Journal of the American Board of Family Medicine最新文献

{"title":"Understanding the Barriers and Facilitators of Implementing a Controlled Substance Safety Committee in a Primary Care Practice.","authors":"Mechelle Sanders, Anna Russell, Kaela Mali, Jenny Ganay Vasquez, Sean Chambers, Holly Ann Russell","doi":"10.3122/jabfm.2024.240220R3","DOIUrl":"10.3122/jabfm.2024.240220R3","url":null,"abstract":"<p><strong>Purpose: </strong>The few studies about primary care based controlled substance safety committees (CSSC) to date have been primarily quantitative, focused on patient outcomes and lacked contextual data around their implementation. The purpose of this study is to qualitatively identify barriers and facilitators to the use of CDCs guidelines around opioid prescribing and the implementation of controlled substance safety committee in a primary care practice.</p><p><strong>Methods: </strong>Ten semistructured interviews were conducted with primary care clinicians in an academic medical practice. Potential barriers and facilitators to the uptake and use of the CDC opioid guidelines and the practice's CSSC were coded and analyzed against the Capability, Opportunity, and Motivation framework for Behavior change framework (COM-B).</p><p><strong>Results: </strong>Six key themes were identified around uptake of the CDC guidelines. In general, the CSSC addressed some of the capability barriers around the guidelines but had limited impact on increasing motivation to follow the guidelines. We found the same recommendation in the guidelines could have differing impact on prescribing behavior.</p><p><strong>Conclusions: </strong>Simply promoting guidelines may be insufficient, especially for those viewing them as rules rather than recommendations. Our findings underscore the fact that guidelines are merely a starting point, not an endpoint of implementation.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"577-585"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823092","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":"Conducting Research That Matters to Rural Practice and Communities.","authors":"Sebastian T Tong, Melinda M Davis, Allison M Cole","doi":"10.3122/jabfm.2024.240358R1","DOIUrl":"10.3122/jabfm.2024.240358R1","url":null,"abstract":"<p><p>Even though 20% of Americans live in rural communities, few research studies intentionally include or engage rural communities. The National Institutes of Health recently launched the CARE for Health™ Initiative that is initially focusing on engaging rural communities and primary care practices in research. In this commentary, we describe activities designed to improve rural clinical and community engagement in research led by two practice-based research networks (the Oregon Rural Practice Research Network and the WWAMI [Washington, Wyoming, Alaska, Montana and Idaho] region Practice and Research Network) funded through this initiative.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"603-606"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976615","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":"Reducing Anticoagulation Duration for Children After a Provoked Deep Venous Thrombosis.","authors":"Benjamin Feijóo, Roxanne Radi, Corey Lyon","doi":"10.3122/jabfm.2025.250001R0","DOIUrl":"10.3122/jabfm.2025.250001R0","url":null,"abstract":"<p><p>In patients younger than 21 years of age with a provoked deep venous thrombosis (DVT), anticoagulation for 6 weeks is noninferior to anticoagulation for 3 months.¹.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"589-591"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976658","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":"Evaluation of Asymptomatic Fasting Hypoglycemia in Outpatients Without Diabetes.","authors":"Tomás González-Vidal, Óscar Lado-Baleato, Carmen Fernández-Merino, Juan Sánchez-Castro, Manuela Alonso-Sampedro, Jessica Ares, Elías Delgado, Edelmiro Menéndez-Torre, Francisco Gude","doi":"10.3122/jabfm.2024.240274R1","DOIUrl":"10.3122/jabfm.2024.240274R1","url":null,"abstract":"<p><strong>Background: </strong>There are no studies on the clinical significance of asymptomatic hypoglycemia detected incidentally during routine testing.</p><p><strong>Methods: </strong>Baseline fasting serum glucose was determined in 1333 individuals without diabetes (43.3% males, median age 50 years, range 18 to 91 years) to investigate the prevalence of hypoglycemia (fasting serum glucose <70 mg/dL) and the associated demographic, lifestyle, and metabolic factors. Individuals with baseline hypoglycemia were followed (median follow-up, 8.7 years) and assessed for hypoglycemia symptoms. Seven-day continuous glucose monitoring was performed in a subsample of 489 individuals.</p><p><strong>Results: </strong>Baseline hypoglycemia was observed in 20 individuals (weighted prevalence, 1.58%, 95% confidence interval 0.87%-2.28%). Hypoglycemia was mild and asymptomatic in all cases (median, 67 mg/dL, range 63 to 69 mg/dL). The characteristics of those with hypoglycemia were similar to those with fasting serum glucose 70 to 80 mg/dL. Hypoglycemia was associated with female sex, younger age, and a more favorable metabolic profile (lower body mass index, glycohemoglobin and insulin resistance) than individuals with fasting serum glucose >80 mg/dL. Individuals with baseline hypoglycemia showed no distinct hypoglycemia features in continuous glucose monitoring (n = 9). During follow-up (n = 19), hypoglycemia in routine determinations, always mild, recurred in 42.1% of individuals, although the mean of successive glucose concentrations was higher than baseline in all cases. None of the individuals had symptoms that could constitute Whipple's triad (low serum glucose, symptoms of hypoglycemia, and symptomatic improvement after correction of hypoglycemia) during the follow-up period.</p><p><strong>Conclusions: </strong>Detection of asymptomatic, mild hypoglycemia in routine blood tests is not indicative of disease and does not require further investigation.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"411-422"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823072","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":"Physician Experience of Discrimination in a Leadership and Well-Being Program.","authors":"Elisabeth Callen, Kathryn Istas, Natabhona Mabachi, Tarin Clay","doi":"10.3122/jabfm.2024.240394R1","DOIUrl":"10.3122/jabfm.2024.240394R1","url":null,"abstract":"<p><strong>Introduction: </strong>Physician workforce shortages are expected to reach 48,000 primary care physicians by 2034 with burnout, discrimination (gender, race, and others), and harassment as contributors. Physicians experience discrimination and harassment on a daily basis and continue to work with patients who routinely discriminate against them, which can be directly related to burnout.</p><p><strong>Methods: </strong>The American Academy of Family Physicians (AAFP) created the Leading Physician Well-Being Certificate Program to combat these issues. Surveys were sent to cohorts at multiple time points - beginning, middle, and end. Multiple evaluation instruments were included in these surveys, but for this analysis, we focused on the Everyday Discrimination Scale (EDS). For Cohort 1 (n = 88, 2021), they received the EDS midway through their cohort. For Cohort 2 (n = 62, 2022), they received the EDS at each time point, but received a Privilege Assessment midway through their cohort due to their answers on the EDS.</p><p><strong>Results: </strong>Cohort 1 consistently rated the questions with higher levels of discrimination than Cohort 2 scholars. In general, Asian women from Cohort 1 experienced the most discrimination of all the groups (7 statements). For the Privilege Assessment, Asian and other women of color were more likely to indicate less privilege than other groups.</p><p><strong>Discussion: </strong>Physicians taking the AAFP Leading Physician Well-Being Certificate Program reported have experienced discrimination and harassment. Certain physician groups experience higher levels of discrimination and harassment, and concurrent lower levels of privilege. While unfortunate, discrimination and harassment will continue to play a large role in physicians' lives.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"566-576"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823087","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":"Re: Performance Evaluation of the Generative Pre-Trained Transformer (GPT-4) on the Family Medicine In Training Examination.","authors":"Karim Hanna","doi":"10.3122/jabfm.2024.240404R0","DOIUrl":"10.3122/jabfm.2024.240404R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"607"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976655","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":"Development and External Validation of the FluScoreVax Risk Score for Influenza That Incorporates Vaccine Status.","authors":"Mark H Ebell, Yewen Chen, Fangzhi Luo, Ye Shen, Samuel Coenen, Paul Little, Bruce Barrett, Daniel Merenstein, Margareta Ieven","doi":"10.3122/jabfm.2024.240366R1","DOIUrl":"10.3122/jabfm.2024.240366R1","url":null,"abstract":"<p><strong>Introduction: </strong>To develop and externally validate a simple risk score for influenza diagnosis based using vaccination history and patient-reported symptoms.</p><p><strong>Methods: </strong>Adult outpatients in 12 European countries during flu season with a chief complaint of acute cough between 2007 and 2010 were used to derive and internally validate the risk score (Genomics to combat Resistance against Antibiotics in Community acquired LRTI in Europe (GRACE) data), and contemporary US data were used for external validation (EAST-PC data). Patient-reported symptoms were recorded and polymerase chain reaction (PCR) was used to diagnose influenza. The score was derived using logistic regression and assigning points based on the <b><i>β</i></b> -coefficients. The score was externally validated in a contemporary US population (EAST-PC data). Accuracy was measured using influenza prevalence in each risk group and the area under the receiver operating characteristic curve (AUC). Calibration was assessed by plotting observed versus expected.</p><p><strong>Results: </strong>We developed a risk score with 6 items (subjective fever, interfered with usual activity, headache, wheeze, phlegm, and recent flu vaccine) and a range from -5 to 6 points. The AUC was 0.75 for both derivation and internal validation subgroups. The prevalence of influenza was 15.1% in the GRACE data and 14.4% in the EAST-PC data. The percentage with influenza in the low, moderate, and high-risk groups was 6.8%, 21.8%, 35.3 in the external validation population (EAST-PC data). The low-risk group included 61% of participants in the external validation. Calibration was excellent.</p><p><strong>Conclusions: </strong>We developed and externally validated the FluScoreVax risk score, available as an app. It classifies 61% of patients as low risk, of whom only 7% had influenza.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"401-410"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823071","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":"Strengths and Weakness of the Atherosclerotic Cardiovascular Risk Calculation: A Qualitative Study.","authors":"Ebiere Okah, Oluwamuyiwa Adeniran, Paul Mihas, Philip D Sloane","doi":"10.3122/jabfm.2024.240324R1","DOIUrl":"10.3122/jabfm.2024.240324R1","url":null,"abstract":"<p><strong>Background: </strong>Patients at risk of atherosclerotic cardiovascular disease (ASCVD) have low statin use. Clinician perceptions of the ASCVD risk estimates that guide statin prescribing may contribute to poor uptake. At the time of the study, the only equations used to predict ASCVD risk (the Pooled Cohort Equations; PCE) provided race-specific estimates, a controversial practice and a potential reason why clinicians may scrutinize these estimates. We sought to examine how clinicians perceived ASCVD estimates, in relation to their perceptions of race and, also, more broadly.</p><p><strong>Methods: </strong>We conducted an interpretive description study using ten 45-minute semistructured interviews with primary care physicians in North Carolina between March and April 2022. Interviews focused on the PCE ASCVD risk calculator and perspectives of race as it relates to ASCVD. Responses were analyzed using both deductive and inductive approaches to identify primary topics.</p><p><strong>Results: </strong>5 men and 5 women participated. Of these, 6 identified as White, 2 as Black, and 2 as Asian. Three main topics emerged. First, participants felt conflicted about the role of race in ASCVD risk. Second, they had several concerns with the calculator that went beyond race, including its emphasis on statin use and lack of social determinants of health. Finally, participants universally valued the PCE ASCVD calculator as a tool to educate patients and inspire statin initiation and behavioral change.</p><p><strong>Conclusions: </strong>The PCE ASCVD risk calculator was seen as most useful in facilitating discussions regarding behavior and lifestyle changes, suggesting the potential benefit of incorporating variables related to patients' health behaviors in a revised model. The new PREVENT equations provide a helpful first step by removing race and including social determinants. The next step may be to add health behaviors and visual images to facilitate patient counseling and comprehension.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"464-474"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823089","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 Impact of Multiple Exercise Modes on the Quality of Life of Stroke Patients: A Network Meta-Analysis.","authors":"Yongtao Fan, Zhikai Qin, Kuiliang Liu, Yingxu Pan, Junsheng Wang","doi":"10.3122/jabfm.2024.240343R1","DOIUrl":"10.3122/jabfm.2024.240343R1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the impact of 6 exercise therapies on the quality of life of stroke patients.</p><p><strong>Methods: </strong>A systematic search was conducted on PubMed, the Web of Science, PsycINFO, and the Cochrane Library to retrieve peer-reviewed articles written in English. The inclusion criteria consisted of (1) experimental or quasi-experimental studies, (2) utilization of different exercise therapies as experimental interventions, (3) inclusion of stroke patients as the target population, and (4) assessment of quality of life as an outcome measure.</p><p><strong>Results: </strong>The analysis included 25 studies involving 1243 subjects aged 18 years or older. The network meta-analysis revealed that among the 6 exercise therapies examined, Virtual Reality Training (82.3%) had the most significant impact on improving the quality of life in stroke patients. This was followed by Resistance Training (77.3%), Mind-Body Training (61%), Underwater Exercise (52%), Aerobic Exercise Training (44.1%), and High-Intensity Interval Training (19.2%).</p><p><strong>Conclusions: </strong>Virtual reality training was found to be highly effective in improving the quality of life in stroke patients. In addition, when combined with other exercise therapies, it enhanced physical function and overall quality of life.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"431-450"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823090","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":"Virtual Diabetes \"Boot Camp\": An Innovative Model for Improving Glycemic Control.","authors":"Yi-Ju Chen, Renu Joshi, Anas Atrash, Safi Khattab, Salim M Saiyed","doi":"10.3122/jabfm.2024.240216R1","DOIUrl":"10.3122/jabfm.2024.240216R1","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine can improve access between physicians and patients and improve outcomes when deployed strategically in patients with chronic diseases. Telemedicine not only showed success in the care of chronic diseases, but its application also expanded exponentially during the COVID-19 pandemic. At our institution, a 12-week telemedicine diabetes \"boot camp\" was launched for patients with uncontrolled diabetes as an innovative means of providing accessible and high-quality patient care in primary care settings.</p><p><strong>Methods: </strong>Patients at primary care and endocrinology clinics with diabetes mellitus (DM) and glycohemoglobin (A1C) > 8.0% were voluntarily enrolled from September 2020 to November 2021. Dietitians and diabetes care and education specialists conducted biweekly visits via telemedicine for twelve weeks. Patient demographics, A1C, body mass index (BMI), and blood pressure were measured before and after the intervention.</p><p><strong>Results: </strong>A total of 134 patients were included, and 94 patients (70.2%) completed 6 visits for the full 12-week program. The mean A1C reduction was -2.09% ± 2.4%, and the A1C change was uniform across age groups, gender, ethnicity, BMI, and referral clinic type. A greater A1C reduction in patients who completed all 6 visits was noted although not statistically significant. We found a negative correlation between the initial A1C and the change of A1C. No significant BMI or mean arterial pressure change was observed.</p><p><strong>Conclusion: </strong>This single arm study demonstrated an improvement in A1C for all patients with a history of poorly controlled diabetes, regardless of patient characteristics. Higher initial A1C was associated with a greater A1C reduction.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"556-560"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823105","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}