Journal of the American Board of Family Medicine最新文献_第10页

Caregiving Responsibilities, Organizational Policy, and Burnout Among Primary Care Clinicians and Staff. 初级保健临床医生和工作人员的护理责任、组织政策和职业倦怠。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-09-01 DOI: 10.3122/jabfm.2024.240011R1

Rachel Willard-Grace, Eric McNey, Beatrice Huang, Kevin Grumbach

{"title":"Caregiving Responsibilities, Organizational Policy, and Burnout Among Primary Care Clinicians and Staff.","authors":"Rachel Willard-Grace, Eric McNey, Beatrice Huang, Kevin Grumbach","doi":"10.3122/jabfm.2024.240011R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240011R1","url":null,"abstract":"Background: Health care workers with responsibilities caring for dependent adults or children outside of work may be particularly vulnerable to burnout. We examined the relationship between gender, caregiving, and burnout among primary care clinicians and staff in the context of the COVID-19 pandemic.Methods: Longitudinal cohort study using survey data collected in February 2020 and May 2021 from primary care clinicians and staff in a university-based health system. The association between gender, caregiving hours, and perceived workplace support for caregiving responsibilities on the outcome of emotional exhaustion was tested using linear models with fixed effects.Results: The response rate for the survey was 76% for clinicians and 90% for staff in February 2020% and 70% for clinicians and 85% for staff in March 2021. Respondents included 336 clinicians and staff, with 77% identifying as female. Female clinicians reported greater emotional exhaustion than male clinicians in 2021. Female gender, more caregiving hours, and lower workplace support were associated with higher clinician burnout. In longitudinal analysis for clinicians, hours of caregiving but not work supportiveness was associated with an increase in emotional exhaustion from 2020 to 2021. For staff, supportiveness of the workplace for caregiving responsibilities, but not gender or caregiving hours, was associated with lower exhaustion in 2021 and was protective against increased exhaustion from 2020 to 2021.Conclusions: Beyond the acute stressors of the COVID-19 pandemic, ensuring the sustainability of a health care workforce that shoulders caregiving responsibility requires policies and operational models that adequately support workers with high caregiving responsibilities and work supports that encourage workers to take full advantage of the accommodations for which they are eligible.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 5","pages":"847-856"},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469221","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}

引用次数: 0

Treatment of Vasomotor Symptoms. 血管舒缩症状的治疗

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-09-01 DOI: 10.3122/jabfm.2023.230408R1

Karina Atwell, Morgan White, Greta Kuphal, Makeba Williams, Sarina Schrager

引用次数: 0

Benefits of Testosterone Replacement Therapy in Hypogonadal Males. 睾酮替代疗法对性腺功能低下男性的益处。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-09-01 DOI: 10.3122/jabfm.2024.240025R1

Kelli M Blackwell, Hannah Buckingham, Krishna K Paul, Hamza Uddin, Dietrich von Kuenssberg Jehle, Thomas A Blackwell

{"title":"Benefits of Testosterone Replacement Therapy in Hypogonadal Males.","authors":"Kelli M Blackwell, Hannah Buckingham, Krishna K Paul, Hamza Uddin, Dietrich von Kuenssberg Jehle, Thomas A Blackwell","doi":"10.3122/jabfm.2024.240025R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240025R1","url":null,"abstract":"Importance: Hypogonadism is defined by consistently low serum testosterone levels in conjunction with clinical symptoms. Testosterone replacement therapy (TRT) can be used to achieve physiologic levels of testosterone. Testosterone deficiency is associated with increased mortality and poorer health outcomes.Purpose: To compare rates of mortality, atrial fibrillation (AF), stroke, myocardial infarction (MI), and prostate cancer in hypogonadal men who received TRT versus those who did not.Methods: The TriNetX database was utilized to access deidentified, retrospective propensity matched EMR data from 57 participating health care organizations between 2005 to 2020. Cohorts included males 40 to 80 years old diagnosed with hypogonadism who were prescribed TRT versus no TRT. Propensity matching was performed to reduce bias and balance confounding factors between the 2 groups. The following 3-year outcomes were analyzed: mortality, AF, stroke, MI, and prostate cancer.Results: There were 163,456 male patients identified with hypogonadism, and 133,584 were included after propensity matching. There was a lower mortality rate, (3.1% vs 3.6%; RR, 0.886; P < .001), decreased risk of AF (3.6% vs 4.0%; RR 0.900; P < .001), less stroke (1.6% vs 1.8%; RR, 0.898; P < .011), and fewer cases of prostate cancer (1.9% vs 2.9%; RR 0.648; P < .001) for patients on TRT.Conclusions: Using TRT is associated with moderately lower rates of mortality, atrial fibrillation, stroke, and prostate cancer in hypogonadal men versus no TRT. There is potential for missed cases of stroke, prostate cancer, and cardiovascular disease incidence not captured by the database. As prescriptions of TRT increase, understanding risks and benefits will help guide future practice.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 5","pages":"816-825"},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469812","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}

引用次数: 0

Opioid Dose Reductions by Sex and Race in a Cohort of Patients in a Family Medicine Clinic. 按性别和种族分列的全科诊所患者阿片类药物剂量减少情况。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-08-14 DOI: 10.3122/jabfm.2023.230220R2

Mechelle Sanders, Kevin Fiscella, Mathew Devine, Jefferson Hunter, Yasin Mohamed, Colleen T Fogarty

{"title":"Opioid Dose Reductions by Sex and Race in a Cohort of Patients in a Family Medicine Clinic.","authors":"Mechelle Sanders, Kevin Fiscella, Mathew Devine, Jefferson Hunter, Yasin Mohamed, Colleen T Fogarty","doi":"10.3122/jabfm.2023.230220R2","DOIUrl":"10.3122/jabfm.2023.230220R2","url":null,"abstract":"Background: The 2022 Centers for Disease Control's \"Clinical Practice Guidelines for Prescribing Opioids for Pain in United States\" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients' race and sex.Methods: We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME's and logistic regression to determine associations between patient characteristics and MME changes.Results: Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME's at baseline compared with their White men counterparts, P = .04.Discussion: Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"383-388"},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472101","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}

引用次数: 0

Families' Perspectives on Social Services Navigation After Pediatric Urgent Care. 家庭对儿科急诊后社会服务导航的看法。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-08-14 DOI: 10.3122/jabfm.2023.230232R2

Alison Aronstam, Denisse Velazquez, Holly Wing, Danielle Hessler, Victoria F Keeton, Karen Sokal-Gutierrez, Laura M Gottlieb

{"title":"Families' Perspectives on Social Services Navigation After Pediatric Urgent Care.","authors":"Alison Aronstam, Denisse Velazquez, Holly Wing, Danielle Hessler, Victoria F Keeton, Karen Sokal-Gutierrez, Laura M Gottlieb","doi":"10.3122/jabfm.2023.230232R2","DOIUrl":"10.3122/jabfm.2023.230232R2","url":null,"abstract":"Background: Interest is growing in clinic-based programs that screen for and intervene on patients' social risk factors, including housing, food, and transportation. Though several studies suggest these programs can positively impact health, few examine the mechanisms underlying these effects. This study explores pathways through which identifying and intervening on social risks can impact families' health.Methods: This qualitative study was embedded in a randomized clinical trial that examined the health impacts of participation in a social services navigation program. We conducted semi-structured interviews with 27 English or Spanish-speaking caregivers of pediatric patients who had participated in the navigation program. Interviews were analyzed using thematic analysis.Results: Caregivers described 3 pathways through which the navigation program affected overall child and/or caregiver health: 1) increasing families' knowledge of and access to social services; 2) helping families connect with health care services; and 3) providing emotional support that reduced caregiver isolation and anxiety. Participants suggested that navigation programs can influence health even when they do not directly impact resource access.Discussion: Social care programs may impact health through multiple potential pathways. Program impacts seem to be mediated by the extent to which programs increase knowledge of and access to social and health care services and support positive relationships between families and program personnel.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"479-486"},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472088","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}

引用次数: 0

Adjusting Clinical Plans Based on Social Context. 根据社会背景调整临床计划。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-08-14 DOI: 10.3122/jabfm.2023.230289R1

Emilia H De Marchis, Benjamin Aceves, Na'amah Razon, Rosy Chang Weir, Michelle Jester, Laura M Gottlieb

{"title":"Adjusting Clinical Plans Based on Social Context.","authors":"Emilia H De Marchis, Benjamin Aceves, Na'amah Razon, Rosy Chang Weir, Michelle Jester, Laura M Gottlieb","doi":"10.3122/jabfm.2023.230289R1","DOIUrl":"10.3122/jabfm.2023.230289R1","url":null,"abstract":"Background: Social risk data collection is expanding in community health centers (CHCs). We explored clinicians' practices of adjusting medical care based on their awareness of patients' social risk factors-that is, changes they make to care plans to mitigate the potential impacts of social risk factors on their patients' care and health outcomes-in a set of Texas CHCs.Methods: Convergent mixed methods. Surveys/interviews explored clinician perspectives on adjusting medical care based on patient social risk factors. Survey data were analyzed with descriptive statistics; interviews were analyzed using thematic analysis and inductive coding.Results: Across 4 CHCs, we conducted 15 clinician interviews and collected 97 surveys. Interviews and surveys overall indicated support for adjustment activities. Two main themes emerged: 1) clinicians reported making frequent adjustments to patient care plans based on their awareness of patients' social contexts, while simultaneously expressing concerns about adjustment; and 2) awareness of patients' social risk factors, and clinician time, training, and experience all influenced clinician adjustments.Conclusions: Clinicians at participating CHCs described routinely adjusting patient care plans based on their patients' social contexts. These adjustments were being made without specific guidelines or training. Standardization of adjustments may facilitate the contextualization of patient care through shared decision making to improve outcomes.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"466-478"},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472086","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}

引用次数: 0

Implementation Strategies Used by Facilitators to Improve Control of Cardiovascular Risk Factors in Primary Care. 促进者为改善初级保健中对心血管风险因素的控制而采用的实施策略。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-08-14 DOI: 10.3122/jabfm.2023.230312R1

Allison M Cole, Gina A Keppel, Laura-Mae Baldwin, Erika Holden, Michael Parchman

{"title":"Implementation Strategies Used by Facilitators to Improve Control of Cardiovascular Risk Factors in Primary Care.","authors":"Allison M Cole, Gina A Keppel, Laura-Mae Baldwin, Erika Holden, Michael Parchman","doi":"10.3122/jabfm.2023.230312R1","DOIUrl":"10.3122/jabfm.2023.230312R1","url":null,"abstract":"Background: Practice facilitation supports practice change in clinical settings. Despite its widespread use little is known about how facilitators enable change.Objective: This study identifies which implementation strategies practice facilitators used and the frequency of their use in a study to improve the quality of cardiovascular care in primary care.Design: Cross-sectional analysis of data collected by practice facilitators in the Healthy Hearts Northwest (H2N) study.Participants: Notes collected by facilitators in the H2N study.Approach: We coded these field notes for a purposeful sample of 44 practices to identify Expert Recommendations for Implementation Change (ERIC) strategies used with each practice and calculated the proportion of practices where each implementation strategy was coded at least once. Strategies were categorized as foundational (used in 80% to 100% of practices), moderately used (20%-<80% of practices), rarely used (1-[Formula: see text]% of practices), or absent (0%).Key results: We identified 26 strategies used by facilitators. Five strategies were foundational: Develop and/or implement tools for quality monitoring, Assess barriers that may impede implementation, Assess for readiness or progress, Develop and support teams, and Conduct educational meetings.Conclusions: Commonly used strategies can help guide development of the core components of practice facilitation strategies.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"444-454"},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472100","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}

引用次数: 0

Barriers and Facilitators to Using a Clinical Decision Support Tool for Opioid Use Disorder in Primary Care. 在初级医疗中使用阿片类药物使用障碍临床决策支持工具的障碍和促进因素。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-08-14 DOI: 10.3122/jabfm.2023.230308R1

Stephanie A Hooker, Leif I Solberg, Kathleen M Miley, Caitlin M Borgert-Spaniol, Rebecca C Rossom

{"title":"Barriers and Facilitators to Using a Clinical Decision Support Tool for Opioid Use Disorder in Primary Care.","authors":"Stephanie A Hooker, Leif I Solberg, Kathleen M Miley, Caitlin M Borgert-Spaniol, Rebecca C Rossom","doi":"10.3122/jabfm.2023.230308R1","DOIUrl":"10.3122/jabfm.2023.230308R1","url":null,"abstract":"Purpose: Clinical decision support (CDS) tools are designed to help primary care clinicians (PCCs) implement evidence-based guidelines for chronic disease care. CDS tools may also be helpful for opioid use disorder (OUD), but only if PCCs use them in their regular workflow. This study's purpose was to understand PCC and clinic leader perceptions of barriers to using an OUD-CDS tool in primary care.Methods: PCCs and leaders (n = 13) from clinics in an integrated health system in which an OUD-CDS tool was implemented participated in semistructured qualitative interviews. Questions aimed to understand whether the CDS tool design, implementation, context, and content were barriers or facilitators to using the OUD-CDS in primary care. Recruitment stopped when thematic saturation was reached. An inductive thematic analysis approach was used to generate overall themes.Results: Five themes emerged: (1) PCCs prefer to minimize conversations about OUD risk and treatment; (2) PCCs are enthusiastic about a CDS tool that addresses a topic of interest but lack interest in treating OUD; (3) contextual barriers in primary care limit PCCs' ability to use CDS to manage OUD; (4) CDS needs to be simple and visible, save time, and add value to care; and (5) CDS has value in identifying and screening patients and facilitating referrals.Conclusions: This study identified several factors that impact use of an OUD-CDS tool in primary care, including PCC interest in treating OUD, contextual barriers, and CDS design. These results may help others interested in implementing CDS for OUD in primary care.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"389-398"},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472087","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}

引用次数: 0

Be SMART About Asthma Management: Single Maintenance and Reliever Therapy. 哮喘管理要SMART：单一维持和缓解疗法

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-07-01 DOI: 10.3122/jabfm.2023.230456R1

Alexander F Infante, Christina Wells, Julie Loza, Keia Hobbs, Jennie B Jarrett, Abigail T Elmes

引用次数: 0

Potential Drawbacks of Noninvasive Diagnostic Methods for Nonalcoholic Fatty Liver Disease. 非酒精性脂肪肝无创诊断方法的潜在缺点。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-07-01 DOI: 10.3122/jabfm.2023.230005R2

Yasir M Khayyat

{"title":"Potential Drawbacks of Noninvasive Diagnostic Methods for Nonalcoholic Fatty Liver Disease.","authors":"Yasir M Khayyat","doi":"10.3122/jabfm.2023.230005R2","DOIUrl":"10.3122/jabfm.2023.230005R2","url":null,"abstract":"The rising obesity epidemic is a phenomenon that has gained increasing attention from health providers and health policy makers. This led to recognition of nonalcoholic fatty liver disease (MASLD). The standard for its assessment has been histologic, which is neither practical nor acceptable by patients. Subsequently, a number of noninvasive assessment methods have been developed. However, despite ease of implementation, their confounding variables do hinder their accuracy. Nonetheless, the development of the liver stiffness measurement (LSM) and incorporation of other biological parameters has minimized but not eliminated the need for liver biopsy. Imaging methods are useful in evaluation, estimation, and following the progression of steatosis and fibrosis with particular attention to controlled attenuation parameter (CAP) and MRI-Proton Density Fat Fraction (MRI-PDFF). The choices for the family physician are broad and rely on tests' availability, cost, and patient acceptance. Great efforts have been undertaken to produce more robust and novel noninvasive markers that indicate fibrinogenesis directly in an implementable and cost-effective way.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 4","pages":"753-772"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512067","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}

引用次数: 0