate the broad scope of interest of family physicians in 1985, which remains just as relevant today. Our findings indicate that relatively few questions were fully answered, with even fewer questions answered in family medicine journals.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"S106-S121"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640120","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":"Current and Future Challenges to Publishing Family Medicine Research.","authors":"Dean A Seehusen, Sarina B Schrager, Sumi M Sexton","doi":"10.3122/jabfm.2023.230438R1","DOIUrl":"10.3122/jabfm.2023.230438R1","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"S80-S84"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640123","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":"Past Is Prologue: The Essential Role of Advocacy in Shaping the Future of Family Medicine Research.","authors":"Winston Liaw, Sebastian T Tong, Nina DeJonghe, Hope R Wittenberg","doi":"10.3122/jabfm.2023.230407R1","DOIUrl":"10.3122/jabfm.2023.230407R1","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"S92-S95"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640128","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":"Team Science in Family Medicine Research.","authors":"Arch G Mainous","doi":"10.3122/jabfm.2023.230437R1","DOIUrl":"10.3122/jabfm.2023.230437R1","url":null,"abstract":"<p><p>Collaboration, particularly interdisciplinary collaboration, is very common in family medicine research. Interdisciplinary collaboration and team science are encouraged and have significant advantages but they also have challenges to implementation. Addressing those challenges, even with changes to how promotion and tenure are conceptualized to reward team science is necessary for family medicine research to continue to grow and prosper.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"S56-S58"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640130","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":"Diversity in Family Medicine Research.","authors":"Santina J G Wheat, José E Rodríguez","doi":"10.3122/jabfm.2024.240082R1","DOIUrl":"10.3122/jabfm.2024.240082R1","url":null,"abstract":"<p><p>In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, \"Grow the family medicine research workforce by expanding pathways and strengthening mentorship,\" the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, \"Increase funding for family medicine research and advocate for enhanced health policy and support,\" the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, \"Build a national infrastructure for organizing and optimizing family medicine research opportunities,\" the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"S64-S68"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640124","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}