Journal of the American Board of Family Medicine最新文献

{"title":"Barriers and Facilitators to Screening for Anxiety and Intimate Partner Violence.","authors":"Amy G Cantor, Chrystal Barnes, Sonja Likumahuwa-Ackman, Tamar Wyte-Lake, Miranda Pappas, Keeley Blackie, Heidi D Nelson","doi":"10.3122/jabfm.2025.250108R1","DOIUrl":"10.3122/jabfm.2025.250108R1","url":null,"abstract":"<p><strong>Background: </strong>Periodic universal screening for anxiety and for intimate partner violence (IPV) for women and adolescent girls are national clinical practice recommendations. However, screening rates in primary care settings are low. This study aimed to increase awareness and adoption of screening for anxiety and for IPV in women and adolescent girls by identifying screening barriers and facilitators to inform clinical resource development.</p><p><strong>Methods: </strong>Two-phase, qualitative study using semistructured interviews to identify screening barriers and facilitators; thematic analysis of interview data using a rapid evaluation approach.</p><p><strong>Results: </strong>Twenty-seven clinicians and staff members were interviewed in 12 clinics in 2 primary care networks in Oregon. All participants recognized the importance of screening in primary care settings but were generally unaware of screening recommendations and insurance coverage and were unsure of their clinic's policies and practices, citing a lack of protocols for referrals for positive screens. Barriers to both anxiety and IPV screening included screening fatigue, lack of metrics, uncertain documentation and reporting, and unclear referral and follow-up procedures. For IPV screening specifically, barriers included discomfort with screening, privacy concerns, and perceived low occurrence. Facilitators for both services included leveraging existing screening practices and electronic health record tools, and clear recommendations for universal screening best practices.</p><p><strong>Conclusion: </strong>Implementation of routine screening for anxiety and IPV in women and adolescents in primary care is low but may improve with targeted clinician resources and education. Workflow diagrams and resource guides responsive to identified screening barriers and facilitators, including clarification of insurance coverage for preventive services, and resources to support implementation of protocols of screening methods, clinical documentation, and referrals for anxiety and IPV in primary care settings, could improve screening practices.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"1049-1063"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208436","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":"Effect of Initiating HPV Vaccination Before Age 11 on HPV Vaccination Completion.","authors":"Jessica Calderón-Mora, Maianh Nguyen, Amir Hernandez, Jennifer Molokwu","doi":"10.3122/jabfm.2025.250212R1","DOIUrl":"10.3122/jabfm.2025.250212R1","url":null,"abstract":"<p><strong>Background and objective: </strong>The human papillomavirus (HPV) vaccine, launched in 2006, has proven effective at reducing HPV infection rates and preventing HPV-associated cancers. However, less than 60% of adolescents have completed the recommended vaccine series, and the rate is even lower among Hispanic children and adolescents. This study explores the age of initiation within our comprehensive vaccination program in West Texas<i>, Tiempo de Vacunarte</i>.</p><p><strong>Methods: </strong>This study is a retrospective analysis of HPV vaccine completion among individuals 9 to 17 years old from <i>Tiempo de Vacunarte</i> between June 2015 and February 2018. The program was open to individuals 9 to 26 years old who had at least one prior dose of the HPV vaccine, were uninsured or underinsured, and had a Texas address. The primary outcome was completion of the HPV vaccine series.</p><p><strong>Results: </strong>A total of 2,380 individuals were enrolled, and this study analyzed a subset of 613 children aged 9 to 17 years; 59.8% completed the vaccine series. Most were female (53.8%) and had parents born in Mexico (75.2%). Children 11 to 14 years old were likelier to complete the vaccine series than other age groups (OR: 2.802, <i>P</i> = .006). Children with parents with higher education and less time residing in the US were likelier to complete the series.</p><p><strong>Conclusion: </strong>Our study supports advocating for initiating the HPV vaccine at a younger age and completing the series by 14 years old. Multi-component and culturally tailored programs are an effective means to increasing HPV vaccine uptake and decreasing the burden of HPV-associated cancers.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"1075-1081"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208467","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 Differing Career Choice Paths of MD and DO Family Medicine Residents: A Call to Action.","authors":"Julie P Phillips, Tracy O Middleton, Karen B Mitchell","doi":"10.3122/jabfm.2025.250398R0","DOIUrl":"10.3122/jabfm.2025.250398R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"983-985"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094914","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":"Prostate Specific Antigen Ordering After Implementation of a Point-of-Care Reminder to Discuss Screening.","authors":"Joshua J Fenton, Daniel J Tancredi","doi":"10.3122/jabfm.2025.250218R1","DOIUrl":"10.3122/jabfm.2025.250218R1","url":null,"abstract":"<p><strong>Background: </strong>In 2018, prostate cancer screening with prostate specific antigen (PSA) received a \"C\" recommendation from the US Preventive Services Task Force for men aged 55 to 69 years. In January 2023, our health system implemented a point-of-care electronic reminder for primary care clinicians to discuss PSA screening for men aged 55 to 69.</p><p><strong>Methods: </strong>We assessed the impact of reminder implementation on monthly rates of PSA ordering from January 1, 2022 to July 31, 2024 by performing interrupted time series analyses for men aged 55 to 69 years (for whom the reminder was implemented) and men aged 50 to 54, 70 to 74, and ≥75 years.</p><p><strong>Results: </strong>Before reminder implementation, PSA was ordered in a median of 6.4% of visits for men aged 55 to 69 years versus a median of 10.2% of visits after reminder [adjusted incidence rate ratio (aIRR) 1.57 (95% CI: 1.43-1.73)]. The postreminder period was associated with smaller but significantly increased rates of PSA ordering in men aged 50 to 54 [aIRR 1.44 (1.25-1.65)], 70 to 74 [aIRR 1.26 (1.14-1.39)], and ≥75 years [aIRR 1.11 (1.02-1.11)].</p><p><strong>Conclusions: </strong>Implementation of an electonic medical record (EMR) reminder to discuss PSA screening was associated with a large increase in PSA ordering among men in the targeted age-group, but also smaller increases in age groups for whom the balance of benefits and harms of PSA screening may be less favorable.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"991-994"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094775","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":"Medical Aid in Dying State Laws: A Thirty Year Evolution.","authors":"Eli Y Adashi, I Glenn Cohen","doi":"10.3122/jabfm.2025.250175R1","DOIUrl":"10.3122/jabfm.2025.250175R1","url":null,"abstract":"<p><p>The notion of medical aid in dying dates back to 1994 and the approval of the Death with Dignity Act by the citizens of Oregon. Therein was incorporated the notion of competent terminally ill patients being permitted to resort to the self administration of lethal physician-prescribed drugs. Several other states followed suit. Medical aid in dying is now broadly applied in the US under strict legal oversight in an ever-growing number of states.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"977-979"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094802","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":"Evaluation of the Need for Comprehensive Care for Patients with Cystic Fibrosis.","authors":"Kendall Kolk, Douglas B Hornick, Tahuanty Pena, Brittany A Wright","doi":"10.3122/jabfm.2025.250076R2","DOIUrl":"10.3122/jabfm.2025.250076R2","url":null,"abstract":"<p><strong>Introduction: </strong>Cystic fibrosis transmembrane conductance regulator (CFTR) modulators have revolutionized care for people with cystic fibrosis (pwCF) by improving quality of life and extending life spans. These factors support the need for pwCF to establish care with a Primary Care Provider (PCP). It is currently unclear how many adult pwCF routinely interact with a PCP.</p><p><strong>Methods: </strong>This IRB approved, retrospective study included patients over 18 years old, seen in the adult Cystic fibrosis (CF) clinic, who were prescribed elexacaftor/tezacaftor/ivacaftor (ETI) between 8/31/2022 and 8/31/2023 at University of Iowa Health Care. The primary outcome of the study was to determine the percentage of pwCF with a PCP designated as a member of their care team in the electronic medical record (EMR). The secondary outcomes determined the percentage of pwCF who completed preventative health screenings for comorbid conditions and received appropriate cancer screenings and immunizations.</p><p><strong>Results: </strong>Of the 115 included patients, 60% (69/115) had a PCP identified in the EMR. PwCF have uncontrolled blood pressure regardless of whether they have a PCP identified in the EMR (76.5%) or not (78.3%). Rates of influenza (p=0.006) and pneumococcal (p=0.006) vaccinations were significantly lower for pwCF without a PCP.</p><p><strong>Discussion: </strong>There is a gap in healthcare for pwCF, especially for those who do not routinely interact with a PCP. CF clinicians may not be up to date on primary care management and PCPs may not be comfortable with treating patients with a high acuity chronic condition. PCPs should be better integrated into the CF care team to ensure pwCF are receiving comprehensive care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"1001-1005"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094788","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":"How High-Performing Community Health Clinics Accomplish Social Risk Screening.","authors":"Sara L Ackerman, Holly Wing, Maura Pisciotta, Danielle Hessler Jones, Laura M Gottlieb","doi":"10.3122/jabfm.2025.250123R3","DOIUrl":"10.3122/jabfm.2025.250123R3","url":null,"abstract":"<p><strong>Purpose: </strong>Recent national policies encourage health care delivery systems to document patients' social risks (SR), for example, food, housing, and transportation insecurity, and provide referrals to community services. Under-resourced community health centers (CHCs) face challenges integrating SR screening into care delivery. We sought out CHCs with consistently higher-than-average SR screening rates to understand what drives sustained integration.</p><p><strong>Methods: </strong>This qualitative study used semistructured interviews to collect data about strategies for implementing and sustaining SR screening, staff and patient experiences, and external influences. We recruited 5 CHCs in 3 states with SR screening rates in the top 20% of a large national CHC network. Clinic staff in a variety of roles were invited to participate. Thematic analysis was used for interpretation of interview transcripts.</p><p><strong>Results: </strong>Interviews were conducted with 27 clinicians and other clinic staff. Responses highlighted both internal and external influences on SR screening. Internally, organization-wide investments in team-based care, longitudinal commitments to quality improvement activities, and capacity to coordinate social services were all cited as key drivers of staff commitment to screening. External influences included Accountable Care Organization incentives, Primary Care Medical Home certification requirements, and support from CHC consortia and external grants. Across interviews, SR screening was framed as a collective endeavor aligned with CHCs' collective mission to serve the whole patient.</p><p><strong>Conclusion: </strong>CHCs with a sustained culture of team-based care, quality improvement, and care coordination may be more likely to integrate SR screening. Alongside enhanced external supports, investments in these well-characterized and mutually reinforcing building blocks of primary care are likely to translate to sustained SR screening in primary care clinical settings.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"1064-1074"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208440","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":"Is the Availability of Immediate Inpatient Postpartum Long-Acting Reversible Contraception (LARC) Associated with a Decrease in Rapid Repeat Pregnancy?","authors":"Allison Hoynes, Brittany Cox, Roma Amin, Chelsey Foster, Annalise Celano, Jonathan Yun","doi":"10.3122/jabfm.2025.250137R1","DOIUrl":"10.3122/jabfm.2025.250137R1","url":null,"abstract":"<p><strong>Introduction: </strong>Immediate postpartum long-acting reversible contraception (IPP-LARC) after delivery may decrease rapid repeat pregnancy (RRP). RRP is associated with preterm birth, small for gestational age, low birth weight, and infant/maternal mortality. In April 2017, the Ohio legislature passed SB 332, mandating immediate postpartum LARC coverage. Later that year, our hospital made the IPP-LARC Nexplanon (and not intrauterine devices [IUDs]) available to all delivering patients. This study aimed to see if SB 332 is associated with decreased RRP.</p><p><strong>Methods: </strong>Using electronic health record and state registry data, we examined sociodemographic and perinatal care variables for 726 pregnant adolescents and adults delivering at our hospital during the 12 months before and after IPP-LARC became available. We then determined the association between RRP and these variables.</p><p><strong>Results: </strong>After LARC became available, 62/368 patients chose Nexplanon. Gravidity (OR: 1.128) and vaginal delivery (OR: 1.682) were negatively associated with RRP while age at delivery was inversely associated (OR: 0.902, <i>p</i> < .001). The adjusted mean probability of RRP was 6% for those who had IPP-LARC placement, compared with 20% for those who did not. LARC availability was positively associated with RRP but not significantly (OR: 1.287, <i>p</i> = .195).</p><p><strong>Conclusions: </strong>After SB 332's passage, IPP-LARC availability was positively associated with RRP, but the percentage of patients who chose IPP-LARC was low. However, RRP occurred less often among patients who chose IPP-LARC placement. Hospital systems must actively invest in patient education and provider support to ensure interventions to reduce rapid repeat pregnancy are optimally utilized by vulnerable populations.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"802-811"},"PeriodicalIF":2.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795219","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":"Menstrual Equity: A Survey Study with ZIP-Code Level Analysis.","authors":"Rosalie Mattiola, Susan E Hansen, Shae Duka, Amanda Hoyer, Belle P Marks, Crystal Perez, Nicole M Burgess, Ashwini Kamath Mulki","doi":"10.3122/jabfm.2025.250089R1","DOIUrl":"10.3122/jabfm.2025.250089R1","url":null,"abstract":"<p><strong>Objectives: </strong>This cross-sectional retrospective survey study modeled on previous research explored the prevalence of period poverty in 1 urban setting to inform future targeted interventions toward improving menstrual equity.</p><p><strong>Methods: </strong>An 8-item questionnaire was developed by a menstrual health equity work group led by the Allentown Health Bureau, Pennsylvania. Data collection occurred for 1.5 years, using an anonymous online survey tool and convenience sampling. Study participants were recruited with an informational flier (with QR code and web address pointing to the questionnaire) posted in various public locations.</p><p><strong>Results: </strong>A total of 353 people who menstruate, aged 13 to 54, representing 5 of Allentown's 7 ZIP code regions responded. The majority were impacted by period poverty, either by missing a life event (77.9%) or engaging in an at-risk menstrual hygiene behavior (79.0%). Most (91.5%) had been educated in menstrual health. Doctor's offices (40.3%) and social media (27.8%) were the most frequently cited sources for learning about the survey. ZIP codes were significantly associated with engaging in at-risk behaviors (<i>P</i> < .001), missing a life event (<i>P</i> < .001), no menstrual health education (<i>P</i> = .03), and preference for period underwear (<i>P</i> = .04). Age was significantly associated with preferring pads (<i>P</i> = .007) and tampons (<i>P</i> = .03).</p><p><strong>Conclusions: </strong>Period poverty was found to impact a substantial number of people in Allentown, Pennsylvania. Interventions will need to be tailored to ZIP code and age-group. Future study should aim for a larger sample size and additional questions, about menstrual education.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 5","pages":"781-790"},"PeriodicalIF":2.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913677","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":"Advancing Equitable, Person-Centered Contraceptive Care Using Data-Driven Quality Improvement.","authors":"Christine Dehlendorf, Erin Wingo, Lindsey Gibson, Sonja Goetsch-Avila, Rebecca Kriz, Danielle Hessler","doi":"10.3122/jabfm.2025.250073R1","DOIUrl":"10.3122/jabfm.2025.250073R1","url":null,"abstract":"<p><strong>Objective: </strong>Expanding access to high-quality contraceptive care in primary care is key to achieving reproductive health equity. We assessed the impact of an equity-focused quality improvement learning collaborative (QILC) on contraceptive care at community health centers (CHCs) through innovative performance measurement.</p><p><strong>Methods: </strong>We developed a 9-month QILC including monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources, peer-learning opportunities, and technical assistance. We assessed QILC impact through 3 performance measures collected prepost QILC: the Person-Centered Contraceptive Counseling (PCCC) measure that assesses contraceptive counseling; the Contraceptive Care Screening electronic clinical quality measure (eCQM) (CCS-SINC); and contraceptive use eCQM (CU-SINC). CHCs collected PCCC surveys from patients prepost QILC, and we extracted electronic health record data to calculate eCQMs. To assess intervention impact, we compared prepost PCCC scores and eCQM percentages.</p><p><strong>Results: </strong>Nine CHCs participated in the QILC. Assessing contraceptive care screening, median increase in CCS-SINC was 14.4% (Interquartile range [IQR]: 7.5%-40.4%) between baseline and endline. CHCs realized an increase in CU-SINC (median relative Δ: 4.9%; IQR [3.7%-22.3%). Compared with baseline, at endline, 5 of 9 CHCs improved their PCCC score (Δ 2.1% to 26.2%) and 3 of those surpassed the 80% benchmark for high-quality care. Greater improvement in performance measure scores was noted among CHCs with leadership buy-in and lower staff turnover.</p><p><strong>Conclusions: </strong>Participation in an equity-focused and measurement-driven QILC led to improvements in person-centered contraceptive care delivery.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"791-801"},"PeriodicalIF":2.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795237","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}