Journal of the American Board of Family Medicine最新文献

{"title":"The Essential Role of Primary Health Care for Health Security.","authors":"Robert L Phillips, Marci Nielsen, Deborah J Cohen, Lauren S Hughes, Asaf Bitton, Andrew W Bazemore","doi":"10.3122/jabfm.2023.230449R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230449R1","url":null,"abstract":"<p><p>In July 2023, primary health care experts from more than 20 countries, the World Health Organization (WHO), and most agencies within the US Department of Health and Human Services (HHS) met at the National Academy of Sciences in Washington, DC, to catalyze action toward revitalizing primary care in the United States align efforts to advance primary health care worldwide, and improve health and security for all.¹ This meeting was informed by the NASEM's critical primary care report, which highlighted the need for federal leadership to strengthen primary care services in the United States, especially for underserved populations, and to inform primary care systems around the world. To that end, this meeting was designed to explore the challenges and opportunities of investing in primary health care as a common good and critical for health security and resilience across the globe.² In this issue, you will find {number} special communications from this conference that highlight the need to evolve from primary care to primary health care, the importance of primary care and public health collaboration, and the necessity for ongoing external scientific expertise to inform US federal government coordination efforts.Despite the clear consensus among global stakeholders regarding the importance of Primary Health Care to health equity, behavioral health, health security, and pandemic resilience, a year later the anticipated HHS Action Plan to guide implementation of the NASEM primary care recommendations has yet to be launched. While some agencies are moving ahead with initiatives and programs within their purview, the lack of a Primary Care Action Plan remains a missed opportunity to coalesce politically powerful stakeholders around a united and much-needed vision for a US health system centered on Primary Health Care, particularly in light of our challenges in responding to COVID-19.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement1","pages":"S21-S25"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717384","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":"Improving Care for Unhealthy Alcohol Use: Results from the Facilitating Alcohol Screening and Treatment (FAST) Colorado Study.","authors":"Bonnie T Jortberg, L Miriam Dickinson, Douglas H Fernald, Andrew Bienstock, Dionisia de la Cerda, Kim Wiggins, Carolyn Swenson, Jennifer Halfacre, Stephanie Kirchner, W Perry Dickinson","doi":"10.3122/jabfm.2024.240048R1","DOIUrl":"10.3122/jabfm.2024.240048R1","url":null,"abstract":"<p><strong>Introduction: </strong>Unhealthy alcohol use (UAU) is associated with preventable morbidity and mortality and accounted for more than 140,000 deaths per year in the US during 2015 to 2019. The United States Preventive Services Task Force recommends routine screening for UAU in adults aged 18 years and older and pregnant persons, followed by brief counseling for a positive screening (B recommendation). Primary care clinicians can improve UAU outcomes by universally screening and offering brief counseling. This study aimed to increase screening, brief intervention, medication-assisted treatment (MAT), or referral for treatment (SBI/RT + MAT) in primary care practices.</p><p><strong>Methods: </strong>Cluster-randomized study to investigate 1) the effectiveness of virtual practice facilitation as a method to enhance implementation of SBI/RT + MAT and 2) the potential added benefit of using alcohol use eLearning modules to guide and focus the process and content of virtual practice facilitation.</p><p><strong>Results: </strong>Sixty-one primary care practices in Colorado enrolled in the study, with 43 primary practices completing the intervention and reporting 9-month data. Results show significant overall improvements in SBI/RT + MAT practice implementation scores from baseline to 9-month follow-up (<i>P</i> < .0001) and no differences between groups. The number of patients screened for UAU and/or Alcohol Use Disorder (AUD), receiving brief intervention, receiving an AUD diagnosis all significantly increased from baseline (<i>P</i> < .0001); and number receiving MAT also significantly increased (<i>P</i> < .0014).</p><p><strong>Discussion: </strong>Practice facilitation can assist primary care practices in improving SBI/RT + MAT processes and patient outcomes, with the results providing initial evidence for successful use of virtual practice facilitation.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1027-1037"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674798","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":"Peer-Coaching for Family Physicians to Close the Intention-to-Action Gap.","authors":"Tara Kiran, Kimberly Devotta, Laura Desveaux, Noor Ramji, Karen Weyman, Margarita Lam Antoniades, MaryBeth DeRocher, Julia Rackal, Noah Ivers","doi":"10.3122/jabfm.2023.230489R2","DOIUrl":"10.3122/jabfm.2023.230489R2","url":null,"abstract":"<p><strong>Introduction: </strong>Peer coaching has the potential to enhance the effectiveness of clinical performance feedback reports to family physicians, but few peer-coaching quality improvement programs have been implemented and evaluated in primary care. Authors designed, implemented and evaluated a peer-coaching program for family physicians in a large, academic primary-care organization to explore its potential to enhance family physicians' use of clinical performance data for quality improvement.</p><p><strong>Methods: </strong>Coaches were nominated by their peers and were trained to follow an evidence-informed facilitated feedback model for coaching. Data were collected through surveys, a focus-group with coaches, and individual interviews with coached family physicians (\"coachees\"). Data were analyzed inductively using reflexive thematic analysis.</p><p><strong>Results: </strong>Authors trained 10 coaches who coached 25 family physicians over 3 months. Coachees who completed the survey (21/25) indicated a desire for additional coaching sessions in future; most (19/21) reported confidence in making practice change. Interview (n = 11) and focus-group participants (n = 8) findings validated acceptability of the coaching approach that emphasized empathy ahead of change-talk. Coaches helped coachees interpret care-quality measures, deal with negative emotional responses evoked, encouraged a sense of accountability for improvement, and sometimes offered new ways to manage common challenges. Coaching sessions led to a wide range of practice-improvement goals. However, effects on practice change were felt to be limited by the data available and the focus on individual physician factors when broader clinic issues acted as important barriers to improvement.</p><p><strong>Conclusions: </strong>Peer coaching is a feasible approach to supporting family physicians' use of data for learning and practice improvement. More research is needed to understand the impact on practice outcomes and physician wellness.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"996-1008"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674858","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 Role of PhDs in Family Medicine Research.","authors":"Mark S Johnson, Abiodun Otolorin","doi":"10.3122/jabfm.2024.240157R2","DOIUrl":"10.3122/jabfm.2024.240157R2","url":null,"abstract":"<p><p>Research is being recognized as important to the further growth of Family Medicine. It is also important to improving the health of the nation. Family Medicine must consider the barriers and facilitators to research to plan for the future. Understanding the role of all members of the research team is necessary. In February 2024, a descriptive analysis of Family Medicine Principal Investigator (PI) with active projects funded by the National Institutes of Health(NIH) was performed using the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) tool. Sixty-four percent of the 310 grants identified were awarded to Principal Investigators (PIs) with PhD degrees. Researchers with a PhD have been able to significantly contribute to the research mission of the discipline. Family medicine will need to continue to expand the research team to optimize productivity.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement2","pages":"S53-S55"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701967","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":"Strong Primary Health Care in the United States - Closer Than We Might Think.","authors":"Asaf Bitton, Bruce Finke","doi":"10.3122/jabfm.2023.230401R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230401R1","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement1","pages":"S4-S7"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717379","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":"Family Medicine: Finding Its Way on the Federal Research Roadmap.","authors":"Alyssa M Indelicato, Amanda Weidner, Christopher P Morley","doi":"10.3122/jabfm.2024.240118R1","DOIUrl":"10.3122/jabfm.2024.240118R1","url":null,"abstract":"<p><strong>Introduction: </strong>Challenges persist in securing substantial funding for the Family Medicine (FM) research enterprise, particularly from major sources like the National Institutes of Health (NIH). Analyses from a decade ago revealed stagnant funding levels, prompting further investigation into the subsequent years.</p><p><strong>Methods: </strong>To elucidate funding trends over the most recent decade, the NIH RePORTER database was queried for grants awarded to departments identified as \"Family Medicine\" from 2014 to 2023. Data encompassed awards from various federal agencies, predominantly including the US National Institutes of Health and others. We also explored the relationship between funding success and multidisciplinarity, examining whether Departments of FM (DFMs) incorporating diverse disciplines in their names exhibited higher chances of securing research funding.</p><p><strong>Results: </strong>The investigation identified 73 funded DFMs in the NIH RePORTER database out of a total of 131 DFMs at Liaison Committee on Medical Education (LCME) accredited schools. Despite notable increases in both the total funding and percentage of funding allocated to DFMs over the decade, FM still accounted for less than 1% of total NIH awards. Multidisciplinary departments displayed a higher likelihood of securing research funding compared with their counterparts identified solely as DFMs.</p><p><strong>Discussion: </strong>While the study reveals a mild upward trend in funding levels for DFMs, challenges persist in securing a more substantial share of federal research funding. Despite limitations, including the exclusion of non-NIH funding sources, the study provides valuable insights into the current state of federal funding for Family Medicine research, urging sustained efforts for further progress in the field.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement2","pages":"S85-S91"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701797","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":"Experiences of Transgender and Nonbinary Patients in an Academic Family Medicine Clinic.","authors":"Benjamin Kaplan, Kaylee Deardorff, Chichi Zhu, Riley Smith","doi":"10.3122/jabfm.2023.230445R2","DOIUrl":"10.3122/jabfm.2023.230445R2","url":null,"abstract":"<p><strong>Background: </strong>Transgender and nonbinary (TGNB) patients face significant health disparities and negative experiences in health care spaces. With our family medicine residency clinic caring for an increasing number of TGNB patients, we sought to better understand the unique experiences and needs of this population.</p><p><strong>Methods: </strong>We utilized a mixed methods approach, recruiting participants via our online patient portal and inviting them to complete a 36-item online survey and/or participate in one of four 90-minute focus groups exploring their interactions with a variety of care team members, perspectives on our physical clinic space, ideas for improvement, and other areas. We analyzed survey data using descriptive statistics and performed open coding on survey free-text responses and interview transcripts to identify salient themes.</p><p><strong>Results: </strong>90 TGNB patients completed the survey, and 20 participated in the focus groups. Participants described a variety of positive interpersonal and noninterpersonal experiences including being gendered correctly, clinicians being knowledgeable and responsive to feedback, and seeing visible markers of LGBTQ+ inclusivity. Negative experiences included misgendering and deadnaming, being asked unnecessary questions, and being outed as TGNB without their consent.</p><p><strong>Conclusions: </strong>Participants' positive and negative health care experiences, along with their specific recommendations for interpersonal and system-level change, will help guide ongoing efforts to improve the care of TGNB patients at our clinic. Future needs assessments and ongoing conversations with our TGNB patients are needed to further explore this study's emerging themes, with particular attention to the impact of age, race/ethnicity, primary language, and other intersecting identities on TGNB patient experiences.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1072-1087"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674814","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 Simplified Approach to Evaluate and Manage Shoulder Pain.","authors":"Kartik Sidhar, Hyung Jin Lim, Laurel Gutierrez","doi":"10.3122/jabfm.2024.240114R2","DOIUrl":"10.3122/jabfm.2024.240114R2","url":null,"abstract":"<p><p>With the lifetime prevalence of shoulder pain approaching 70%, accurate diagnosis and management remains essential. The shoulder is a complex joint with a vast range of motion making it susceptible to injury due to limited bony stabilization. This manuscript shares a simplified, novel approach to evaluating and managing atraumatic shoulder pain based on triaging symptoms on presence or loss of range of motion. In patients with loss of active and passive range of motion, the likely etiologies of pain include adhesive capsulitis or glenohumeral joint arthritis depending on imaging. In patients with preserved active and passive range of motion, implementing specific special testing can help pinpoint the diagnosis, and further guide appropriate management. Ultrasound plays an increasingly key role in diagnosing and managing shoulder pathology.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1156-1166"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674781","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 Effects of Testosterone on Cervicovaginal Cytology in Transgender and Gender-Diverse Individuals.","authors":"Derek Chen, Jeremy Erroba, Shuling Liu, Tahlia Hodes, Heather Holderness, Nathalie Huguet, Christina Milano","doi":"10.3122/jabfm.2023.230468R1","DOIUrl":"10.3122/jabfm.2023.230468R1","url":null,"abstract":"<p><strong>Background: </strong>The Papanicolaou (Papanicolaou) test is an effective and widely used cervical cancer screening procedure. Recommendations for cervical cancer screening do not incorporate patients' gender identities nor gender-affirming hormone statuses in determining screening surveillance intervals and interpreting test results. This study assessed the association between testosterone and rates of abnormal Papanicolaou specimens and specimen adequacy by comparing testosterone-associated Papanicolaou specimens and nontestosterone Papanicolaou specimens among transgender and gender-diverse (TGD) patients.</p><p><strong>Methods: </strong>Retrospective electronic health record chart review of 211 TGD patients with cervixes, contributing 298 unique Papanicolaou tests, with a visit to a primary care clinic between 2012 and 2019. Primary outcomes included specimen quality (transformation zone [TZ] present, TZ absent, atrophic specimen, scant cellularity), presence of inflammation (yes/no), and cytology results (normal, abnormal, inadequate specimen). χ² and <i>t</i> test were used to compare results between testosterone-associated Papanicolaou specimens (TAPS) and nontestosterone specimens (NTS).</p><p><strong>Results: </strong>A higher proportion of TAPS had missing TZ, showed atrophy, or had scant cellularity than NTPS (58.8% vs 33.5%; <i>P</i> < .001). In addition, a higher proportion of TAPS showed inflammation (16.0% vs 3.4%; <i>P</i> < .001). There was no significant difference in the proportion of abnormal results (ie, cytologic features concerning for dysplasia) between the TAPS and NTPS groups.</p><p><strong>Conclusions: </strong>Findings confirmed an association between testosterone usage and cytology specimen adequacy and quality. No association was found between testosterone usage and rates of abnormal results within our TGD population. More research is needed to disentangle the effect of missing TZ on risk of future cervical dysplasia among this younger population.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 6","pages":"1009-1013"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674873","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":"Family Medicine's Role in Generating Evidence to Inform Primary Care Payment Reform and New Care Delivery Models.","authors":"Helen Newton, Margaret Helton, Erin Fraher","doi":"10.3122/jabfm.2024.240009R1","DOIUrl":"10.3122/jabfm.2024.240009R1","url":null,"abstract":"<p><p>Given that half of physician office visits are for primary care and family physicians make up 40% of all primary care clinicians in the US, family medicine researchers can play a key role in evaluating and reporting on state and federal innovations to redesign primary care payment and care delivery. We used Dimensions, a comprehensive publications and citations research platform, to measure the impact of family medicine-affiliated scholarship (research articles, letters to the editor, research letters, and editorials) published from 2018 to 2022 in 14 of the highest-impact journals that routinely publish articles on payment and delivery system reform. Among 6212 peer-reviewed articles related to primary care payment and delivery system reform, we found that 519 (8.4%) included at least 1 author with an affiliation with a department of family medicine compared with 1197 articles (19.3%) that had at least 1 author with an affiliation with a department of internal medicine and 504 articles (8.1%) that had at least 1 author affiliated with a department of pediatrics. Taken together, these findings suggest that academic departments of family medicine are lagging in scholarly contributions that evaluate payment and delivery system reform.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 Supplement2","pages":"S164-S172"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701953","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}