Journal of the American Board of Family Medicine最新文献

{"title":"Hospital Utilization Among Users of Electronic Nicotine Delivery Systems (ENDS) Compared to Other Tobacco Users.","authors":"Niharika Khanna, Carissa S Kwan, Elena N Klyushnenkova, Colleen Kernan, Michael Dark, Julia Melamed, Janaki Deepak","doi":"10.3122/jabfm.2025.250265R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250265R1","url":null,"abstract":"<p><strong>Introduction: </strong>Use of electronic nicotine delivery systems (ENDS) poses a significant and avoidable risk to respiratory health, yet its effect is not fully understood. This study examines the levels of hospital utilization among those who use ENDS and/or other tobacco and develop respiratory conditions.</p><p><strong>Methods: </strong>260,149 adult patients were screened for ENDS use between August 2020 and June 2022 at the University of Maryland Medical System. Multivariable nominal logistic regression modeling was used to assess associations between tobacco/nicotine use and emergency department (ED) or inpatient utilization due to respiratory conditions defined by admission or discharge ICD-10 J codes. Covariates included age, sex, race, Elixhauser comorbidity score, and history of COVID-19.</p><p><strong>Results: </strong>Among ENDS-only users, non-Hispanic White and Other-race patients had statistically significant increased healthcare utilization compared to never users (those who never use ENDS or tobacco). 18-44 year-old patients in these two race groups had 1.9-2.3 times higher odds of utilizing the ED compared to those who never used tobacco; and 65+ year-old non-Hispanic White patients had 2.4 times higher odds of inpatient admission compared to patients who never used tobacco. The odds of increased healthcare utilization among those who used both ENDS and other tobacco ranged from 1.4-2.4 and also varied by age and race.</p><p><strong>Conclusions: </strong>ENDS and tobacco use were associated with increased hospital utilization, including ED and inpatient, due to respiratory illnesses in an age- and race-dependent manner.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978511","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":"Large Language Model versus Clinician Written Summaries of Research Papers.","authors":"Richard Guthmann, Robert Martin, Erin Lee, Christopher Boisselle","doi":"10.3122/jabfm.2025.250401R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250401R1","url":null,"abstract":"<p><strong>Introduction: </strong>Clinicians require concise, accurate summaries of new research to inform practice. Patient-Oriented Evidence that Matters (POEMs), published in American Family Physician, are a benchmark for summarizing primary literature in family medicine, while large language models (LLMs) offer scalable summarization but require rigorous evaluation. The objective of this study was to evaluate the accuracy and quality of summaries generated by large language models compared with expert-authored POEMs.</p><p><strong>Methods: </strong>In this study, we compared LLM-generated summaries (Microsoft Copilot, GPT-4o class) with 24 recent matched POEMs using a standardized prompt. Two trained raters independently scored each summary with a 13-item tool (score range 0-13), cataloged errors, recorded word counts, and indicated preferences on a 5-point scale.</p><p><strong>Results: </strong>LLM summaries outperformed POEMs in total score (mean 12.1 vs 10.6; mean difference 1.5, 95% CI 1.1-2.0; P < 0.001), with similar lengths (328 vs 353 words; P = 0.23). Errors occurred in fewer LLM-DOCSs (2/24) than POEMs (9/24), with a mean error score difference of 20% (95% CI 7% -33%; P < 0.001). POEMs most often missed in the categories Contextual Background and Limitations; both approaches frequently missed in Clinical Applicability. Reviewer preference favored LLM-DOCS (mean 2.44 on a 1-5 scale; 95% CI 2.1-2.8).</p><p><strong>Conclusions: </strong>An enterprise LLM, prompted in POEM style, produced accurate, low-error clinical summaries that matched or exceeded expert-edited POEMs and were generally preferred by reviewers, though further research is needed to assess broader applicability and impact. Findings support pragmatic LLM-assisted summarization and highlight the need for standardized evaluation tools and explicit prompts for clinical applicability.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892703","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 Power of Primary Care to Improve Health.","authors":"Sumi M Sexton, Sarina Schrager, Dean A Seehusen, Christopher P Morley, Caroline Richardson, Jon Neher, James DomDera","doi":"10.3122/jabfm.2026.260266R0","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260266R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892656","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":"Demographic Disparities Among Emerging Adults Experiencing Loneliness.","authors":"Brennan Keiser, Karina Cortez, Chialing Hsu, Kari A Stephens, Sebastian T Tong","doi":"10.3122/jabfm.2025.250144R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250144R2","url":null,"abstract":"<p><strong>Background: </strong>Loneliness has increased in recent years and is associated with poorer physical and mental health outcomes. While much research has focused on older adults, to date there has been limited research into loneliness in young adults who have the highest rates of loneliness. This study explores loneliness rates among subgroups of emerging adults ages 18-25.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted in a large primary-care health system in Washington State.</p><p><strong>Results: </strong>Out of 243 emerging adult respondents, 136 (56%) reported experiencing loneliness. Bivariate analyses showed no significant difference for racial/ethnic minorities, while women and nonbinary individuals were significantly lonelier than men (P = 0.03), sexual and gender minority (SGM) groups were lonelier than heterosexuals (P < 0.01) and single individuals were lonelier than those in a relationship (P = 0.02). In a logistic regression model (R2 = 0.11), SGM individuals had OR = 2.01 of loneliness compared to heterosexuals (95% CI = 1.09-3.75; P = 0.03) and individuals in a relationship had OR = 0.37 compared to single individuals (95% CI = 0.20-0.66; P < 0.01).</p><p><strong>Discussion: </strong>These findings show that it is feasible to identify emerging adults with loneliness and demonstrate the need for targeted loneliness interventions in primary care settings to reduce health disparities among this demographic group.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765677","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":"A Computerized Clinical Decision Support Tool Increases Rates of Confirmatory Testing in MASLD Patients at Risk for Advanced Fibrosis.","authors":"Ted Xiao, James Miller, Bradley Rowland, Richa Bundy, Adam Moses, Lauren Witek, Corey Obermiller, Ajay Dharod, Sean Rudnick","doi":"10.3122/jabfm.2025.250261R0","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250261R0","url":null,"abstract":"<p><strong>Background and aims: </strong>Metabolic-dysfunction associated steatotic liver disease (MASLD) is highly prevalent in primary care. The Fibrosis-4 (FIB-4) index noninvasively risk-stratifies patients needing confirmatory testing for advanced fibrosis. However, screening is underutilized, contributing to underdiagnosis and low rates of testing at-risk patients. Computerized clinical decision support (cCDS) tools can enhance recognition of MASLD and guide clinicians to appropriate care pathways. We aimed to determine if a cCDS tool identifying patients with MASLD at increased risk for advanced fibrosis improves rates of confirmatory testing and subspecialist referral.</p><p><strong>Methods: </strong>The cCDS tool was implemented in 3 primary care clinics for a 3-month period. The cCDS tool triggered if an encounter met criteria for high or indeterminate FIB-4 score (> 1.3) plus diabetes, or ≥ 2 metabolic risk factors. The cCDS prompted testing with elastography and/or subspecialty referral. The primary outcome was proportion of encounters in which confirmatory testing/further evaluation was ordered.</p><p><strong>Results: </strong>In intervention clinics, the cCDS tool triggered during 1410 encounters. Confirmatory testing increased from 0% to 2.1% (P < 0.001) and subspecialty referral increased from 4% to 20% (P = 0.12). The cCDS was ignored in 75.4% of encounters.</p><p><strong>Conclusions: </strong>Implementation of a cCDS tool increased rates of confirmatory testing and subspecialty referrals in at-risk patients, though overall rates remained low, likely related to high rates of ignoring the tool. This study demonstrates the feasibility of utilizing a cCDS tool in primary care to screen for patients with MASLD who are in highest need of further evaluation. Further optimization of triggering criteria and user interface may increase use of the tool.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841944","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 Future of Patient Panel Size in Primary Care.","authors":"Scott M Strayer, Timothy Hoff","doi":"10.3122/jabfm.2025.250403R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250403R1","url":null,"abstract":"<p><p>Britz et al present an important contribution to the understanding of primary care capacity by identifying all Primary Care Physicians (PCPs) in one state and quantifying their patient panel sizes. Their findings, showing median panels between 1196 and 1290 patients, provide critical insight into how many individuals each PCP can realistically serve amid a national primary care shortage. This commentary explores emerging trends that may reshape how ideal panel size is defined in the future, particularly the increasing integration of non-physician providers, digital health platforms, and artificial intelligence (AI) tools. Technologies such as ambient dictation, automated order entry, and AI-driven patient messaging can reclaim valuable clinician time and help mitigate burnout, potentially allowing physicians to manage larger panels. Likewise, wearable sensors, virtual visits, and non-traditional care outlets such as retail clinics and urgent care centers offer additional opportunities to expand system-wide capacity. However, these efficiencies must be balanced against current capacity issues in primary care, including potential added monitoring workload, increasing complexity of patients, as well as currently over-burdened primary care practices due to administrative burden and high volumes of patient messaging. Future studies are needed to determine whether these innovations truly expand capacity or simply redistribute effort within the evolving ecosystem of primary care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686467","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":"Should Family Medicine Embrace Community Involvement and Engagement?","authors":"Colleen T Fogarty, Saroj Misra, Brian A Kessler","doi":"10.3122/jabfm.2026.260096R0","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260096R0","url":null,"abstract":"<p><p>Family medicine takes a whole-person, contextual approach to patient care, and understanding community context is important. The Centers for Disease Control and Prevention (CDC) definition of community, \"a group of people with diverse characteristics who are linked by social ties, shared common perspectives and identity, and engagement in joint action,\" provides a broad conceptual framework. While community service doesn't have a standard definition, many physicians and residency training programs incorporate such activity into practice and training. Community engagement consists of ten key principles framing public health and programmatic involvement in improving the health of a community. Despite the importance of understanding the community in practice, true community engagement for contemporary family physicians, given panel size, visit volume, and documentation burden, is unrealistic as a core part of the work of most practicing family physicians.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686495","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":"Comprehensiveness Revisited for Next-Generation Family Medicine.","authors":"Andrew Bazemore, Alexander Krist, Alan Katz","doi":"10.3122/jabfm.2026.260030R0","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260030R0","url":null,"abstract":"<p><p>Comprehensiveness has long been a defining principle of family medicine (FM), and a reason that primary care delivers better outcomes at lower cost with greater equity. Yet rising patient complexity, narrower scopes of practice, workforce strain, and misaligned payment and credentialing systems have made sustaining traditional \"full-basket\" care increasingly difficult. In 2025, the Family Medicine Leadership Consortium convened a national dialogue to examine whether and how the discipline should reaffirm comprehensiveness as its core organizing principle. Participants agreed it remains essential to family medicine's identity and public value but emphasized the need to redefine it for modern realities, balancing breadth and depth of care, recognizing limits on individual physicians, and shifting accountability toward interprofessional teams and broader care ecosystems. The envisioned next-generation model situates comprehensiveness across the clinician, team, practice, and community levels, supported by longitudinal relationships, team-based care, and enabling technologies such as artificial intelligence (AI). This reconceptualization offers a framework for training, workforce strategy, measurement, and payment that preserves family medicine's generalist identity while advancing access, quality, equity, and sustainability.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800908","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":"Association of Asynchronous Virtual Scribe Services: Patient Experience in Primary Care.","authors":"Jennifer Stephens, Nyann Biery, Autumn Kieber-Emmons, Roya Hamadani, Nicole Allen, Grant Greenberg","doi":"10.3122/jabfm.2026.260173R0","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260173R0","url":null,"abstract":"<p><strong>Background: </strong>Virtual scribe services are increasingly utilized to reduce documentation burden and mitigate clinician burnout. While evidence supports their positive impact on clinician wellness and productivity, the effect on patient experience has not received as much attention. We hypothesized that clinicians using virtual scribes would demonstrate improved patient satisfaction scores due to enhanced face-to-face interaction during visits.</p><p><strong>Methods: </strong>Using a pre-post design, we analyzed patient satisfaction data for 81 primary care clinicians utilizing asynchronous virtual scribe services (two different vendor programs) within a large integrated health network in Eastern Pennsylvania. Patient satisfaction was measured using four vendor-administered questions assessing overall rating of care, likelihood to recommend, clinician listening, and trust. Pre-implementation scores (6 months prior to scribe utilization) were compared to post-implementation scores (months 3-9 with a scribe service) using related-samples Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>Statistically significant improvements in patient-reported satisfaction metrics were observed in overall rating of the visit (P < .001) and trust (P = .012). Likelihood to recommend and listening showed positive trends but did not reach statistical significance (P = .086 and P = .705, respectively).</p><p><strong>Conclusion: </strong>Virtual scribe implementation was associated with significant improvements in patient-reported overall experience and trust in their clinicians. These findings suggest that reducing documentation burden may enhance the patient-clinician relationship, providing additional justification for scribe investment beyond clinician wellness.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686451","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 Association Between Continuity of Care and Emergency Department Utilization Among Canadian Senior Adults.","authors":"Raaj Tiagi","doi":"10.3122/jabfm.2025.250211R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250211R1","url":null,"abstract":"<p><strong>Objective: </strong>Continuity of care with a primary care physician is critical for appropriate healthcare utilization, particularly among seniors with complex health needs. This study examines the association between the length of care continuity and the usual place of care for minor health problems, focusing on emergency department (ED) use.</p><p><strong>Methods: </strong>Data were drawn from the 2019-2020 Canadian Health Survey on Seniors (CHSS), a nationally representative 15-minute supplement to the Canadian Community Health Survey (CCHS) for Canadians aged 65 years and older. Of 245,639 selected households, 100,797 individuals responded to the CCHS (41.0%), and 41,635 of 45,863 eligible respondents completed the CHSS (90.8%). Minor health problems or nonurgent conditions were defined as self-reported difficulties accessing immediate care for issues such as fever, vomiting, headaches, sprains, minor burns, cuts, rashes, or other nonlife-threatening conditions. A multinomial logistic regression model examined the association between continuity of care (< 1 year, 1-< 2 years, ≥ 2 years, or no regular provider) and usual place of care, adjusting for demographic, socioeconomic, health, access, and provincial factors.</p><p><strong>Results: </strong>Among 41,060 seniors, most reported having continuity of care with a primary care physician for two years or more. Males and those reporting poorer health were more likely to use the ED for minor problems, whereas individuals with higher income or education more often sought care at a doctor's office. Longer continuity of care was associated with lower odds of ED use for minor problems, with consistent effects in both unadjusted (coef. = -0.251, P < 0.001) and adjusted models (coef. = -0.086, P = 0.083). Other determinants, including income, access to care, and province, also influenced care location.</p><p><strong>Conclusion: </strong>Longer continuity with a primary care physician is associated with reduced ED use for minor health problems among seniors. These findings highlight the value of sustained patient-provider relationships in promoting appropriate care utilization and alleviating pressures on emergency departments.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686516","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}