Journal of the American Board of Family Medicine最新文献

{"title":"Characteristics of Children Seeking Care at School-Based Health Centers.","authors":"Michelle Trivedi, Jorge Kaufmann, Holly Pereira, Brenda M McGrath, Miguel Marino, Michelle Spano, Jennifer A Lucas, Sarabeth Broder-Fingert, Michael Arenson, Arvin Garg, John Heintzman","doi":"10.3122/jabfm.2025.250321R1","DOIUrl":"10.3122/jabfm.2025.250321R1","url":null,"abstract":"<p><strong>Purpose: </strong>There has yet to be a comprehensive multi-state study describing the children that use school-based health centers (SBHCs). This study seeks to determine sociodemographics, care utilization patterns, and prevalence of asthma and overweight among children seeking care at SBHCs.</p><p><strong>Methods: </strong>This retrospective cross-sectional analysis examined electronic health record data of children utilizing SBHCs within a large network of community-based clinics, consisting of 180 SBHCs in 14 U.S. states from 2012-2018. Demographics of exclusive SBHC users (SBHC-only group) were compared to utilizers of SBHCs plus non-SBHC community health centers (SBHC+ group).</p><p><strong>Results: </strong>Of 179,970 children with ≥1 ambulatory visit at a SBHC, 75.6% received care exclusively at SBHCs. Many SBHC-users reported family income <138% of the federal poverty line (48.9%) and self-identified as Hispanic (45.7%). Among SBHC utilizers, the prevalence of asthma (8%) and overweight (30%) were comparable to national statistics. Overall, 33% of children received well-childcare and 24% received influenza vaccinations exclusively at SBHCs. When comparing the two groups within the study, the SBHC-only group were older, and more lacked insurance (13.4%) compared with SBHC+ children (2.6%). The SBHC-only group had fewer total yearly visits, fewer yearly well-child visits, and fewer influenza vaccinations. In age stratified groups, preschool-aged children received the most well-childcare and influenza vaccinations in SBHCs.</p><p><strong>Conclusions: </strong>SBHCs serve a pediatric population that is disproportionately low-income, uninsured, and Hispanic. Children, particularly preschoolers, receive preventive healthcare at SBHCs. Given the population served, SBHCs have strong potential to address pediatric health inequities if adequately resourced, utilized, and integrated with other facilities including community health centers.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377796","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":"To Team or Not to Team: A Foundational Debate for the Future of Family Medicine-Insights from the Family Medicine Leadership Council.","authors":"David Rushlow, Andrew Bazemore, Patricia Klatt","doi":"10.3122/jabfm.2026.260014R0","DOIUrl":"10.3122/jabfm.2026.260014R0","url":null,"abstract":"<p><p>In some form, team-based care is an essential element of family medicine practice; however, the composition, roles, and definitions of team members vary widely. Team-based care has been promoted as a strategy to address rising clinical complexity, workforce shortages, and clinician burnout in family medicine. This article synthesizes a structured dialogue convened by the Family Medicine Leadership Council (FMLC) that examined both the promise and limitations of team-based primary care. Drawing on evidence, national data, and leadership perspectives, the discussion highlights key design considerations, tensions related to continuity and professional identity, and the importance of context-sensitive implementation. The article argues for team models adapted to the specific circumstances of diverse practice settings that preserve continuity, accountability, and the core values of family medicine.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609598","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":"An Analysis of Common Questions and Concerns of Older Adults with Multiple Chronic Conditions.","authors":"Kevin Lal, Clara Schneider, Anna M Espinoza, Z Noah Hendrix, Richard A Young, Annesha White, Cindy M Lopez, Yan Xiao, Kimberly G Fulda","doi":"10.3122/jabfm.2025.250240R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250240R1","url":null,"abstract":"<p><strong>Purpose: </strong>Studies have shown that facilitating patient dialogue through a structured question prompt list (QPL) during patient encounters results in greater patient engagement, improved communication and increased patient understanding. Topics most interesting to patients are unclear, thus limiting how to optimally design and use QPLs. This study identified topics most interesting to patients to discuss with their clinicians in primary care office visits.</p><p><strong>Methods: </strong>We collected responses to a 20-item visit guide including questions to ask, concerns to tell, and positive behaviors to report. We focused on the ask and tell sections which involved general questions and concerns patients could choose from. Participants were 50 years or older and taking 5 or more medications at family medicine clinics from a public safety net hospital system (240) and an urban private practice (211).</p><p><strong>Results: </strong>Of 451 visit guides collected, the selected top topics involved: 1) Diet (20.4%), 2) Taking fewer medications (15.3%), and 3) Understanding their condition (14.6%). The most common medication concerns included: 1) stopping or skipping medications due to cost, side effects, or other reasons (11.1%), 2) medications from multiple doctors (8%), and 3) specific concerns about medications (5.7%).</p><p><strong>Conclusions: </strong>Patients reported interest in discussing questions and concerns related to diet, reducing medications, and self-care knowledge on their conditions. The questions and concerns identified in this study provide insight into the communication priorities of older adults managing multiple medications. These findings can further inform the future development of QPLs and therefore potentially reap the benefits of improved clinician-patient communication.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377751","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":"Primary HPV Testing for Cervical Cancer Screening Among Family Medicine Educators.","authors":"Alisa P Young, Rosa Reyes, Chidera Mgbudem, Dongru Chen, Ananda Sen, Diane M Harper","doi":"10.3122/jabfm.2025.250328R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250328R1","url":null,"abstract":"<p><strong>Background: </strong>Half of the women who develop cervical cancer in the US have never had a cervical cancer screen. Self-sampling is an equivalent technique to the invasive speculum exam. We aim to evaluate the current knowledge, attitudes, and behaviors toward self-sampled primary HPV testing in family medicine.</p><p><strong>Methods: </strong>The annual cross-sectional survey of the Council of Academic Family Medicine's general membership included knowledge, attitudes, and beliefs about primary human papillomavirus (HPV) screening using self-sampling. The knowledge questions were based on current guidelines, as defined by the 2024 United States Preventive Services Task Force (USPSTF) 1. The attitude and belief questions were based on the Question-Behavior Theory 2. All surveys were emailed to the membership with up to five weekly reminders to complete.</p><p><strong>Results: </strong>We had a 62% survey response rate with 744 respondents. Regardless of demographic descriptors, all respondents significantly changed their intended behavior regarding offering self-sampling for cervical cancer screening (p < 0.001). Of those with a baseline attitude of not offering self-sampling, 88% changed their response to offer self-sampling at the end of the survey. Baseline knowledge of the advantages of primary HPV screening was lowest among underrepresented minority Hispanic respondents (52% correct, compared to 80% among Whites, p < 0.001). Women respondents were 2.96 times more likely to intend to offer self-sampling for cervical cancer screening than men (OR 2.96 (95% CI: 1.18, 7.44, p<0.05).</p><p><strong>Conclusions: </strong>Based on the Question-Behavior Theory, over 90% of family medicine educators intend to offer women self-sampling for cervical cancer screening.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377791","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 Qualitative Study of Family Physician and Patient Perspectives on Professionalism.","authors":"Annie Koempel, Madeline Byrd, Tanya Lord, Robert L Phillips","doi":"10.3122/jabfm.2026.260058R0","DOIUrl":"10.3122/jabfm.2026.260058R0","url":null,"abstract":"<p><p>Despite a robust literature on the topic, a consistent definition of medical professionalism remains elusive. A single, generalizable definition is ineffective and tends to emphasize prohibited behaviors rather than aspirational concepts. As physicians are increasingly employed by corporate entities, the nature of healthcare work has changed, as well as professional expectations. This study explores how patients and family physicians understand medical professionalism and its drivers.We recruited family physicians who completed the ABFM Continuing Certification Questionnaire in 2024 to participate in in-depth, semi-structured interviews. A trained qualitative researcher used Zoom to interview 27 demographically diverse physicians. We utilized modified snowball sampling to recruit patients through a key informant. All interviews were transcribed verbatim and analyzed utilizing NVivo software following an inductive content analysis approach.Interview results coalesced into a model of professionalism that represents the clinic visit, the practice site, and the overarching system. Three main components of individual physician professionalism emerged, including foundational duties, relationship-based care, and communication. Patient trust in the overarching healthcare system and individual physicians was deeply influenced by the interconnected system.This study presents key elements of physician professionalism while highlighting how deeply physicians are entangled within the larger practice and healthcare systems. Professionalism extends beyond-and is impacted by-more than individual attitudes and behaviors. Institutions must interrogate their own policies to support physicians in developing their skills in relationship-based care and communication.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609526","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":"Advancing a Public-Centered Vision for Primary Care-Lessons from Ontario and Inspiration from the Netherlands.","authors":"Tara Kiran","doi":"10.3122/jabfm.2026.260037R1","DOIUrl":"10.3122/jabfm.2026.260037R1","url":null,"abstract":"<p><p>Primary care reforms often proceed without a clear articulation of what patients and the public expect primary care to deliver. In Canada, nearly six million people lack access to a regular primary care clinician despite universal health insurance. Through the OurCare initiative, nearly 10,000 people across Canada participated in a structured, deliberative process to define what primary care should provide. The resulting OurCare Standard articulates six expectations for a publicly funded, relationship-based, timely, culturally safe, and accountable primary care system. Ontario has recently embedded these priorities in legislation through the Primary Care Act and committed to achieving universal access to primary care by 2029. Yet longstanding variation in team implementation, inequitable distribution of resources, limited evidence of expanded physician capacity, and increasing movement of family physicians toward focused practice complicate this goal. Experience from the Netherlands-where near-universal access to primary care has been achieved-highlights several design features that support timely access at scale, including stronger demand management in practices, substitutive team roles, an educated public and family physicians working at top of scope. Achieving primary care for all will require not only expanding teams but redesigning how care is organized, delivered, and kept accountable to meet the needs of the communities primary care is meant to serve.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609511","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":"\"Hard Fork\" for Family Medicine - Artificial Intelligence Will Change the Way We Experience Practice.","authors":"Gene A Kallenberg, Ian M Bennett","doi":"10.3122/jabfm.2025.250251R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250251R2","url":null,"abstract":"<p><p>The increasing advance of artificial intelligence (AI) in medicine will affect the future of Family Medicine in many ways. Some of the effects may be salutary, but others may infringe on the real work of family medicine/primary care. AI will change the way we experience practice. If AI can perform many current physician tasks, what will be left for the practicing human family physician? We believe that there will be several types of patient encounters that will still require the human touch that comes from established long-term continuous healing relationships between family physicians and their patients. As AI applications in primary care become more robust it will assume the function of a new member of the multi-professional healthcare team, and physicians will learn to operate in a new triad: the \"doctor-patient-AI partner relationship\". We explore possible further effects on the practice of family medicine under these new AI-enhanced circumstances and contemplate their impact on the current gap in primary care availability, continuity of care and the attractiveness of primary care careers. As we pass through this potential \"hard fork\" for family medicine we are convinced that family medicine is the most likely component of the healthcare system to survive and prosper with AI.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377805","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":"Access to Continuity-Strategies for Symbiotic Improvement of Access and Continuity of Care.","authors":"Marianna Kong, Steven Lin, Jason D Ramm, Samuel Weir, Warren P Newton","doi":"10.3122/jabfm.2026.260055R0","DOIUrl":"10.3122/jabfm.2026.260055R0","url":null,"abstract":"<p><p>Family medicine and primary care face ongoing pressures for access, with demand for care overwhelming the capacity to deliver it. Common strategies to maximize access often operate to the exclusion or detriment of continuity of care. During the August 2025 Family Medicine Leadership Consortium meeting, rather than presuming a tradeoff between the two as inevitable, the proposition that family medicine is committed to improving access to continuity of care was put forth.This article summarizes concepts and models for improving access that simultaneously preserve or elevate continuity of care. A full understanding of access requires nuanced data around demand and capacity at the day-to-day level. This data can be used to prioritize both access and continuity by incorporating both into appointment templates, right-sizing panels, and directing capacity to the times of greatest demand. Investing in innovative team models such as those incorporating upskilled medical assistants, or panels shared among small teams of physicians and advanced practice practitioners, allow expanded capacity to deliver access while maintaining continuity. Advanced access scheduling models build on foundations of managing demand and capacity to most efficiently match day-to-day visit capacity to demand and maximize access to the continuity clinician.Improving access and continuity of care do not have to be a zero-sum game-by valuing and centering continuity among access interventions, healthcare systems can shift the paradigm between access and continuity from \"either/or\" to a symbiotic relationship, with access meaning access to continuity of care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609587","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 Importance of Primary Care Subject Matter Experts: Output Quality in Large Language Models Prompt Engineering.","authors":"Winston Liaw, Quang Hung Bui, Omolola Adepoju, Hien Van Nguyen","doi":"10.3122/jabfm.2025.250326R1","DOIUrl":"10.3122/jabfm.2025.250326R1","url":null,"abstract":"<p><p>Large language models (LLMs) offer new opportunities to support primary care by generating documentation, summarizing records, answering messages, and providing education. While LLMs show promise, their effectiveness depends on how well their outputs align with real-world clinical needs. This commentary describes one team's development of Primary Care (PC) Navigator, a multimodal artificial intelligence (AI) tool that combines audio and video from clinical encounters with an LLM to generate behavior change plans. Our pilot study showed that prompt design plays a critical role in shaping output quality. Through collaboration between clinicians and engineers, we created more effective prompts and recommend that others use the CARE framework (Context, Action, Result, Example) to ensure the outputs are accurate, relevant, and actionable. Clinician involvement is essential not just for evaluating the LLM's performance, but also for shaping its development. By participating in prompt engineering, clinicians move from passive users to co-developers. Their input ensures that LLMs in primary care are both technically functional and aligned with patient needs, professional values, and the realities of frontline practice.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229011","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":"Daily Nutrient Intake and Inflammation Among US Adults.","authors":"Arch G Mainous, Lu Yin, Frank A Orlando, Aaron A Saguil","doi":"10.3122/jabfm.2025.250393R1","DOIUrl":"10.3122/jabfm.2025.250393R1","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic inflammation has long been associated with chronic disease and mortality. Dietary interventions have been a proposed mechanism to decrease inflammation. Using high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammation, we investigated whether daily intake of nutrients purported to be anti-inflammatory had an association with current inflammation.</p><p><strong>Methods: </strong>We used the National Health and Nutrition Examination Survey 2021-2023 to conduct a population level analysis of US adults. Individual diets were translated into daily nutrient intakes. hs-CRP was measured in close temporal proximity to dietary assessment. For each nutrient, intake was categorized as low, moderate (includes recommended intake), or high. hs-CRP and dietary nutrient intake were examined with parametric and non-parametric statistics.</p><p><strong>Results: </strong>High intake of certain nutrients was significantly associated with lower levels of hs-CRP when compared to low intake of these nutrients (dietary fiber: 2.7 vs. 3.9, p=0.001; folate: 3.3 vs. 4.1, p=0.002; magnesium: 2.8 vs. 4.0, p=0.001; vitamin B6: 3.4 vs. 4.0, p=0.01; vitamin C: 3.4 vs. 4.0, p=0.04; vitamin D: 1.3 vs. 3.8, p=0.03; vitamin K: 3.1 vs. 4.1, p=0.0001). For dietary fiber and magnesium, the significant association was also demonstrated when comparing low to moderate intake. Not all hypothesized nutrients showed significant associations with inflammation.</p><p><strong>Conclusion: </strong>Usual dietary intake of dietary fiber and magnesium indicate that they are anti-inflammatory. Folate, and vitamins B6, C, D, and K appear to confer greater anti-inflammatory benefit only above recommended dietary levels. Dietary strategies emphasizing these nutrients may help individuals lower hs-CRP and potentially mitigate inflammation-related health risks.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228891","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}