Journal of the American Board of Family Medicine最新文献_第2页

A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators. 对初级保健医疗与法律合作关系的定性分析：影响、障碍和促进因素。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2023.230328R2

Winston Liaw, Christine Bakos-Block, Thomas F Northrup, Angela L Stotts, Abigail Hernandez, Lisandra Finzetto, Pelumi Oloyede, Bruno Moscoso Rodriguez, Skye Johnson, Lauren Gilbert, Jessica Dobbins, LeChauncy Woodard, Thomas Murphy

{"title":"A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators.","authors":"Winston Liaw, Christine Bakos-Block, Thomas F Northrup, Angela L Stotts, Abigail Hernandez, Lisandra Finzetto, Pelumi Oloyede, Bruno Moscoso Rodriguez, Skye Johnson, Lauren Gilbert, Jessica Dobbins, LeChauncy Woodard, Thomas Murphy","doi":"10.3122/jabfm.2023.230328R2","DOIUrl":"10.3122/jabfm.2023.230328R2","url":null,"abstract":"Background: Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization.Objective: The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics.Methods: A qualitative design using a semistructured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke's framework was used to identify themes and subthemes.Results: Sixteen (n = 16) participants were included in this study. Most respondents were women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact.Conclusion: HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"637-649"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114243","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

How Early Career Family Medicine Women Physicians Negotiate Their First Job After Residency. 早期从事家庭医学工作的女医生如何在住院医生实习结束后谈好第一份工作。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2023.230473R1

Annie Koempel, Melissa K Filippi, Madeline Byrd, Emma Bazemore, Anam Siddiqi, Yalda Jabbarpour

{"title":"How Early Career Family Medicine Women Physicians Negotiate Their First Job After Residency.","authors":"Annie Koempel, Melissa K Filippi, Madeline Byrd, Emma Bazemore, Anam Siddiqi, Yalda Jabbarpour","doi":"10.3122/jabfm.2023.230473R1","DOIUrl":"10.3122/jabfm.2023.230473R1","url":null,"abstract":"Background: Nested within a growing body of evidence of a gender pay gap in medicine are more alarming recent findings from family medicine: a gender pay gap of 16% can be detected at a very early career stage. This article explores qualitative evidence of women's experiences negotiating for their first job out of residency to ascertain women's engagement with and approach to the negotiation process.Methods: We recruited family physicians who graduated residency in 2019 and responded to the American Board of Family Medicine 2022 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women's experiences through the transitory stages from residency to workforce. A qualitative researcher used Zoom to interview 19 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed using NVivo software following an Inductive Content Analysis approach.Results: Three main themes emerged from the data. First, salary was found to be nonnegotiable, exemplified by participants' inability to change initial salary offers. Second, the role of peer support throughout residency and early career was crucial to uncovering and rectifying salary inequity. Third, a pay expectation gap was identified among women from minority and low-income households.Conclusion: To rectify the gender pay gap in medicine, a systems-level approach is required. This can be achieved through various levels of interventions: societally expanding the use of and removing the stigma around parental leave, recognizing the importance of contributions not currently valued by productivity-based payment models, examining assumptions about leadership; and institutionally moving away from fee-for-service systems, encouraging flexible schedules, increasing salary transparency, and improving advancement transparency.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"690-697"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114244","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 of an Opt-Out Outpatient HIV Screening Program. 实施选择性退出门诊病人 HIV 筛查计划。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2023.230352R1

Cameron T Miller, Kristin S Alvarez, Ank E Nijhawan, Virali Soni, Lena Turknett, Raja Paspula, Helen L King

{"title":"Implementation of an Opt-Out Outpatient HIV Screening Program.","authors":"Cameron T Miller, Kristin S Alvarez, Ank E Nijhawan, Virali Soni, Lena Turknett, Raja Paspula, Helen L King","doi":"10.3122/jabfm.2023.230352R1","DOIUrl":"10.3122/jabfm.2023.230352R1","url":null,"abstract":"Background: Screening rates for Human Immunodeficiency Virus (HIV) remain low despite guidelines by both the CDC and USPSTF recommending that all adolescents and adults be screened at least once. The aim of this quality improvement study was to increase HIV screening among eligible patients.Methods: This quality improvement study assessed the impact of interventions to increase HIV screening in an outpatient population at a large urban safety-net hospital. Outcomes were compared from the preintervention (December 2020 to November 2021) to postintervention years (December 2021 to November 2022). Stepwise electronic alerts to prompt HIV screening paired with provider financial incentives were implemented. The proportion of eligible individuals screened for HIV were compared after intervention implementation.Results: Average monthly HIV screening increased from 506 ± 97 to 2484 ± 663 between the pre- and postintervention periods, correlating to a 5.1-fold increase in screening (7.8% to 39.8%, P < .01). Increases were seen across all ages, and those aged 55 to 64 and 65+ had the highest relative increase in screening at 7.5 and 9.3-fold, respectively (P < .01). Screening rates increased for Hispanics (7.9% preintervention vs 43.6% postintervention, P < .01). In the pre- and postintervention periods, 41 patients with new HIV diagnoses were identified (13 preintervention and 28 postintervention) and 85.4% were linked to care within 30 days.Conclusions: Stepwise interventions targeted at primary care clinicians are an effective way to increase HIV screening rates, particularly in older demographics. Earlier HIV diagnosis coupled with linkage to care is an important strategy in ending the HIV epidemic.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"650-659"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114246","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

The Priority Updates from the Research Literature (PURLs) Methodology. 研究文献中的优先更新（PURLs）方法。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2024.230410R0

Paige Smith, Gregory Castelli

引用次数: 0

Performance Evaluation of the Generative Pre-trained Transformer (GPT-4) on the Family Medicine In-Training Examination. 全科医学在训考试中的生成预训练转换器 (GPT-4) 性能评估。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2023.230433R1

Ting Wang, Arch G Mainous, Keith Stelter, Thomas R O'Neill, Warren P Newton

{"title":"Performance Evaluation of the Generative Pre-trained Transformer (GPT-4) on the Family Medicine In-Training Examination.","authors":"Ting Wang, Arch G Mainous, Keith Stelter, Thomas R O'Neill, Warren P Newton","doi":"10.3122/jabfm.2023.230433R1","DOIUrl":"10.3122/jabfm.2023.230433R1","url":null,"abstract":"Objective: In this study, we sought to comprehensively evaluate GPT-4 (Generative Pre-trained Transformer)'s performance on the 2022 American Board of Family Medicine's (ABFM) In-Training Examination (ITE), compared with its predecessor, GPT-3.5, and the national family residents' performance on the same examination.Methods: We utilized both quantitative and qualitative analyses. First, a quantitative analysis was employed to evaluate the model's performance metrics using zero-shot prompt (where only examination questions were provided without any additional information). After this, qualitative analysis was executed to understand the nature of the model's responses, the depth of its medical knowledge, and its ability to comprehend contextual or new information through chain-of-thoughts prompts (interactive conversation) with the model.Results: This study demonstrated that GPT-4 made significant improvement in accuracy compared with GPT-3.5 over a 4-month interval between their respective release dates. The correct percentage with zero-shot prompt increased from 56% to 84%, which translates to a scaled score growth from 280 to 690, a 410-point increase. Most notably, further chain-of-thought investigation revealed GPT-4's ability to integrate new information and make self-correction when needed.Conclusions: In this study, GPT-4 has demonstrated notably high accuracy, as well as rapid reading and learning capabilities. These results are consistent with previous research indicating GPT-4's significant potential to assist in clinical decision making. Furthermore, the study highlights the essential role of physicians' critical thinking and lifelong learning skills, particularly evident through the analysis of GPT-4's incorrect responses. This emphasizes the indispensable human element in effectively implementing and using AI technologies in medical settings.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"528-582"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114247","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

Physician Satisfaction Should Be the Measure of Electronic Health Record Quality for the Nation. 医生满意度应成为衡量全国电子健康记录质量的标准。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2024.240187R0

Alex H Krist

引用次数: 0

Impact of COVID-19 on Chronic Ambulatory-Care-Sensitive Condition Emergency Department Use Among Older Adults. COVID-19 对老年人使用慢性门诊护理敏感疾病急诊的影响。

IF 2.4 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-10-25 DOI: 10.3122/jabfm.2023.230386R1

Arch G Mainous, Lu Yin, James F Medley, Aaron A Saguil, Frank A Orlando

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