Journal of the American Board of Family Medicine最新文献

{"title":"Impact of an Online Group-Coaching Program on Ambulatory Faculty Physician Well-Being: A Randomized Trial.","authors":"Tyra Fainstad, Carlos Rodriguez, Carlee Kreisel, Jennifer Caragol, Pari Shah Thibodeau, Marisa Kostiuk, Adrienne Mann","doi":"10.3122/jabfm.2024.240022R1","DOIUrl":"10.3122/jabfm.2024.240022R1","url":null,"abstract":"<p><strong>Background: </strong>Physician burnout contributes to distress, turnover, and poor patient outcomes. Evidence suggests individual professional coaching may mitigate burnout but is costly and time intensive. Group coaching evidence is lacking. Here, we assess a group coaching program in ambulatory-based faculty.</p><p><strong>Methods: </strong>A randomized trial occurred from February 1, 2023, to May 31, 2023, in 5 ambulatory and/or primary care-based departments at an academic institution. Participants were randomly assigned to an intervention (offered a 4-month, online, group coaching) or to a control group (not offered coaching). Surveys measuring validated dimensions of distress (burnout, impostor syndrome, moral injury, loneliness) and well-being (self-compassion, flourishing) were administered before and after the intervention. A linear mixed model analysis was performed on an intent-to-treat basis.</p><p><strong>Results: </strong>Among 160 participants, the mean (SD) age was 42.0 (8.4), 131 (81.9%) identified as female, and 135 (85.4%) as White. Group coaching improved intervention participants' burnout domain of depersonalization (δ: -1.72 points [CI: -3.26, -0.17]; <i>P</i> = .03), impostor syndrome (δ: -0.82 points [95% CI: -1.47, -0.18, <i>P</i> = .01), and flourishing (0.35 points (95% CI: 0.03, 0.66), <i>P</i> = .03) compared with the control. There were no significant differences in the other domains of burnout, or moral injury, loneliness, or self-compassion.</p><p><strong>Discussion: </strong>Four months of group-coaching improved some well-being outcomes in ambulatory-based clinicians. The intervention may be particularly useful given its accessibility, and online delivery supports greater scalability and lower cost than individual coaching.</p><p><strong>Conclusion: </strong>Group coaching is an institutionally provided, individually harnessed tool to heal physician burnout.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05635448.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"1055-1071"},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899959","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":"Barriers and Facilitators of Shared Decision Making in Prostate Cancer Treatment Among African American Men.","authors":"Andrew Anderson, Mohua Chakraborty Choudhury, Sarah M Savaski, Louis S Krane","doi":"10.3122/jabfm.2024.240228R1","DOIUrl":"10.3122/jabfm.2024.240228R1","url":null,"abstract":"<p><strong>Background: </strong>African American men face significant disparities in prostate cancer outcomes, influenced by low trust in health care providers and disparities in treatment quality. Shared decision making (SDM) is recommended to improve engagement and outcomes within this population.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 15 African American men diagnosed with early-stage prostate cancer within the Veterans Administration health system in Louisiana. The Theoretical Domains Framework guided the interview guide development and qualitative data analysis.</p><p><strong>Results: </strong>Participants had a mean age of 68.8 years; 53% held a high school diploma or GED, and 40% had higher education. Employment statuses included 27% retired and 53% employed part-time. Self-reported physical health was rated as \"poor/fair\" by 47% and mental health by 53%. We found that 46.67% believed health care organizations cover up mistakes, and 40% felt deceived or misled. Despite these concerns, 73.33% disagreed that mistakes are common. Regarding physician trust, 86.67% felt their doctor cared about them, but 66.67% believed their care was not comprehensive. However, 80% trusted their doctor's judgments, and 66.67% followed their doctor's advice. Participants highlighted gaps in prostate cancer awareness and varied prediagnosis health management practices. Social support varied; some relied heavily on family, while others preferred independence. Trust in health care providers was generally high despite past negative experiences and high physician turnover. The SDM process was valued, needing clearer communication about treatment options and side effects.</p><p><strong>Conclusions: </strong>While African American veterans generally trusted their physicians and valued the SDM process, significant mistrust toward health care organizations, concerns about comprehensive care, and gaps in prostate cancer awareness and health management practices highlight the need for improved communication and support.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"302-311"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512668","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":"Blood Pressure Medication Side Effect Symptoms and Patient Treatment Satisfaction and Adherence.","authors":"Karen L Margolis, A Lauren Crain, Pamala A Pawloski, Jeanette Y Ziegenfuss, Nicole K Trower, Anna R Bergdall, MarySue Beran, Christine K Norton, Patricia K Haugen, Daniel J Rehrauer, Beverly B Green, Leif I Solberg, JoAnn M Sperl-Hillen","doi":"10.3122/jabfm.2024.240288R1","DOIUrl":"10.3122/jabfm.2024.240288R1","url":null,"abstract":"<p><strong>Background: </strong>Side effect symptoms to blood pressure (BP) medications may be associated with medication nonadherence, treatment dissatisfaction, and worse BP control. This article describes the frequency and characteristics of BP medication side effect symptoms in a primary care population with poorly controlled hypertension and their relationships to treatment satisfaction and adherence.</p><p><strong>Methods: </strong>Patients in a pragmatic trial were surveyed at baseline to identify and characterize 6 potential BP medication side effect symptoms (tiredness, dizziness, foot swelling, cough, frequent urination, sexual symptoms). Reported symptoms were rated on severity (not a problem, somewhat/moderate problem, big/very big problem) and perceived relatedness to medications (yes/no). Logistic regression models used symptom severity and perceived relatedness to medications to predict BP treatment satisfaction (very satisfied to very dissatisfied) and medication adherence (changing/stopping medications).</p><p><strong>Results: </strong>Among survey responders (n = 1,719/3,071, 56%), 90% of respondents taking BP medications reported a symptom that was at least somewhat of a problem. Overall, 39% had at least one symptom that was a big or very big problem and 34% had at least one symptom that they perceived as related to their medication. For most symptoms, both higher problem severity and perceived relatedness to medication were significantly associated with lower BP treatment satisfaction and decreased adherence.</p><p><strong>Conclusions: </strong>BP medication side effect symptoms were very common and often big problems for patients. Identifying and managing them could potentially improve BP outcomes. The brief symptom assessment developed for this study could help identify opportunities to address side effect symptoms and improve patient satisfaction and adherence.<b>Clinical trial registration</b>: www.</p><p><strong>Clinicaltrials: </strong>gov NCT02996565.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"312-329"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512669","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":"Protecting the Right to a Family Through IVF.","authors":"Forrest Bohler, Daniel P O'Mahony, Eli Y Adashi","doi":"10.3122/jabfm.2024.240312R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240312R1","url":null,"abstract":"<p><p>Since its introduction to the US in 1981, In vitro fertilization (IVF) has facilitated the birth of over 1.5 million Americans, largely evading political controversy. This avoidance of political controversy was upended after the judicial interpretation of Alabama's Wrongful Death of a Minor Act that deemed embryos \"unborn children\" in early 2024. This decision has sparked a national dialog on IVF, leading to significant legislative efforts at the national level such as the Right to IVF Act, which aims to establish and protect the right to fertility treatment, ensure insurance coverage, and expand access for veterans and marginalized communities. This article examines these legislative initiatives and their potential impacts on the future of IVF in the United States. In addition, it explores the crucial role of primary care clinicians (PCPs) in this evolving landscape, highlighting their importance in patient education, initial fertility assessments, and ongoing support throughout the IVF journey. As the first point of contact for many patients, PCPs are uniquely positioned to navigate the changing legal and ethical considerations surrounding IVF, making their understanding of these developments essential for comprehensive patient care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"345-347"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512700","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":"National Trends of Telehealth Use in Medicare Annual Wellness Visits.","authors":"Jonathan A Staloff, Joseph H Joo, Anna M Morenz, Lingmei Zhou, Bianca K Frogner, Joshua M Liao","doi":"10.3122/jabfm.2024.240354R0","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240354R0","url":null,"abstract":"<p><strong>Introduction: </strong>In response to COVID-19, Medicare began reimbursing for Annual Wellness Visits (AWVs) via telehealth in March 2020. Little is known about nationwide utilization of telehealth AWVs as a preventive care service among Medicare beneficiaries.</p><p><strong>Methods: </strong>We used 100% Medicare data on payment for physician services between 2020 and 2022 to calculate total and telehealth AWVs stratified by specialty.</p><p><strong>Results: </strong>Between 2020 and 2022, physicians performed a total of 24.7 million AWVs corresponding to $3.2 billion in payments from Medicare. Over this period, AWV utilization increased from 7.8 million services in 2020 to 8.6 million services in 2022. Telehealth AWVs accounted for 6.7% of all AWVs in 2020 and 2.1% of all AWVs in 2022. Primary care physicians provided the most telehealth AWVs (96.8%), compared to medical subspecialists (1.6%) and other specialists (1.6%) (p = .042). Family medicine physicians provided approximately half of all telehealth AWVs in 2020 (46.3%) and 2022 (51.6%).</p><p><strong>Discussion: </strong>Despite increasing utilization of AWVs overall, telehealth AWV utilization decreased during our study period. Telehealth AWVs were most frequently conducted by primary care physicians, with a majority by family medicine physicians in the study period's final year. Our findings highlight potential challenges of providing AWVs via telehealth at broader scale, but also underscore the feasibility of providing telehealth AWVs. As they consider long-term telehealth reimbursement policy, leaders can prioritize how telehealth complements in-person care to promote broader adoption of preventive services.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"375-377"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512697","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 Care and Emergency Room Visits: The Virginia All-Payer Claims Database.","authors":"Michael Topmiller, Hannah Shadowen, Mark A Carrozza, Jacqueline B Britz, Roy T Sabo, Derek A Chapman, Scott M Strayer, Alex H Krist","doi":"10.3122/jabfm.2024.240273R1","DOIUrl":"10.3122/jabfm.2024.240273R1","url":null,"abstract":"<p><strong>Introduction: </strong>This study utilizes the Virginia all-payer claims database (APCD) to examine the relationship between primary care utilization and emergency department (ER) use and to explore geographic variation in primary care utilization and ER use. We hypothesize that higher rates of primary care utilization will be associated with lower ER use rates, with maps showing clear geographic patterns.</p><p><strong>Methods: </strong>This retrospective observational analysis utilized Bayesian smoothing techniques, regression analysis, and geographic information system (GIS) mapping to explore the association of ER use with primary care utilization. Our analysis included 866 ZIP Code Tabulation Areas (ZCTAs) in Virginia.</p><p><strong>Results: </strong>Primary care utilization was significantly associated with ER usage rates. The results show that for every increase of 10 primary care visit rates per 1,000 population, ER use rates decline by 7 per 1,000. The maps show clusters of higher rates of PC utilization throughout central and eastern Virginia, with lower rates in many parts of southern Virginia. Higher rates of ER use are observed in western Virginia, particularly along the border with West Virginia, with clusters of lower rates in northern Virginia near Washington, DC.</p><p><strong>Conclusions: </strong>Utilizing the Virginia APCD and GIS mapping, this study finds that primary care utilization is associated with lower rates of ER use. The maps show clear geographic patterns for both ER use and primary care utilization. Important next steps include identifying priority areas, exploring their characteristics, and conducting qualitative research to better understand local factors contributing to their high or low rates of ER use.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"247-252"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512699","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":"Diagnosis and Management of Post-Bariatric Hypoglycemia.","authors":"Helen M Lawler, Timothy McGinnis, Mary-Elizabeth Patti","doi":"10.3122/jabfm.2024.240335R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240335R1","url":null,"abstract":"<p><p>With 1 in 8 people worldwide living with obesity, bariatric procedures continue to increase in popularity with more than a half million surgeries performed yearly. Postbariatric hypoglycemia (PBH) is now recognized as a complication of bariatric and upper gastrointestinal surgeries. While prevalence remains uncertain, symptoms have been reported in up to 30% of postsurgical patients. PBH is characterized by postprandial hypoglycemia causing neuroglycopenic symptoms of confusion, loss of consciousness, and seizures in a smaller subset of patients. Patient symptoms are often falsely attributed to other more common medical conditions due to the nonspecific nature of symptoms and lack of recognition of this complication, contributing to a frequent delay in diagnosis for many years. Our narrative review provides a summary of how to diagnose PBH, distinction of PBH from dumping syndrome, and detailed evidence-based guidance on selecting treatment. We also present the most up-to-date research involving the pathophysiology of PBH. Our goal is to raise awareness of how to diagnose and treat PBH as prompt diagnosis can lead to early treatment intervention to reduce hypoglycemic episodes and potentially decrease the development of hypoglycemia unawareness.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"383-394"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512671","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":"Electronically-Delivered Push Notifications Improve Patient Adherence to Preventive Care.","authors":"Lenard I Lesser, Esha Datta, Raj Behal","doi":"10.3122/jabfm.2024.240088R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240088R1","url":null,"abstract":"<p><strong>Background: </strong>Preventive care improves patient health and is cost-effective, yet many patients are not up to date on recommended screenings.</p><p><strong>Objective: </strong>Evaluate the effectiveness of an automated system for outreach to patients in need of annual preventive examinations, cervical cancer screening, and diabetes monitoring labs.</p><p><strong>Methods: </strong>As part of a quality improvement project, we created a population health algorithm and outreach system which was designed to send e-mail and smartphone notifications to patients overdue for preventive services. The study was a cohort study, with a matched control sample. We compared completion of preventive exams and screenings between the 2 groups, in the 4 weeks following the outreach.</p><p><strong>Results: </strong>For annual preventive visits, the intervention group had 9.0% more visits (95%CI: 8.2 to 9.7) than the control group. For cervical cancer screening, the intervention group had 3.2% (95%CI: 2.0% - 4.4%) more visits. Lab action orders for diabetes showed the largest increases. The intervention group had 5.2% (2.5% - 7.9%) more patients get bloodwork and 20.8% (16.9% - 24.6%) get more urine microalbumin tests.</p><p><strong>Conclusions: </strong>A population health outreach system that used reminders for prevention resulted in patients completing appointments for necessary medical services. Such a system, when deployed more broadly could help close care gaps and improve health for people that are asymptomatic but are due for preventive screenings.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"239-246"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512672","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 Million Dollar Question: Why is There Still a Gender Wage Gap in Family Medicine?","authors":"Katherine Majzoub Morgan, Ishani Ganguli","doi":"10.3122/jabfm.2025.250057R0","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250057R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"352-354"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512673","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":"Developing Content Domain Weights for the 2025 Family Medicine Certification Scale.","authors":"Thomas R O'Neill, Keith Stelter, Warren Newton","doi":"10.3122/jabfm.2024.240282R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240282R1","url":null,"abstract":"<p><strong>Purpose: </strong>The American Board of Family Medicine approved the use of a new blueprint for the Family Medicine Certification Examination, the In-Training Examination, Family Medicine Certification Longitudinal Assessment, and the Continuous Knowledge Self-Assessment. It will go into effect in January 2025. The blueprint defines the content domains for the questions on the examination and the percentage of questions in each domain. This article describes the process used to establish the percentage of questions in each domain.</p><p><strong>Methods: </strong>A random sample of 2000 clinically active ABFM Diplomates were surveyed about the frequency and risk of patient harm associated with 202 clinical activities. The results were translated into recommended percentages of questions for each content domain.</p><p><strong>Results: </strong>The survey response rate was 48% and the demographic data for the responders was representative of ABFM-certified, clinically active Diplomates.</p><p><strong>Conclusions: </strong>This article demonstrates how the examination content is directly connected to the clinical activities that comprise the scope of family practice in a way that considers both how often the activities are performed and their risk of patient harm if the activity is not performed correctly.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"330-344"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512670","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}