Journal of the American Board of Family Medicine最新文献

{"title":"Induction of Medication for Opioid Use Disorder in Primary Care.","authors":"Tristen L Hall, Douglas H Fernald, Vivian Jiang, Kristen Curcija, Joseph W LeMaster, John M Westfall, Donald E Nease, Linda Zittleman","doi":"10.3122/jabfm.2024.240317R1","DOIUrl":"10.3122/jabfm.2024.240317R1","url":null,"abstract":"<p><strong>Background: </strong>Overdoses and deaths from synthetic opioids grew sharply in the past decade. Most people with opioid use disorder (OUD) do not receive recommended evidence-based treatment: nationally, 72% to 87% of people who need OUD treatment do not receive medication for opioid use disorder (MOUD). Little is known about practice teams' experiences with home, office, and telehealth induction for MOUD, particularly in primary care.</p><p><strong>Methods: </strong>We conducted semistructured interviews with primary care clinicians and staff from February through September 2023 to understand experiences providing MOUD via home, office, and telehealth induction. Interviews were part of a PCORI-funded trial, Home versus Office versus telehealth for Medication Enhanced Recovery (HOMER). We used template and editing coding styles to categorize text according to deductive codes derived from research questions and inductive codes derived from multiple readings of transcripts. We used immersion-crystallization to iteratively review coded text and identify interview themes.</p><p><strong>Results: </strong>Thirty-eight clinicians and staff from 21 US primary care practices participated in interviews. Home induction is increasingly common and preferred by patients and practice teams, social determinants of health affect induction and maintenance in treatment, clinicians and staff use honest communication to build trusting relationships with patients, practices identified patients as MOUD candidates through word-of-mouth and referrals, and an evolving OUD landscape are causing practices to adapt their care.</p><p><strong>Conclusion: </strong>Primary care practices are committed to offering MOUD. Findings offer insights about the challenges facing primary care practices in their efforts to deliver MOUD to address a rapidly evolving opioid epidemic.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"539-550"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823073","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":"Uncovering Four Types of Care Coordination in Primary Care.","authors":"Meghan M JaKa, Ella A B Chrenka, Steven P Dehmer, Joan M Kindt, Melissa Winger, Mary Sue Beran, Robin R Whitebird, Angela Booher, Kathryn M McDonald, Jeanette Y Ziegenfuss, Jennifer M Dinh, Anna R Bergdall, Leif I Solberg","doi":"10.3122/jabfm.2024.240315R1","DOIUrl":"10.3122/jabfm.2024.240315R1","url":null,"abstract":"<p><strong>Background: </strong>Care coordination helps patients with complex needs, but heterogeneity in its implementation is not understood. Latent class analysis (LCA) was used to describe types of care coordination in primary care using data from The Minnesota Care Coordination Effectiveness Study (MNCARES), a large representative observational study of Minnesota clinics. We also explore whether program types are associated with clinic, community, or patient characteristics.</p><p><strong>Methods: </strong>Primary care clinics with care coordination participating in MNCARES were included in this exploratory analysis. Care coordinators responded to survey items about their programs' approaches to addressing social and complex medical needs, communication, care coordination volume, and support and resources available for care coordination. LCA was used to identify and describe distinct types of care coordination using 42 survey items. Bivariate analysis compared types to clinic, community, and patient characteristics.</p><p><strong>Results: </strong>Four types of care coordination emerged across 316 clinics: type 1 a well-supported social/medical approach, type 2 a high volume social/medical approach, type 3 a well-resourced complex medical needs approach, and type 4 an onsite low volume approach. Type 1 clinics were more likely to have medical and community service access and serve younger patients and those born outside the US. Type 4 clinics were more likely urban with less community service access and served older adults.</p><p><strong>Conclusion: </strong>This novel LCA approach successfully identified 4 distinct types of care coordination used by participating clinics. These results will help researchers to learn which approaches to care coordination are most effective in which contexts and help clinics decide how to operationalize care coordination.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"500-512"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823091","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 Snapshot of Family Medicine Physician Engagement with State Policy: Findings from the 2023 CERA Survey.","authors":"Amogh Shukla, Amy Clithero-Eridon, Cameron Crandall, David Chartash, Reiana Mahan, Danielle Albright","doi":"10.3122/jabfm.2024.240414R1","DOIUrl":"10.3122/jabfm.2024.240414R1","url":null,"abstract":"<p><strong>Background: </strong>Health care professionals are in a unique position to enact health-related social change. Medicine is subject to regulation at the organizational, local, state, and national levels. Federal laws apply to physicians throughout the US; as such, federal policy affects physician practice intentions similarly. However, there is little research on state-level engagement in the political process and none on the participation by family medicine physicians.</p><p><strong>Methods: </strong>This article examines the nature of physician civic engagement at the state level. Data were gathered and analyzed as part of the 2023 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of Family Medicine educators and practicing physicians. We used nonparametric statistics (Kruskal-Wallis tests) to analyze ordinal variables. Categorical variables were analyzed using χ² tests. We used multivariable ordinal logistic regression to assess the joint effects of participant characteristics on study outcomes and to adjust for potential confounding.</p><p><strong>Results: </strong>The policy question section of the survey received 709 responses, a response rate of 21%. Our results show a lack of civic engagement, including less than a third voting in state elections and only 4% making financial contributions to political campaigns. Seventeen percent of respondents reported considering relocating due to state health policies. For all questions, we observed variations by geographical region and gender.</p><p><strong>Conclusions: </strong>Our findings provide a timely analysis of family medicine physician participation in the political process, the effect of specific health policies, and how these policies are comparatively received among family medicine physicians in the United States.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"610-618"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976526","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":"Continuity of Care in Federally Qualified Health Centers: Examining Patient-Provider Relationships and Patient Centered Medical Home Recognition.","authors":"Jodi Simon, Jeffrey Panzer, Abbey Ekong, David T Liss, Christine A Sinsky, Katherine M Wright","doi":"10.3122/jabfm.2024.240365R1","DOIUrl":"10.3122/jabfm.2024.240365R1","url":null,"abstract":"<p><strong>Purpose: </strong>Continuity of care between patients and physicians is a defining element of primary care and a pillar of the Patient Centered Medical Home (PCMH) program. We aimed to investigate the level of short- and long-term continuity within a network of Federally Qualified Health Centers (FQHCs) and the relationship of continuity to PCMH recognition.</p><p><strong>Methods: </strong>This multi-method study utilized Electronic Health Record data to investigate patient continuity, and survey data to investigate PCMH history. The study population included patients with at least 2 visits between 2008 and 2023 to one of 18 FQHCs. Continuity was measured by calculating the number of primary care providers (PCPs) seen by the patient and the usual provider of care index (UPC Index [the number of visits with the most frequent PCP/total visits]).</p><p><strong>Results: </strong>Our population consisted of 1,323,547 patients and 19,768,516 encounters. The mean (SD) number of PCPs per patient over one year was 2.01 (1.1). For patients who had visits spanning at least 5 years, the mean was 7.2 (4.7). The mean one-year UPC was .72 (.25) and 5+ year UPC was .47 (.21). No meaningful association was found between continuity measures and PCMH recognition.</p><p><strong>Conclusions: </strong>These findings show, on average, high numbers of PCPs and poor continuity with a single \"usual provider of care\" for each patient's care over time at FQHCs. Leveraging performance measures, such as PCMH recognition, to incentivize continuity may be inadequate. Different approaches should be considered to preserve the long-term continuity at the heart of primary care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"490-499"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823070","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: The Gender Wage Gap Among Early-Career Family Physicians.","authors":"Kristin Reavis, Daniel Harris, Brittany N Watson","doi":"10.3122/jabfm.2024.240413R0","DOIUrl":"10.3122/jabfm.2024.240413R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"608-609"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976650","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 4Cs of Primary Care, Leveraging Artificial Intelligence, and Improving Clinical Practice.","authors":"Jacqueline Britz, Marjorie A Bowman, Dean A Seehusen, Christy J W Ledford","doi":"10.3122/jabfm.2025.250167R0","DOIUrl":"10.3122/jabfm.2025.250167R0","url":null,"abstract":"<p><p>This <i>JABFM</i> issue covers key clinical topics, leveraging large language models, and the 4Cs of primary care. A validated \"FluScoreVax risk score\" can guide flu diagnoses. Do you know what symptoms are most predictive of flu? Other articles cover a breadth of clinical topics. For example, how should you evaluate asymptomatic fasting hypoglycemia? Does virtual reality exercise training improve quality of life in stroke patients? Does pitavastatin reduce risk of cardiovascular events in adults with HIV? One featured manuscript provides insights for home, office, and telehealth induction for MOUD in primary care practices. This issue also addresses large language models in physician learning and diagnostic excellence. Several articles cut across the 4Cs of primary care, including primary care comprehensiveness, first contact access, coordination, and continuity. For example, One manuscript reviews balancing access, well-being, and collaboration in care delivery models with team-based care. Finally, this issue addresses the gender wage gap among early-career family physicians.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"631-633"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976677","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":"Long COVID and Days of Work Missed Due to Illness or Injury by Adults in the United States, 2022.","authors":"Rachel Liu-Galvin, Frank A Orlando, Tamkeen Khan, Gregory D Wozniak, Arch G Mainous","doi":"10.3122/jabfm.2024.240367R1","DOIUrl":"10.3122/jabfm.2024.240367R1","url":null,"abstract":"<p><strong>Introduction: </strong>There are concerns of postacute sequelae of COVID-19, but the impact of long COVID on the US workforce is unclear.</p><p><strong>Methods: </strong>We analyzed the nationally representative 2022 Medical Expenditure Panel Survey (MEPS). Adult (aged 18 or above) full time workers were classified as those who had never had COVID-19, those who had COVID-19 without long COVID, and those who had long COVID. The number of days of work missed due to illness in 2022 was assessed in unadjusted negative binomial regressions and those adjusted for paid sick leave, age, sex, race and comorbidities.</p><p><strong>Results: </strong>Among 125,151,402 (weighted) adults, 42.9% never had COVID-19, 49.6% had COVID-19 without long COVID, and 7.5% had long COVID. Patients with long COVID missed more than 8 days of work in a year which was 171% higher than patients without COVID-19% and 62% higher than those who had COVID-19 without long COVID. After adjusting for potential confounding variables, patients who had COVID-19 without long COVID had a greater rate of missing work (IRR 1.75; 95% CI 1.51, 2.04) compared with those who did not have COVID-19. Long COVID patients had an even higher rate of missing work (IRR 2.21; 95% CI 1.79, 2.73) compared with those who did not have COVID-19.</p><p><strong>Discussion: </strong>An additional outcome for patients with long COVID is an impact on the workforce and significantly more missed workdays.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"551-555"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823085","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":"Is Cognitive Impairment Associated with Inadequate Bowel Preparation for Colonoscopy?","authors":"Jeanette M Daly, Yinghui Xu, Seth D Crockett, Richard M Hoffman, Barcey T Levy","doi":"10.3122/jabfm.2024.240338R1","DOIUrl":"10.3122/jabfm.2024.240338R1","url":null,"abstract":"<p><strong>Purpose: </strong>Inadequate bowel preparation (IBP) for colonoscopies is associated with missed polyps and cancers, prolonged procedure times, lower colonoscopy completion rates, and need for a repeat procedure. The purposes of this study were to assess: 1) whether impaired cognitive status (measured by an abnormal clock drawing test) was associated with IBP, and 2) the association of participant demographic and clinical characteristics with IBP.</p><p><strong>Methods: </strong>Cross-sectional cohort study conducted in 3 academic centers. Subjects, 50 to 85 years old, completed 5 stool tests on a single sample and a clock drawing before undergoing a screening or surveillance colonoscopy. Clock drawings were validated by the Mendes-Santos method and Watson method. A generalized linear mixed model was conducted to estimate factors associated with IBP, based on Aronchick bowel preparation score.</p><p><strong>Results: </strong>The 2,016 participants had a mean age of 63 years (SD = 7.95); 1,274 (63%) were female; 119 (6%) had IBP; and 421 (21%) had an abnormal clock drawing. After controlling for age in the multivariable model, the odds of having an IBP versus adequate were 1.44 (95% CI, 0.94-2.22) for those with an abnormal clock drawing score compared with those with a normal score. The only variable significantly associated with IBP was household income, with an odds of 2.48 (95% CI, 1.56-3.95) for household income of <$40,000 compared with income >$80,000.</p><p><strong>Conclusions: </strong>Lower household income was associated with greater odds of IBP. The association between an abnormal clock drawing score and IBP was not statistically significant.NCT03264898 (clinicaltrials.gov) - Comparative Effectiveness of FITs with Colonoscopy.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"423-430"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823074","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":"Utilizing National Survey Data to Benchmark Comprehensive Care in a Large Health System.","authors":"John S Maier, Derek Baughman, Chris Schiermeyer, Kevin Kindler","doi":"10.3122/jabfm.2024.240254R1","DOIUrl":"10.3122/jabfm.2024.240254R1","url":null,"abstract":"<p><strong>Background: </strong>Comprehensiveness in primary care is defined as the breadth of services provided by a health care clinician team and is an important metric related to patient outcomes and care delivery. We describe a novel measure of comprehensiveness based on ICD-10 codes.</p><p><strong>Methods: </strong>We compare the distribution of ICD-10 codes from the care of a large population at a regional academic health system to the distribution of codes from the National Ambulatory Medical Care Survey (NAMCS) using linear regression and the mathematical inner product.</p><p><strong>Results: </strong>The linear regression between the pattern of ICD-10 codes for the selected population and the NAMCS has a slope 1.00, 95% CI 0.57:1.43, <i>P</i> = .0002, R² 0.62. When considering specific specialty areas of practice, primary care is distinct from specialty care based on the inner product between the distribution of care for a given specialty independent of whether a regional or national reference population is used.</p><p><strong>Conclusion: </strong>The distribution of care based on ICD-10 codes provides a stable and possibly generalizable reference for comprehensive care. The inner product of an ICD-10 care distribution and a reference provides a quantitative estimate of comprehensiveness that distinguishes primary care from specialty care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"561-565"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823093","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":"Intervention to Improve Psychosocial Care for People with Type 2 Diabetes.","authors":"Deborah J Cohen, Shannon M Sweeney, Rachel Springer, Bijal A Balasubramanian, LeAnn Michaels, Miguel Marino, Danielle Hessler, Andrea Baron, Johanna Nesse","doi":"10.3122/jabfm.2024.240265R1","DOIUrl":"10.3122/jabfm.2024.240265R1","url":null,"abstract":"<p><strong>Background: </strong>This proof-of-concept study tested the feasibility and acceptability of INTEGRATE-D, an implementation support intervention for primary care clinics to improve the psychosocial care of patients with type 2 diabetes.</p><p><strong>Methods: </strong>Cluster randomized controlled pragmatic trial, with a parallel, convergent mixed methods design. Two Intervention Clinics (ICs) were offered tailored training on American Diabetes Association (ADA)-recommended psychosocial care and facilitation to identify and support clinical change. Two Control Clinics (CCs) received no intervention.</p><p><strong>Primary outcomes: </strong>intervention acceptability, appropriateness and feasibility.</p><p><strong>Secondary outcomes: </strong>process-of-care metrics (eg, depression screening, diabetes management) and clinical outcomes measures (PHQ-9 and A1C). Qualitative data were collected to assess implementation and experience with the intervention.</p><p><strong>Results: </strong>ICs were offered training and received 15-months of facilitation. To accommodate COVID-19-related safety restrictions, the intervention was changed to be delivered virtually (eg, remote facilitation and training sessions). Despite an adapted delivery and COVID-19 and staffing stressors, clinics exposed to INTEGRATE-D found it to be acceptable, well-aligned with clinics' needs, and feasible. Qualitative data suggest COVID-19 stressors tempered feasibility. The effect of INTEGRATE-D on process and clinical outcome measures were mixed. Several factors, including differences in ICs and CCs not addressed in randomization and delivery of a less intensive intervention due to the pandemic, may help explain these results.</p><p><strong>Conclusions: </strong>Given the growing number of people with type 2 diabetes and the importance of psychosocial care for these patients, INTEGRATE-D warrants further pilot-testing with a larger sample of clinics and patients, and under conditions where in-person facilitation and expanded training is possible.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"253-274"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512706","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}