Journal of the American Board of Family Medicine最新文献

{"title":"Just Pop It: Early AROM After Cervical Ripening Reduces the Time to Delivery.","authors":"Paige K Macky, Haroon Samar, Stephen J Conner, Ashley L Urick, Catherine A Yeager, Derrick J Tiel, J Scott Earwood, Bob Marshall","doi":"10.3122/jabfm.2023.230344R1","DOIUrl":"10.3122/jabfm.2023.230344R1","url":null,"abstract":"<p><p>In pregnant patients at term undergoing induction of labor, early time-based artificial rupture of membranes (AROM) within 1 hour of Foley bulb expulsion results in a shorter duration of labor by nearly 9 hours with no significant difference in cesarean delivery rates or maternal or neonatal adverse outcomes.¹.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"147-149"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050854","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 Effect of Veteran Status and Chronic Pain on Past 30-Day Sedative Use Among Community-Dwelling Adult Males.","authors":"Ayodeji Otufowora, Yiyang Liu, Aderonke Okusanya, Afeez Ogidan, Adedoyin Okusanya, Linda B Cottler","doi":"10.3122/jabfm.2023.230226R2","DOIUrl":"10.3122/jabfm.2023.230226R2","url":null,"abstract":"<p><strong>Introduction: </strong>Given the high sedative prescription rate, the sedative-associated morbidity, and mortality nationally (especially among veterans), we aimed to test the hypothesis that veteran status in the presence of chronic pain would be associated with greater sedative use when compared with nonveteran status.</p><p><strong>Methods: </strong>The study participants were recruited by Community Health Workers (CHWs) through the ongoing community engagement program (HealthStreet) at the University of Florida. CHWs collected information on sociodemographic factors, health status, and past 30-day drug use patterns.</p><p><strong>Results: </strong>The study sample comprised 4,732 male participants, of which 21% were veterans, 58% were Blacks and 8.4% had used prescription sedatives in the past 30 days. Veterans (vs nonveterans) were twice as likely to have used prescription sedatives in the past 30 days in the presence of chronic pain.</p><p><strong>Conclusions: </strong>Veterans with chronic pain are a high-risk population for current prescription sedative use.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"118-128"},"PeriodicalIF":2.4,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050859","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 Impact of the Medicaid Reimbursement Bump on Influenza Vaccination Rates Among US Teens: Evidence from the National Immunization Survey-Teen 2011-2020.","authors":"Felippe O Marcondes, Mary Price, Alex McDowell, Joseph P Newhouse, John Hsu, Vicki Fung","doi":"10.3122/jabfm.2023.230170R2","DOIUrl":"10.3122/jabfm.2023.230170R2","url":null,"abstract":"<p><strong>Background: </strong>Many adolescents do not receive basic preventive care such as influenza vaccinations. The Affordable Care Act (ACA) temporarily increased Medicaid reimbursements for primary care services, including vaccine administration, in 2013 to 2014. The objective of this study is to assess the impact of reimbursement increases on influenza vaccination rates among adolescents with Medicaid.</p><p><strong>Methods: </strong>This repeated cross-sectional study used a difference-in-difference approach to compare changes in annual influenza vaccination rates for 20,884 adolescents 13 to 17 years old covered by Medicaid with adequate provider-reported data in 18 states with larger extended (>$5, 2013 to 2019) versus larger temporary (2013 to 2014 only) versus smaller reimbursement changes. We used linear probability models with individual-level random effects, adjusting for state and individual characteristics and annual time trends to assess the impact of a Medicaid vaccine administration reimbursement increase on annual influenza vaccination.</p><p><strong>Results: </strong>Mean Medicaid reimbursements for vaccine administration doubled from 2011 to 2013 to 2014 (eg, from $11 to $22 for CPT 90460). States with smaller reimbursement changes had higher mean reimbursements and higher adjusted vaccination rates at baseline (2011) compared with states with larger temporary and extended reimbursement changes. The reimbursement change was not associated with increases in influenza vaccination rates.</p><p><strong>Discussion: </strong>Influenza vaccination rates were low among adolescents with Medicaid throughout the study period, particularly in states with lower Medicaid reimbursement levels before the ACA.</p><p><strong>Conclusion: </strong>That reimbursement increases were not associated with higher vaccination rates suggests additional efforts are needed to improve influenza vaccination rates in this population.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 1","pages":"137-146"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102717","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 Clinicians' Attitude, Knowledge, and Willingness to Address Climate Change in Shared Decision-Making.","authors":"Frank Müller, Jesse I Skok, Judith E Arnetz, Michael J Bouthillier, Harland T Holman","doi":"10.3122/jabfm.2023.230027R1","DOIUrl":"10.3122/jabfm.2023.230027R1","url":null,"abstract":"<p><strong>Background: </strong>Climate change poses a threat to the health of people worldwide. Little is known about the awareness of primary care clinicians toward climate change and if they are open and prepared to address climate change issues with their patients. As pharmaceuticals are the main source of carbon emissions in primary care, avoiding the prescription of particular climate-harmful medications is a meaningful contribution to the reduction of greenhouse gases.</p><p><strong>Methods: </strong>This is a cross-sectional questionnaire survey among primary care clinicians in West Michigan conducted in November 2022.</p><p><strong>Results: </strong>One hundred three primary care clinicians responded (response rate 22.5%). Nearly 1/3 (29.1%) were classified as climate change unaware clinicians who perceived that global warming is not happening, or expressed that it is happening but not caused by human activities or is affecting the weather. In a theoretical scenario on a prescription of a new drug, clinicians tended to prescribe the less harmful drug without discussing options with patients. Although 75.5% of clinicians agreed that climate change aspects have its place in shared decision-making, 76.6% of clinicians expressed a lack of knowledge to advise patients in this regard. In addition, 60.3% of clinicians feared that raising climate change issues in consultations may adversely affect the relationship with the patient.</p><p><strong>Discussion: </strong>Although many primary care clinicians are open to addressing climate change in their working environment and with their patients, they lack knowledge and confidence to do so. In contrast, the majority of the US population is willing to do more to mitigate climate change. Although curricula on climate change topics are increasingly implemented in student education, programs to educate mid- and late-career clinicians are lacking.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"25-34"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9698306","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":"High-Performing Teamlets in Primary Care: A Qualitative Comparative Analysis.","authors":"Melinda A Chen, Claude Rubinson, Eloise M O'Donnell, Jing Li, Thomas Bodenheimer, Lawrence P Casalino","doi":"10.3122/jabfm.2023.230105R1","DOIUrl":"10.3122/jabfm.2023.230105R1","url":null,"abstract":"<p><strong>Purpose: </strong>In efforts to improve patient care, collaborative approaches to care have been highlighted. The teamlet model is one such approach, in which a primary care clinician works consistently with the same clinical staff member. The purpose of this study is to identify the characteristics of high-performing primary care teamlets, defined as teamlets with low rates of ambulatory care sensitive emergency department (ACSED) visits and ambulatory care sensitive hospital admissions (ACSAs).</p><p><strong>Methods: </strong>Twenty-six individual qualitative interviews were performed with physicians and their teamlet staff member across 13 teamlets. Potentially important characteristics related to high-performing primary care teamlets were identified, calibrated, and analyzed using qualitative comparative analysis (QCA).</p><p><strong>Results: </strong>Key characteristics identified by the QCA that were often present in teamlets with low rates of ACSED visits and, to a lesser extent, ACSAs were staff proactiveness in anticipating physician needs and physician-reported trust in their staff member.</p><p><strong>Conclusion: </strong>This study suggests that physician trust in their staff and proactiveness of staff in anticipating physician needs are important in promoting high-performing teamlets in primary care. Additional studies are indicated to further explore the relationship between these characteristics and high-performing teamlets, and to identify other characteristics that may be important.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"105-111"},"PeriodicalIF":2.4,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809878","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":"Climate Change and Policy Reforms: A View from the Primary Care Clinic.","authors":"Daniel Wolk, Rebecca Porter","doi":"10.3122/jabfm.2023.230209R1","DOIUrl":"10.3122/jabfm.2023.230209R1","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"19-20"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050791","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":"Considering the Environmental Impact of Practice-Based Research.","authors":"Ben Webel, Gabriela Villalobos, Michelle S Rockwell, Alison Huffstetler, Jacqueline B Britz, E Marshall Brooks, Alex H Krist","doi":"10.3122/jabfm.2023.230202R1","DOIUrl":"10.3122/jabfm.2023.230202R1","url":null,"abstract":"<p><strong>Introduction: </strong>Practice-based research networks (PBRNs) improve primary care by addressing issues that matter to clinicians. Building trust between researchers and care teams is essential to this process, which often requires visiting practices to cultivate relationships and perform research activities. However, in a recent study using practice facilitation to improve the delivery of a preventive service, the COVID-19 pandemic prompted us to convert all planned facilitation from an in-person to virtual format. This eliminated the need to commute by automobile to and from practices across the state, greatly reducing the carbon footprint of the study.</p><p><strong>Methods: </strong>From practice facilitator field notes that detailed practice locations and number of sessions, we calculated the total number of driving miles averted by virtual facilitation. We then determined metric tons of carbon dioxide we avoided producing using the Environmental Protection Agency Greenhouse Gases Equivalencies Calculator. During post-intervention interviews, we assessed practices' perspectives and experiences with the virtual format.</p><p><strong>Results: </strong>Three practice facilitators provided an average of 3.4 sessions for 64 practices. Virtual facilitation averted 32,574.8 drive miles and prevented the release of 12.7 metric tons of carbon dioxide, an offset equivalent to growing 210 trees for 10 years. Practices reported that virtual facilitation fostered greater engagement and allowed more clinicians and staff to attend sessions.</p><p><strong>Discussion: </strong>Climate change poses a significant threat to the health of people and communities. Given their commitment to improving population health, it may be time for PBRNs to routinely assess their environmental impact and minimize preventable environmental costs.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"22-24"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050853","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":"Changes in Metabolic Parameters of Hemoglobin A1c, Weight, and Blood Pressure During and After COVID-19 Stay-at-Home Orders.","authors":"Elizabeth M Bickenbach, Caroline L Keegan, Makenzie C Brockel, Olivia G Mast, Adithya Ghantae, Andrew Y Hwang, Christina H Sherrill","doi":"10.3122/jabfm.2023.230205R1","DOIUrl":"10.3122/jabfm.2023.230205R1","url":null,"abstract":"<p><strong>Background: </strong>Due to the COVID-19 pandemic, a \"state of emergency\" was declared in North Carolina on March 10, 2020. Subsequent \"stay-at-home\" (SAH) orders restricted activities including use of fitness facilities, and teleworking was encouraged. This study investigates metabolic effects of these changes in activity level.</p><p><strong>Methods: </strong>This retrospective prepost study included adults diagnosed with type 2 diabetes mellitus and hypertension with hemoglobin A1c (HbA1c), weight, and blood pressure (BP) measurements for 3 time periods: 3/10/2019-9/9/2019 (\"pre-SAH\"), 3/10/2020-9/9/2020 (\"during SAH\"), and 3/10/2021-9/9/2021 (\"post-SAH\"). The primary outcome was change in HbA1c pre-SAH to during SAH and during SAH to post-SAH. Secondary outcomes were changes in weight, systolic BP (SBP), and diastolic BP (DBP) over the same periods. Exploratory outcomes included health care utilization. Paired <i>t</i> test compared outcomes between time periods using Bonferroni-adjusted α of 0.025 for significance.</p><p><strong>Results: </strong>Analysis included 301 participants with an average age of 69.8 years. HbA1c, SBP, and DBP trended up from pre-SAH to during SAH and then decreased post-SAH with a significant change only for DBP from during SAH to post-SAH (74.2 mmHg to 73.6 mmHg, <i>P < .001</i>). Weight trended down across the 3 study periods. In-office visits significantly decreased from pre-SAH to during SAH, and telehealth visits significantly decreased from during SAH to post-SAH (both <i>P < .001</i>).</p><p><strong>Conclusions: </strong>With the exception of DBP, findings reveal consistency in HbA1c, weight, and BP across time periods before, during, and after COVID-19 SAH orders in North Carolina.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"129-133"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565252","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":"Less Is More: Backing off Sliding Scale Insulin for Hospitalized Patients.","authors":"Lakshmi Karra, Roxanne Radi, Corey Lyon","doi":"10.3122/jabfm.2023.230349R1","DOIUrl":"10.3122/jabfm.2023.230349R1","url":null,"abstract":"<p><p>In hospitalized patients with type 2 diabetes (T2DM), a less aggressive supplemental insulin regimen is noninferior to a standard, more aggressive, supplemental regimen.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"150-152"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050856","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":"Smoking Cessation Support in the Context of Other Social and Behavioral Needs in Community Health Centers.","authors":"Michael B Potter, Janice Y Tsoh, Kara Lugtu, Jose Parra, Vicky Bowyer, Danielle Hessler","doi":"10.3122/jabfm.2023.230239R1","DOIUrl":"10.3122/jabfm.2023.230239R1","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking rates remain disproportionately high among low income populations with unmet social and behavioral health needs. To address this problem, we sought to develop and evaluate the feasibility, acceptability, and preliminary effectiveness of a novel smoking cessation program for community health centers that serve these populations.</p><p><strong>Methods: </strong>We implemented a randomized pilot trial of two smoking cessation programs in three county operated community health center (CHC) sites: (1) a systematic assessment of smoking habits and standard tools to assist with smoking cessation counseling (\"Enhanced Standard Program\" or ESP), and (2) another that added a structured assessment of social and behavioral barriers to smoking cessation, (\"Connection to Health for Smokers\" or CTHS). Clinical outcomes were evaluated between 10 to 16 weeks, supplemented with interviews of patient participants and health care team members.</p><p><strong>Results: </strong>141 adults were randomized and 123 completed the intervention (61 in ESP, 62 in CTHS). At follow-up, over half of participants reported ≥1 quit attempts (59.7% ESP and 56.5% CTHS; adjusted <i>p</i> = .66) while more in ESP (24.6% vs. 12.9%) were documented as not smoking in the last 7 days (adjusted <i>p</i> = 0.03). In addition to being in ESP, predictors of smoking cessation included higher baseline confidence in ability to quit (<i>p</i> = 0.02) and more quit attempts during the study (<i>p</i> = 0.04). Health care teams, however, generally preferred the more comprehensive approach of CTHS.</p><p><strong>Conclusion: </strong>Lessons learned from this pilot study may inform the development of effective smoking cessation programs for CHCs that combine elements of both interventions.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"84-94"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050858","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}