Journal of the American Board of Family Medicine最新文献

{"title":"The Minority Tax: Stories from Family Physicians.","authors":"Zuleica Santiago-Delgado, Namita Bhardwaj, Winfred T Frazier, Ashley Collazo, N Ogechi Abara, Kendall M Campbell","doi":"10.3122/jabfm.2023.230495R1","DOIUrl":"10.3122/jabfm.2023.230495R1","url":null,"abstract":"<p><p>The minority tax has been defined as a set of disparities that those who are underrepresented in medicine face in addition to clinical care, education, and research responsibilities. These taxes include systemic racism, diversity efforts, clinical and promotion disparities, lack of faculty development, and isolation. Much has been added to the literature to better define and characterize the minority tax and propose suggestions for mitigations. This article builds on the existing literature that defines clinical efforts and diversity efforts disparities by exploring the intersections of these disparities through the experiences of family medicine faculty in the clinical environment. The authors, who are all academic family medicine physicians from minoritized communities, use their lived experiences to share how the diversity efforts disparity impacts patient care. Themes noted include health system wide challenges for patients whose preferred language is not English and the importance of racial and ethnic concordance between patients and the physician workforce.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"969-973"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069044","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":"Examining the Construct Stability of the Family Medicine Certification Scale Between One-Day Exam and Longitudinal Assessment.","authors":"Thomas R O'Neill, Keith Stelter, Ting Wang","doi":"10.3122/jabfm.2023.230443R1","DOIUrl":"10.3122/jabfm.2023.230443R1","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether the construct of family medicine clinical decision making ability was invariant across modes of administration, the 1-day examination and the longitudinal assessment. We attempted to identify item characteristics associated with differences in difficulty across modes of administration.</p><p><strong>Methods: </strong>The data were item difficulty calibrations based on examinee responses to the 1-day examination and the longitudinal assessment. A repeated measures design was employed to identify question calibration differences across modes of administration, so that the stability of the question difficulty across modes of administration could be assessed. A qualitative review of the flagged questions was conducted to identify characteristics associated with questions becoming easier or more difficult.</p><p><strong>Results: </strong>The correlation between the pairs of calibrations was moderately positive r(298) = 0.558, <i>P</i> < .001 suggesting that the questions are functioning somewhat similarly across the different modes of administration; however, the scatterplot demonstrates that many of the questions became easier. Of the 298 repeated measures <i>t</i> test, 37% (110) did not show a significant difference, 43% (128) became easier on the longitudinal assessment, and 20% (60) became more difficult.</p><p><strong>Conclusions: </strong>This study suggests that changes in item difficulty do occur when extra time and the use of external resources are permitted. Usually the questions get easier, but in some cases the question becomes more difficult. Possible reasons for this are presented, and a method to adjust the item difficulty in a way to maintain a single construct is presented.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"900-908"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069033","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":"Perceptions of Medically Complex Patients Enrolled in an Ambulatory Intensive Care Unit at a Healthcare-for-the-Homeless Clinic.","authors":"Brian Chan, Elizabeth Hulen, Samuel T Edwards, Anna Geduldig, Meg Devoe, Christina Nicolaidis, P Todd Korthuis, Somnath Saha","doi":"10.3122/jabfm.2023.230403R1","DOIUrl":"10.3122/jabfm.2023.230403R1","url":null,"abstract":"<p><strong>Background: </strong>There is great interest in intensive primary care interventions to address high utilization among medically and socially complex patients. How patients experience these interventions has received less attention.</p><p><strong>Objective: </strong>To better understand patients' experience of intensive primary care, we interviewed patients receiving care from the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an ambulatory intensive care intervention at an urban federally qualified health center.</p><p><strong>Methods: </strong>We interviewed 25 participants enrolled in the SUMMIT randomized controlled trial and conducted a Reflective Thematic Analysis using a hybrid inductive-deductive approach.</p><p><strong>Results: </strong>Patients reported high levels of medical and social needs that outstripped prior levels of care and resources. They perceived multiple benefits of SUMMIT through the following themes: 1) Team-based care with improved access to services. Patients appreciated their medical and social needs being met, through higher-level, multidisciplinary care. 2) Caring relationships. Patients described the SUMMIT team as being like family and felt that team members had a genuine sense of duty and obligation toward them. 3) Overcoming stigma. Patients felt valued and treated with dignity. 4) Evolving self-efficacy. Over time, patients experienced increasing success, including engagement in care and improved health behaviors.</p><p><strong>Conclusion: </strong>Patients perceived the SUMMIT team as better meeting their health-related needs, compared with traditional primary care. They spoke of the team as family and felt humanized and supported in overcoming barriers to engagement, which led to increased self-efficacy. Evaluations assessing the effectiveness of intensive primary care should measure potential patient-centered benefits beyond short-term utilization and cost reduction.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"888-899"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900015","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":"The One Taboo Question.","authors":"Jordan M Alpert, Heather McKee Hurwitz, Michael B Rothberg","doi":"10.3122/jabfm.2023.230478R1","DOIUrl":"10.3122/jabfm.2023.230478R1","url":null,"abstract":"<p><p>Income is an important social determinant of health, yet it is rarely discussed among patients and clinicians. Discussing income could open the door to addressing issues like high deductibles, prescription costs, copays, housing expenses, and medical debt. We identify ways to overcome obstacles to talking about this taboo subject.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"979-982"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069053","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":"Colorectal Cancer Screening and Social Needs.","authors":"Isabelle R Franklin, Rebecca Gambatese, Mark C Duggan, Beverly B Green, Robert S Nocon, Gloria D Coronado, Erin E Hahn, Stacey A Honda, Kate Koplan, Theodore R Levin, Claudia A Steiner, Quyen Ngo-Metzger","doi":"10.3122/jabfm.2023.230497R1","DOIUrl":"10.3122/jabfm.2023.230497R1","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. While patient-reported barriers have been previously described, few studies have analyzed how patients' social needs affect screening rates.</p><p><strong>Methods: </strong>This cross-sectional study includes 3,443 Kaiser Permanente (KP) patients ages 50 to 75 years who completed the 2020 KP National Social Needs Survey. Five social needs categories were assessed: \"Financial Strain,\" \"Housing Instability,\" \"Transportation Issues,\" \"Social Isolation,\" and \"Food Insecurity.\" Being up to date on CRC screening was determined from patients' electronic health records, defined as meeting Health care Effectiveness Data and Information (HEDIS) criteria for screening. We used multivariable analyses to explore associations between social needs and completion of colorectal cancer screening in 2020, adjusting for demographic factors.</p><p><strong>Results: </strong>Among the survey respondents, 2,805 (81.5%) were up to date on their colorectal cancer screening. Patients were less likely to be screened if they had severe financial strain (OR 2.1, 95% CI 1.3-3.4), severe social isolation (OR 1.9, 95% CI 1.2 to 3.2), and severe food insecurity (OR 2.5, 95% CI 1.2-5.3). There was a nonsignificant increase in odds of not being up to date with screening for severe transportation issues (OR 3, 95% CI 0.93-10) and severe housing instability (OR 1.7, 95% CI 0.93-3).</p><p><strong>Conclusion: </strong>Even within a fully insured population with high screening rates, respondents with financial strain, social isolation, and food insecurity had lower odds of being up to date with CRC screening. Future efforts should assess how addressing patients' social needs could lead to increased CRC screening rates.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"868-887"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923825","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":"Strategies for Implementing Integrated Behavioral Health into Health Centers.","authors":"Ann M Nguyen, Rebecca A Klege, Theresa Menders, Charu Verma, Stephanie Marcello, Benjamin F Crabtree","doi":"10.3122/jabfm.2023.230417R1","DOIUrl":"10.3122/jabfm.2023.230417R1","url":null,"abstract":"<p><strong>Background: </strong>Integrated behavioral health (IBH) is a promising approach which embeds behavioral health services into primary care. Yet, IBH has had limited implementation. Our objective was to identify strategies to successfully implement the \"Cherokee\" IBH model by examining a 2013 to 2019 IBH demonstration project in New Jersey that included Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs).</p><p><strong>Methods: </strong>We conducted qualitative semistructured interviews of 18 primary care and behavioral health clinicians from 10 FQHCs/CHCs in 2022. Interview guide questions drew on the Proctor Implementation Outcomes Framework to capture strategies to optimize acceptability, appropriateness, feasibility, fidelity, penetration, and sustainability of IBH implementations. A template approach was used to code data and identify themes.</p><p><strong>Results: </strong>All participating FQHCs/CHCs were still offering IBH services 3 years after the demonstration project, suggesting that strategies were successful in implementing and sustaining IBH. Strategies these FQHCs/CHCs employed included: (1) select champions with experience leading organizational change; (2) provide training that emphasizes how brief behavioral health interventions differ from traditional therapy; (3) develop on-going IBH training procedures for new staff; (4) create physical spaces for behavioral health consultants; (5) establish scheduling systems; and (6) identify local IBH billing codes, policies, and procedures.</p><p><strong>Discussion: </strong>Change management approaches can help in the implementation of IBH; however, additional strategies unique to IBH may be needed to address the attitudinal, organizational, and financial challenges inherent to IBH.</p><p><strong>Conclusion: </strong>Future implementations should apply multi-faceted approaches that address persistent and seemingly intractable barriers that have inhibited IBH integration.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"833-846"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069040","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":"Training in Gender Affirming Care is Medically Necessary.","authors":"K Fallin-Bennett, M Arterburn, S T Marks","doi":"10.3122/jabfm.2024.240266R1","DOIUrl":"10.3122/jabfm.2024.240266R1","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"976-978"},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069054","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":"Research on the Social Context of Medicine and the Modern Family Physician.","authors":"Dean A Seehusen, Marjorie A Bowman, Jacqueline Britz, Christy J W Ledford","doi":"10.3122/jabfm.2024.240443R0","DOIUrl":"10.3122/jabfm.2024.240443R0","url":null,"abstract":"<p><p>This <i>JABFM</i> issue has new research on a wide variety of clinical topics. Four articles study the social context of patients and its impact on health care. Insurance churn, prescription biosimilars, integrated behavioral health, and lung cancer screening are additional topics covered. Another group of articles report on a variety of aspects of modern family medicine practice. For example, what is the scope of care of today's family medicine physicians and how does that change over the course of a career? How do family physicians cope with their own chronic medical issues? This issue also addresses the role of family physicians as leaders, including their role in mitigating a growing challenge of maternity care desert.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"1-3"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059441","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":"Buprenorphine: A Better Option for Opioid Use Disorder Treatment in Pregnancy Compared to Methadone.","authors":"Bailey Sanford, Alejandra Espinoza, Kehinde Eniola","doi":"10.3122/jabfm.2024.240349R0","DOIUrl":"10.3122/jabfm.2024.240349R0","url":null,"abstract":"<p><p>Buprenorphine, rather than methadone, should be considered the preferred first-line therapy for opioid use disorder in pregnancy due to its more favorable neonatal outcomes.¹.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"188-191"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024482","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":"A Consultation Model for Intellectual and Developmental Disability Care.","authors":"Rebecca T Putnam, Phillip M Hughes, Chelsea C Atkins, C Micha Belden","doi":"10.3122/jabfm.2024.240183R2","DOIUrl":"10.3122/jabfm.2024.240183R2","url":null,"abstract":"<p><strong>Purpose: </strong>To provide an overview of an innovative, consultative care model for patients with Intellectual and Developmental Disabilities (IDD) within a Family Medicine department.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all patients seen in the clinic between 2017 to 2023 to identify patient demographics (eg, age), clinical needs (eg, diagnoses and referral needs), and administrative characteristics (eg, Medicaid status). We also conducted a spatial analysis to evaluate each patient's estimated travel distance and time to the clinic.</p><p><strong>Results: </strong>The number of patients seen in the IDD clinic totaled 184, with 65% male patients (n = 120) and a mean age of 31.29 years (SD = 16.27). More than half of patients, 65%, were insured by Medicaid (n = 119), and almost half received services paid for by the state Medicaid waiver (43%, n = 80). Many patients lived with family (64%, n = 117) and reported family guardianship (55%, n = 101). The spatial analysis identified that the majority of patients, 86% (n = 159) were nonrural residents based on Rural-Urban Continuum Codes. The mean distance traveled was 20.41 (SD = 21.36) miles with a mean travel time of 27.08 minutes (SD = 21.78). Following the consultations, 38% received outgoing referrals. Referral locations included psychiatry (8%), neurology (3%), behavioral health counseling (3%), and other medical services (17%).</p><p><strong>Conclusion: </strong>This study demonstrates the diverse characteristics of patients with IDD receiving care through a consultative-based model of care. This model appeared to provide services for patients from a wide geographic catchment area that may not have otherwise had health care access.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"180-187"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062956","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}