Journal of the American Board of Family Medicine最新文献

{"title":"Empowering Family Physicians in Medical Staff Leadership to Foster Physician Well-Being.","authors":"Megan R Mahoney, Edward Damrose, Tait Shanafelt","doi":"10.3122/jabfm.2024.240136R1","DOIUrl":"10.3122/jabfm.2024.240136R1","url":null,"abstract":"<p><p>In the evolving landscape of health care, marked by increasing physician distress, the role of family physicians in leadership positions emerges as crucial for driving systemic improvements. Drawing from 9 years of collective experience as chiefs of staff, this commentary outlines a framework for family physicians serving in the Chief of Staff, Medical Staff President role or other physician executive positions aimed at improving physician well-being. Recognizing the comprehensive scope of practice and team-based orientation of family medicine, we highlight the unique capabilities of family physicians to foster organizational changes that address the root causes of physician burnout. The proposed framework emphasizes the importance of effective communication channels to ensure the medical staff's voices are heard and valued. It advocates for physician-centered approaches to credentialing and privileging processes, equitable incident reporting systems, and supportive measures for physicians facing professional challenges. By implementing a wellness-oriented framework, healthcare organizations can safeguard the future of the medical profession and create a healthcare system that prioritizes the well-being of both patients and clinicians.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"168-171"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Feel Again: The Strength of a Support Community.","authors":"Angela Renee Rodgers","doi":"10.3122/jabfm.2024.240117R1","DOIUrl":"10.3122/jabfm.2024.240117R1","url":null,"abstract":"<p><p>Health care professionals are known to prioritize the health of others over themselves. The culture of medicine incentivizes this idea of putting all others first before ourselves. This habit makes physicians with chronic disease less likely to address the psychosocial aspect of how their chronic disease impacts their life. Psychosocial impact of chronic disease can include feelings such as isolation, shame, a false sense of contentment or even depression and anxiety among others. Routinely connecting with those with shared diagnoses offers validation, support, and a sense of freedom. As a woman of color with autoimmune hair loss (alopecia areata), Dr. Angela Rodgers shares her experience attending Baldie Con in 2023, a new national conference for women with various types of hair loss. She reveals how the experience unearthed truths about the relationship between physicians and their diagnoses and provides evidence-based advice on how to stay connected with community.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"172-173"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C Treatment Knowledge, Attitudes, and Practices Among Primary Care Providers-Los Angeles County, 2023.","authors":"Katherine A Loomis, Debika Bhattacharya, Raiza Amiling, Mirna Ponce-Jewel, Michael E Lazarus, Gus Chavez, Prabhu Gounder","doi":"10.3122/jabfm.2024.230354R0","DOIUrl":"10.3122/jabfm.2024.230354R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"192"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insurance Instability Among Community-Based Health Center Patients with Diabetes Post-Affordable Care Act Medicaid Expansion.","authors":"Leo Lester, Dang Dinh, Annie E Larson, Andrew Suchocki, Miguel Marino, Jennifer DeVoe, Nathalie Huguet","doi":"10.3122/jabfm.2024.240186R1","DOIUrl":"10.3122/jabfm.2024.240186R1","url":null,"abstract":"<p><strong>Background: </strong>To evaluate insurance instability (churn) among adults with diabetes receiving care at community-based health centers (CHCs).</p><p><strong>Methods: </strong>Retrospective cohort study using patients' electronic health records data for 300,158 adults aged 19 to 64 with ≥3 ambulatory visits between 2014 and 2019 of which 39,542 churned out of insurance. Generalized estimating equation-based (GEE) logistic regression models were fitted to assess the odds of churning.</p><p><strong>Results: </strong>Among CHC patients, those with diabetes had 1.25 greater odds of churning than those without diabetes (aOR = 1.25; 95%CI = 1.18, 1.33). Among CHC patients with diabetes, the odds of churning were higher for those with uncontrolled diabetes, more complex medication regimens, and acute diabetes complication.</p><p><strong>Conclusions: </strong>CHC patients with diabetes are more likely to experience insurance instability than those without diabetes. Outreach efforts to reduce the impact of the postpandemic Medicaid disenrollment among patients with diabetes and lower income will be critical to reduce harmful health consequences.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"154-164"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Changing Scopes of Practice Among Contemporary Graduates of the Nation's Largest Family Medicine Residency.","authors":"Nicholas LeFevre, Richard A Young","doi":"10.3122/jabfm.2024.240172R1","DOIUrl":"10.3122/jabfm.2024.240172R1","url":null,"abstract":"<p><strong>Background: </strong>John Peter Smith (JPS) Hospital Family Medicine Residency participated in both the P4 (Preparing the Personal Physician for Practice) and LOT (Length of Training) projects, and is known for its emphasis on preparing physicians for full-scope practice. Scope of practice outcomes among graduates of these programs are previously described, but how and why the scope of practice of these physicians change in their early career merits further exploration.</p><p><strong>Methods: </strong>A structured questionnaire was sent to all JPS graduates who matriculated as interns in the years 2007 to 2016 with information on cognitive and procedural scope of practice. Graduates were asked about their scope of practice both in their initial jobs out of residency and their current jobs. They were also asked about the forces affecting their scope of practice with both structured and open-ended questions. Responses were analyzed quantitatively and through qualitative thematic analysis.</p><p><strong>Results: </strong>A total 184 graduates provided information about practice scope. Graduates stopped providing inpatient care for children (9.2%), prenatal care (8.8%), long-acting reversible contraception (7.8%), ICU care of adults (7.8%), joint injections (7.4%), and inpatient care of adults (6.9%) at the highest rates between initial and current jobs. Scope of practice changes over time found to be statistically significant included inpatient care of children, ICU care of adults, inpatient care of adults, nursing home, substance use disorder including medication assisted therapy, and obstetric deliveries. The most common reasons for change were personal preference and work-life balance, rather than institutional and related systematic barriers.</p><p><strong>Conclusion: </strong>In the graduates of one institution, it is common for the scope of practice to change over time, both by discontinuing and adding services. Changes seem most driven by choice and work-life balance, rather than outside pressures or a feeling of inadequate preparation for practice.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"133-138"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Factors Influencing Patient Confidence in Screening Mammography.","authors":"Sergio Castellanos, Laura Manuela Olarte Bermúdez, Javier Andrés Romero Enciso, Gloria Ines Palazuelos Jimenez","doi":"10.3122/jabfm.2024.240307R0","DOIUrl":"10.3122/jabfm.2024.240307R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"193-194"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Adverse Childhood Experiences and Social Risks Screening in Adult Primary Care.","authors":"India Gill, Ariana Thompson-Lastad, Denise Ruvalcaba, Laura M Gottlieb, Danielle Hessler Jones","doi":"10.3122/jabfm.2024.240170R1","DOIUrl":"10.3122/jabfm.2024.240170R1","url":null,"abstract":"<p><strong>Background: </strong>In 2020, the state of California started financially incentivizing primary care practices to screen for adverse childhood events (ACEs). In its current Medicaid 1115 waiver, the state also has encouraged health care teams to screen for social risks (SR) - (eg, food, housing, and transportation insecurity). In this qualitative study, we explore community health center (CHC) staff and patient perspectives about opportunities and barriers to integrating adult screening for ACEs and SR.</p><p><strong>Methods: </strong>We identified eligible California CHCs through Medicaid claims data on ACEs screening and/or participation in ACEs or SR-related learning collaboratives. Staff and/or patients in 12 clinics participated in semistructured interviews exploring opportunities and barriers to integrated ACEs and SR screening. Interviews were analyzed using a rapid qualitative data analysis approach.</p><p><strong>Results: </strong>Thirty-nine clinic staff (including clinic leaders, allied health professionals, licensed clinicians) and 10 patients participated. While staff and patients often conceptually endorsed integrated ACEs and SR screening, they identified substantial practical barriers to integration. Barriers primarily related to different screening frequencies and workflows. Other barriers reflected broader primary care time constraints and workforce shortages. Participants shared multiple recommendations to improve screening programs, including strategies for combining ACEs and SR screening.</p><p><strong>Discussion: </strong>California CHC staff and patients described several conceptual benefits of integrating ACEs and SR screening, but longstanding primary care challenges make it complicated to integrate these activities. Standardizing the integration of ACEs and SR screening will require institutional and structural shifts to overcome common barriers to providing whole person care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"15-27"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perspectives on Delayed Specialty Follow-Up After a Primary Care Visit.","authors":"Leonor Fernández, Dru Ricci, Amie Pollack, Maelys J Amat, Meghan Drielak, Talya Salant, Gordon D Schiff, Umber Shafiq, Scot B Sternberg, James Benneyan, Mark Aronson, Erin Sullivan, Russell S Phillips","doi":"10.3122/jabfm.2024.240063R3","DOIUrl":"10.3122/jabfm.2024.240063R3","url":null,"abstract":"<p><strong>Background: </strong>Patients are often referred for important diagnostic tests or consultations after a concerning symptom or finding is identified at a primary care visit, but many referrals are delayed or not completed.</p><p><strong>Methods: </strong>In this qualitative study, we reviewed electronic health record data to identify patients who did not have timely completion of a recommended referral at an academic primary care hospital-based practice and an affiliated community health center. Using semistructured interview guides, we interviewed 15 patients who did not complete a cardiac stress test within 28 days of a primary care visit associated with a diagnosis of chest pain, and 15 patients who did not complete a dermatology referral within 90 days of identification of a concerning skin lesion.</p><p><strong>Results: </strong>Thematic analysis highlighted 3 areas: 1) Patients desired clear communication to inform, equip and empower them, 2) Clinician-patient communication regarding a referral's rationale and value is key, and 3) Referral appointment processes were often challenging and/or delayed. Patients wished to understand why they were being referred, the specific value and reason for the referral, and what to expect. We developed a conceptual model describing how the initial clinician-patient communication may influence referral completion.</p><p><strong>Conclusions: </strong>Failure to close diagnostic loops may be more likely when a patient is not given sufficient meaningful information, particularly if there is health system \"friction\" that reduces the patient's ability and ease to obtain a timely diagnostic referral appointment. Clinicians should use accessible language to communicate why a diagnostic referral is useful and important for the patient's health, and include a specific optimal time frame. The initial communication and the ease of the subsequent appointment booking both matter, and may compound or mitigate each other's effect. To reduce diagnostic referral failures and delays. clinicians should advocate for consistent appointment booking processes that systematically inform, equip, and empower patients with clear and meaningful referral information and timely appointments.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"139-153"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of AI in Family Medicine Publications: A Joint Editorial from Journal Editors.","authors":"Sarina Schrager, Dean A Seehusen, Sumi Sexton, Caroline Richardson, Jon Neher, Christopher Pimlott, Marjorie Bowman, Jose Rodriguez, Christopher P Morley, Li Li, James Dom Dera","doi":"10.3122/jabfm.2024.240397R0","DOIUrl":"10.3122/jabfm.2024.240397R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"4-8"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and Preferences for Defining Biosimilar Products in Prescription Drug Promotion.","authors":"Mihaela Johnson, Jessica E Thompson, Avery A Tilley, Amie C O'Donoghue, Kathryn J Aikin","doi":"10.3122/jabfm.2024.240151R1","DOIUrl":"10.3122/jabfm.2024.240151R1","url":null,"abstract":"<p><strong>Background: </strong>Prescription biosimilars are highly similar to and have no clinically meaningful differences from existing FDA-approved reference products. Despite increased availability in the marketplace, consumers and clinician lack awareness of these products. Our study experimentally tested understanding of and preference for brief descriptions of biosimilars in the form of disclosure statements in a fictitious prescription drug advertisement.</p><p><strong>Methods: </strong>Consumers (n = 379) and HCPs (n = 368) viewed a mock advertisement and responded to an online survey. Study participants were randomized to 1 of 7 biosimilar disclosure definitions or a control. Disclosure conditions varied with regard to 1) identifying the product as a biosimilar; 2) information provided in the definition; and 3) naming the reference product. We tested the effects of disclosure conditions on comprehension, perceptions, attitudes, intentions, and preferences.</p><p><strong>Results: </strong>Overall, comprehension of information in the biosimilar disclosure was less than optimal (48.5%-62.0% and 68.4%-88.4% for consumers and HCPs, respectively), even when provided with a definition. Perceptions of benefit, comparative efficacy, and safety were neutral. Content of the biosimilar definition generally did not influence outcomes, except that HCPs reported more positive attitudes toward the biosimilar and stronger intentions to prescribe when provided with expanded definitions. Both groups preferred the expanded definitions, and HCPs preferred seeing a named reference product. HCPs generally agreed with a statement that biosimilars could be used \"interchangeably\" with the reference product.</p><p><strong>Conclusions: </strong>Our findings signal some knowledge gaps and uncertainty regarding biosimilars among consumers and HCPs. Further education is warranted around these products, and communications for both groups require careful testing to ensure that the information is understood and does not result in a negative perception of the product.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"94-106"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}