Journal of the American Board of Family Medicine最新文献

{"title":"Primary Health Care As a Common Good.","authors":"Rebecca S Etz, Kurt C Stange","doi":"10.3122/jabfm.2023.230430R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230430R1","url":null,"abstract":"<p><p>Growing commodification of health care has resulted in a system that is impersonal, fragmented, and inequitable. A potential antidote to this poisonous situation is to understand and treat primary health care as a common good. Common goods are resources supported as essential to the wellbeing of all. They can be actualized through a Collective Impact approach of a developing a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and backbone support organizations. Investing in primary health care as a common good, with investments in primary medical care spending, support, and workforce development, complemented by integrated support of public health and social drivers of health, can launch a transitional period that moves US health care toward greater accessibility, effectiveness, equity, and sustainability.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement1","pages":"S15-S20"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717374","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":"Implications of Sociodemographic and Clinical Factors Associated with Completion of Cardiac Stress Tests.","authors":"Maelys J Amat, Anthony Zhong, Cancan Zhang, Ernest Gervino, Rishi Wadhera, Russell S Phillips","doi":"10.3122/jabfm.2024.240067R1","DOIUrl":"10.3122/jabfm.2024.240067R1","url":null,"abstract":"<p><strong>Background: </strong>Though cardiac stress tests have long been the standard of care for initial evaluation of cardiac symptoms, our institution, along with others, has noted high rates of incomplete tests.</p><p><strong>Objective: </strong>To identify sociodemographic factors associated with the completion of cardiac stress tests and to assess the value of completed tests.</p><p><strong>Design & participants: </strong>We conducted a retrospective chart review evaluating 150 patients with cardiac stress tests orders placed in 1 urban hospital-based primary care practice from 1/1/2018-12/31/2021.</p><p><strong>Main measures: </strong>Our primary outcome was the completion of the stress test. We examined rates of completion based on sociodemographic factors including age, gender, race, language, and social vulnerability, markers of chronic illness, risk of atherosclerotic cardiovascular disease, and pretest probability of coronary artery disease.</p><p><strong>Key results: </strong>In a multivariable adjusted model, female gender (OR:0.43 [0.18-1.00]), Black race (OR:0.26 [0.11-0.61]), and dyslipidemia (OR:0.27 [0.090-0.78]) were associated with lower test completion rates. We found no relationship between the likelihood of test completion and pretest probability. In an analysis of tests with low pretest probability, 100% of low-risk stress tests were negative; had any of those tests been positive the highest positive predictive value would have been 25%.</p><p><strong>Conclusions: </strong>Test completion rates were significantly lower for individuals with female gender, Black race, and a diagnosis of dyslipidemia, highlighting inequities in the completion rates for a potentially lifesaving test. In addition, a substantial number of ordered tests were low risk and low value, highlighting areas of opportunity by advancing the value of cardiovascular care delivered.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1088-1094"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674818","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":"Primary Care's Essential Role in Advancing Health Equity.","authors":"Diane R Rittenhouse, Ann S O'Malley","doi":"10.3122/jabfm.2023.230423R0","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230423R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement1","pages":"S1-S3"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717364","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":"Clinician and Staff Perspectives on a Social Drivers of Health Program Implementation.","authors":"Stacie M Vilendrer, Samuel C Thomas, Kim Brunisholz, Grace Ann Kumar, Ishita Singh, Nancy Song, Raj Srivastava, Sara J Singer","doi":"10.3122/jabfm.2023.230316R2","DOIUrl":"10.3122/jabfm.2023.230316R2","url":null,"abstract":"<p><strong>Introduction: </strong>Health systems are increasingly pursuing efforts to screen for and address social drivers of health (SDOH), the nonmedical factors that contribute to health outcomes and inequities. A large integrated health system (Intermountain Health) launched a program in 2019 to universally screen for and address SDOH.</p><p><strong>Methods: </strong>Five primary care clinics within Intermountain were purposefully chosen for diversity of setting and practice type (family medicine and pediatric). We conducted 20 semistructured interviews with frontline clinicians and staff from 7/1/2020 to 9/1/2020 to explore attitudes related to feasibility, workflow processes, and facilitators and barriers to successful implementation. We conducted an inductive-deductive analysis to identify key themes and best practices.</p><p><strong>Results: </strong>Five clinics conducted 16,659 SDOH patient screenings from 12/1/2019 to 11/30/2020 (705 to 7,723 screens per clinic with rates ranging from 7.4% to 52.8% per clinic). Respondent perspectives about the program were mixed. Dominant implementation barriers included staff time constraints, limited availability of social services, and reduced morale. Key facilitators included triage protocols for positive screens independent of the primary care clinician, standardizing previsit digital screening, and instilling a culture of shared ownership through education and team SDOH-focused huddles.</p><p><strong>Conclusions: </strong>This evaluation of an early systemwide SDOH program implementation called into question the feasibility of universal screening in primary care given staff time constraints and social service availability. Future investigations should explore the impact of targeted screening approaches in diverse clinical settings and quantifying trade offs between SDOH programs and other clinical and organizational priorities.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1103-1122"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674784","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":"The Essential Role of Primary Health Care for Health Security.","authors":"Robert L Phillips, Marci Nielsen, Deborah J Cohen, Lauren S Hughes, Asaf Bitton, Andrew W Bazemore","doi":"10.3122/jabfm.2023.230449R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230449R1","url":null,"abstract":"<p><p>In July 2023, primary health care experts from more than 20 countries, the World Health Organization (WHO), and most agencies within the US Department of Health and Human Services (HHS) met at the National Academy of Sciences in Washington, DC, to catalyze action toward revitalizing primary care in the United States align efforts to advance primary health care worldwide, and improve health and security for all.¹ This meeting was informed by the NASEM's critical primary care report, which highlighted the need for federal leadership to strengthen primary care services in the United States, especially for underserved populations, and to inform primary care systems around the world. To that end, this meeting was designed to explore the challenges and opportunities of investing in primary health care as a common good and critical for health security and resilience across the globe.² In this issue, you will find {number} special communications from this conference that highlight the need to evolve from primary care to primary health care, the importance of primary care and public health collaboration, and the necessity for ongoing external scientific expertise to inform US federal government coordination efforts.Despite the clear consensus among global stakeholders regarding the importance of Primary Health Care to health equity, behavioral health, health security, and pandemic resilience, a year later the anticipated HHS Action Plan to guide implementation of the NASEM primary care recommendations has yet to be launched. While some agencies are moving ahead with initiatives and programs within their purview, the lack of a Primary Care Action Plan remains a missed opportunity to coalesce politically powerful stakeholders around a united and much-needed vision for a US health system centered on Primary Health Care, particularly in light of our challenges in responding to COVID-19.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement1","pages":"S21-S25"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717384","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":"Peer-Coaching for Family Physicians to Close the Intention-to-Action Gap.","authors":"Tara Kiran, Kimberly Devotta, Laura Desveaux, Noor Ramji, Karen Weyman, Margarita Lam Antoniades, MaryBeth DeRocher, Julia Rackal, Noah Ivers","doi":"10.3122/jabfm.2023.230489R2","DOIUrl":"10.3122/jabfm.2023.230489R2","url":null,"abstract":"<p><strong>Introduction: </strong>Peer coaching has the potential to enhance the effectiveness of clinical performance feedback reports to family physicians, but few peer-coaching quality improvement programs have been implemented and evaluated in primary care. Authors designed, implemented and evaluated a peer-coaching program for family physicians in a large, academic primary-care organization to explore its potential to enhance family physicians' use of clinical performance data for quality improvement.</p><p><strong>Methods: </strong>Coaches were nominated by their peers and were trained to follow an evidence-informed facilitated feedback model for coaching. Data were collected through surveys, a focus-group with coaches, and individual interviews with coached family physicians (\"coachees\"). Data were analyzed inductively using reflexive thematic analysis.</p><p><strong>Results: </strong>Authors trained 10 coaches who coached 25 family physicians over 3 months. Coachees who completed the survey (21/25) indicated a desire for additional coaching sessions in future; most (19/21) reported confidence in making practice change. Interview (n = 11) and focus-group participants (n = 8) findings validated acceptability of the coaching approach that emphasized empathy ahead of change-talk. Coaches helped coachees interpret care-quality measures, deal with negative emotional responses evoked, encouraged a sense of accountability for improvement, and sometimes offered new ways to manage common challenges. Coaching sessions led to a wide range of practice-improvement goals. However, effects on practice change were felt to be limited by the data available and the focus on individual physician factors when broader clinic issues acted as important barriers to improvement.</p><p><strong>Conclusions: </strong>Peer coaching is a feasible approach to supporting family physicians' use of data for learning and practice improvement. More research is needed to understand the impact on practice outcomes and physician wellness.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"996-1008"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674858","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":"Improving Care for Unhealthy Alcohol Use: Results from the Facilitating Alcohol Screening and Treatment (FAST) Colorado Study.","authors":"Bonnie T Jortberg, L Miriam Dickinson, Douglas H Fernald, Andrew Bienstock, Dionisia de la Cerda, Kim Wiggins, Carolyn Swenson, Jennifer Halfacre, Stephanie Kirchner, W Perry Dickinson","doi":"10.3122/jabfm.2024.240048R1","DOIUrl":"10.3122/jabfm.2024.240048R1","url":null,"abstract":"<p><strong>Introduction: </strong>Unhealthy alcohol use (UAU) is associated with preventable morbidity and mortality and accounted for more than 140,000 deaths per year in the US during 2015 to 2019. The United States Preventive Services Task Force recommends routine screening for UAU in adults aged 18 years and older and pregnant persons, followed by brief counseling for a positive screening (B recommendation). Primary care clinicians can improve UAU outcomes by universally screening and offering brief counseling. This study aimed to increase screening, brief intervention, medication-assisted treatment (MAT), or referral for treatment (SBI/RT + MAT) in primary care practices.</p><p><strong>Methods: </strong>Cluster-randomized study to investigate 1) the effectiveness of virtual practice facilitation as a method to enhance implementation of SBI/RT + MAT and 2) the potential added benefit of using alcohol use eLearning modules to guide and focus the process and content of virtual practice facilitation.</p><p><strong>Results: </strong>Sixty-one primary care practices in Colorado enrolled in the study, with 43 primary practices completing the intervention and reporting 9-month data. Results show significant overall improvements in SBI/RT + MAT practice implementation scores from baseline to 9-month follow-up (<i>P</i> < .0001) and no differences between groups. The number of patients screened for UAU and/or Alcohol Use Disorder (AUD), receiving brief intervention, receiving an AUD diagnosis all significantly increased from baseline (<i>P</i> < .0001); and number receiving MAT also significantly increased (<i>P</i> < .0014).</p><p><strong>Discussion: </strong>Practice facilitation can assist primary care practices in improving SBI/RT + MAT processes and patient outcomes, with the results providing initial evidence for successful use of virtual practice facilitation.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1027-1037"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674798","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":"The Role of PhDs in Family Medicine Research.","authors":"Mark S Johnson, Abiodun Otolorin","doi":"10.3122/jabfm.2024.240157R2","DOIUrl":"10.3122/jabfm.2024.240157R2","url":null,"abstract":"<p><p>Research is being recognized as important to the further growth of Family Medicine. It is also important to improving the health of the nation. Family Medicine must consider the barriers and facilitators to research to plan for the future. Understanding the role of all members of the research team is necessary. In February 2024, a descriptive analysis of Family Medicine Principal Investigator (PI) with active projects funded by the National Institutes of Health(NIH) was performed using the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) tool. Sixty-four percent of the 310 grants identified were awarded to Principal Investigators (PIs) with PhD degrees. Researchers with a PhD have been able to significantly contribute to the research mission of the discipline. Family medicine will need to continue to expand the research team to optimize productivity.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement2","pages":"S53-S55"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701967","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":"Strong Primary Health Care in the United States - Closer Than We Might Think.","authors":"Asaf Bitton, Bruce Finke","doi":"10.3122/jabfm.2023.230401R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230401R1","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement1","pages":"S4-S7"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717379","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":"Family Medicine: Finding Its Way on the Federal Research Roadmap.","authors":"Alyssa M Indelicato, Amanda Weidner, Christopher P Morley","doi":"10.3122/jabfm.2024.240118R1","DOIUrl":"10.3122/jabfm.2024.240118R1","url":null,"abstract":"<p><strong>Introduction: </strong>Challenges persist in securing substantial funding for the Family Medicine (FM) research enterprise, particularly from major sources like the National Institutes of Health (NIH). Analyses from a decade ago revealed stagnant funding levels, prompting further investigation into the subsequent years.</p><p><strong>Methods: </strong>To elucidate funding trends over the most recent decade, the NIH RePORTER database was queried for grants awarded to departments identified as \"Family Medicine\" from 2014 to 2023. Data encompassed awards from various federal agencies, predominantly including the US National Institutes of Health and others. We also explored the relationship between funding success and multidisciplinarity, examining whether Departments of FM (DFMs) incorporating diverse disciplines in their names exhibited higher chances of securing research funding.</p><p><strong>Results: </strong>The investigation identified 73 funded DFMs in the NIH RePORTER database out of a total of 131 DFMs at Liaison Committee on Medical Education (LCME) accredited schools. Despite notable increases in both the total funding and percentage of funding allocated to DFMs over the decade, FM still accounted for less than 1% of total NIH awards. Multidisciplinary departments displayed a higher likelihood of securing research funding compared with their counterparts identified solely as DFMs.</p><p><strong>Discussion: </strong>While the study reveals a mild upward trend in funding levels for DFMs, challenges persist in securing a more substantial share of federal research funding. Despite limitations, including the exclusion of non-NIH funding sources, the study provides valuable insights into the current state of federal funding for Family Medicine research, urging sustained efforts for further progress in the field.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement2","pages":"S85-S91"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701797","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}