Journal of the American Board of Family Medicine最新文献_第9页

Climate Change Psychological Distress: An Underdiagnosed Cause of Mental Health Disturbances. 气候变化心理困扰：未被充分诊断的心理健康障碍原因。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230169R1

Jessica de Jarnette

引用次数: 0

Lack of Diversity in Female Family Physicians Performing Women's Health Procedures. 从事妇女健康手术的女性家庭医生缺乏多样性。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230477R0

Kendall Hancock

引用次数: 0

Physician and Advanced Practice Clinician Burnout in Rural and Urban Settings. 农村和城市环境中的医生和进修医生职业倦怠。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230233R1

Melissa L Harry, Nancy L Sudak, Mary J Engels, Karly K Horn, Kate Dean, Sara Poplau, Martin J Stillman, Mark Linzer

{"title":"Physician and Advanced Practice Clinician Burnout in Rural and Urban Settings.","authors":"Melissa L Harry, Nancy L Sudak, Mary J Engels, Karly K Horn, Kate Dean, Sara Poplau, Martin J Stillman, Mark Linzer","doi":"10.3122/jabfm.2023.230233R1","DOIUrl":"10.3122/jabfm.2023.230233R1","url":null,"abstract":"Introduction: Recruiting rural-practicing clinicians is a high priority. In this study, we explored burnout and contributing work conditions among rural, urban, and family practice physicians and advanced practice clinicians (APCs) in an Upper Midwestern health care system.Methods: The Mini Z burnout reduction measure was administered by anonymous electronic survey in March 2022. We conducted bivariate analyses of study variables, then assessed relationships of study variables to burnout with multivariate binary logistic regression.Results: Of 1118 clinicians (63% response rate), 589 physicians and 496 APCs were included in this study (n = 1085). Most were female (56%), physicians (54%), and White (86%), while 21% were in family practice, 46% reported burnout, and 349 practiced rurally. Rural and urban clinician burnout rates were comparable (45% vs 47%). Part-time work protected against burnout for family practice and rural clinicians, but not urban clinicians. In multivariate models for rural clinicians, stress (OR: 8.53, 95% CI: 4.09 to 17.78, P < .001), lack of workload control (OR: 3.06, 95% CI: 1.47-6.36, P = .003), busy/chaotic environments (OR: 2.53, 95% CI: 1.29-4.99, P = .007), and intent to leave (OR: 2.18, 95% CI: 1.06-4.45, P = .033) increased burnout odds. In family practice clinicians, stress (OR: 13.43 95% CI: 4.90-36.79, P < .001) also significantly increased burnout odds.Conclusions: Burnout was comparable between rural and urban physicians and APCs. Part-time work was associated with decreased burnout in rural and family practice clinicians. Addressing burnout drivers (stress, workload control, chaos) may improve rural work environments, reduce turnover, and aid rural clinician recruitment. Addressing stress may be particularly impactful in family practice.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"43-58"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050857","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}

引用次数: 0

When Climate Change Shows Up in the Exam Room. 当气候变化出现在检查室时。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230200R1

Joanna G Katzman, Stefan Wheat, Ann S Christiano

引用次数: 0

Investigating the Effect of Weather Events on Primary Care Clinicians Across the United States. 调查天气事件对美国各地初级保健临床医生的影响。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230128R2

Elisabeth F Callen, Tarin L Clay

{"title":"Investigating the Effect of Weather Events on Primary Care Clinicians Across the United States.","authors":"Elisabeth F Callen, Tarin L Clay","doi":"10.3122/jabfm.2023.230128R2","DOIUrl":"10.3122/jabfm.2023.230128R2","url":null,"abstract":"Background: When we consider weather impacts, we mainly consider how the event affects the person, not the clinicians treating them. There is a paucity of studies discussing the effect of weather on the clinicians and the care of their patients.Methods: A survey covering weather effects was distributed to American Academy of Family Physicians National Research Network (AAFP NRN) members in August 2020. Descriptive statistics and Fisher's exact tests were completed on the survey responses. Postsurvey interviews were conducted with selected respondents about specific weather events.Results: Survey respondents were US physicians (88.7%) and 84.9% indicated more than 1 type of event has affected their practice. Respondents were most affected by snow/snowstorm (81.1%) and indicated they had to close for the day or longer and staff were unable to make it into clinic (79.2%). Respondents indicated respiratory (94.5%), mental health (81.8%), and musculoskeletal conditions (50.9%) were most affected by weather. Interviews with selected respondents covered weather topics including winter, summer, and flooding.Discussion: Survey respondents/interviewees indicated weather affects them in a variety of ways including issues with patients' conditions and practice effects. Clinicians have noticed a change to their areas' weather over the years, but, generally, warming is occurring.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"95-104"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428491","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}

引用次数: 0

Disparities in Screening for Adverse Childhood Experiences. 童年不良经历筛查中的差异。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230262R1

Héctor E Alcalá, Amanda E Ng, Nicholas Tkach, Dahai Yue, Mienah Sharif

{"title":"Disparities in Screening for Adverse Childhood Experiences.","authors":"Héctor E Alcalá, Amanda E Ng, Nicholas Tkach, Dahai Yue, Mienah Sharif","doi":"10.3122/jabfm.2023.230262R1","DOIUrl":"10.3122/jabfm.2023.230262R1","url":null,"abstract":"Introduction: Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed.Methods: Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes.Results: Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts.Conclusions: Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"73-83"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565200","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}

引用次数: 0

Variation in Practice Patterns of Early- and Later-Career Family Physicians. 早期和后期职业家庭医生执业模式的差异。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-11 DOI: 10.3122/jabfm.2023.230176R1

Peter J Carek, Yue Cheng, Andrew W Bazemore, Lars E Peterson

{"title":"Variation in Practice Patterns of Early- and Later-Career Family Physicians.","authors":"Peter J Carek, Yue Cheng, Andrew W Bazemore, Lars E Peterson","doi":"10.3122/jabfm.2023.230176R1","DOIUrl":"10.3122/jabfm.2023.230176R1","url":null,"abstract":"Introduction: Understanding how physicians' practice patterns change over a career is important for workforce and medical education planning. This study examined trends in self-reported practice activity among early- and later-career stage family physicians (FPs).Methods: Data on early career FPs came from the American Board of Family Medicine's National Graduate Survey (NGS) and on later career FPs from its Continuous Certification Questionnaire (CCQ). Both cohorts could complete the Practice Demographic Survey (PDS) 3 years later. Longitudinal cohorts were from 2016 to 2019 and 2017 to 2020, respectively. All surveys included identical items on scope of practice, practice type, organization, and location. We characterized physicians as outpatient continuity only, outpatient and inpatient care (mixed practice), and no outpatient continuity (for example, hospitalist). We conducted repeated cross-sectional and longitudinal analysis of practice type.Results: Our sample included 8,492 NGS and 30,491 CCQ FPs. In both groups, the vast majority provided outpatient continuity of care (77% to 81%). Approximately 25% of NGS had a mixed practice compared with approximately 16% of the CCQ group. The percent of FPs who had a mixed practice declined in both groups (34.21% to 27.10% and 23.88% to 19.33%). In both groups, physicians with higher odds of leaving mixed practice were in metropolitan counties or changed practice types.Conclusion: Although early-career FPs more frequently reported providing both inpatient and outpatient care and serving as hospitalists compared with later-career FPs, both groups had a decline in frequency of providing mixed practice. This change after only 3 years in practice has significant implications for patient care and medical education.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"35-42"},"PeriodicalIF":2.9,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446840","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}

引用次数: 0

The Scope of Multimorbidity in Family Medicine: Identifying Age Patterns Across the Lifespan. 家庭医学中的多病症范围：识别整个生命周期的年龄模式。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-01 DOI: 10.3122/jabfm.2023.230221R1

David Chartash, Aidan Gilson, R Andrew Taylor, Laura C Hart

{"title":"The Scope of Multimorbidity in Family Medicine: Identifying Age Patterns Across the Lifespan.","authors":"David Chartash, Aidan Gilson, R Andrew Taylor, Laura C Hart","doi":"10.3122/jabfm.2023.230221R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230221R1","url":null,"abstract":"Introduction: Multimorbidity rates are both increasing in prevalence across age ranges, and also increasing in diagnostic importance within and outside the family medicine clinic. Here we aim to describe the course of multimorbidity across the lifespan.Methods: This was a retrospective cohort study across 211,953 patients from a large northeastern health care system. Past medical histories were collected in the form of ICD-10 diagnostic codes. Rates of multimorbidity were calculated from comorbid diagnoses defined from the ICD10 codes identified in the past medical histories.Results: We identify 4 main age groups of diagnosis and multimorbidity. Ages 0 to 10 contain diagnoses which are infectious or respiratory, whereas ages 10 to 40 are related to mental health. From ages 40 to 70 there is an emergence of alcohol use disorders and cardiometabolic disorders. And ages 70 to 90 are predominantly long-term sequelae of the most common cardiometabolic disorders. The mortality of the whole population over the study period was 5.7%, whereas the multimorbidity with the highest mortality across the study period was Circulatory Disorders-Circulatory Disorders at 23.1%.Conclusion: The results from this study provide a comparison for the presence of multimorbidity within age cohorts longitudinally across the population. These patterns of comorbidity can assist in the allocation to practice resources that will best support the common conditions that patients need assistance with, especially as the patients transition between pediatric, adult, and geriatric care. Future work examining and comparing multimorbidity indices is warranted.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 2","pages":"251-260"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916769","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}

引用次数: 0

Managing Multiple Chronic Conditions during COVID-19 Among Patients with Social Health Risks. 有社会健康风险的患者在 COVID-19 期间管理多种慢性病。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-01 DOI: 10.3122/jabfm.2023.230053R2

Leah Tuzzio, Kathy S Gleason, James D Ralston, Melanie Drace, Marlaine Figueroa Gray, Ruth Bedoy, Jennifer L Ellis, Richard W Grant, Elizabeth A Bayliss, Leslie Jauregui, Zoe A Bermet

{"title":"Managing Multiple Chronic Conditions during COVID-19 Among Patients with Social Health Risks.","authors":"Leah Tuzzio, Kathy S Gleason, James D Ralston, Melanie Drace, Marlaine Figueroa Gray, Ruth Bedoy, Jennifer L Ellis, Richard W Grant, Elizabeth A Bayliss, Leslie Jauregui, Zoe A Bermet","doi":"10.3122/jabfm.2023.230053R2","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230053R2","url":null,"abstract":"Background: Optimal care for persons with multiple chronic conditions (MCC) requires primary and specialty care continuity, access to multiple providers, social risk assessment, and self-management support. The COVID-19 pandemic abruptly changed primary care delivery to increase reliance on telehealth and virtual care. We report on the experiences of individuals with MCC and their family caregivers on managing their health and receiving health care during the initial pandemic.Methods: Semistructured qualitative interviews with 30 patients (19 English speaking, 11 Spanish speaking) plus 9 accompanying care partners, who had 2+ primary care encounters between March 1, 2020, and November 30, 2020, 2+ chronic conditions, and 1 or more self-reported social risks. Questions focused on access to and experiences with care, roles for care partners, and self-management during the first 6 months of the pandemic.Results: Participants experienced substantial changes in care delivery. The most commonly reported changes were a shift to more virtual relative to in-person care and shifting roles for care partners. Changes fostered new perspectives on self-management and an appreciation of personal resilience and self-reliance. Virtual care was an acceptable complement to in-person care, though not a substitute for periodic in-person visits. It was more acceptable for English speakers and with a usual provider.Conclusion: New models of care delivery that recognize patient and family resilience and resourcefulness, emphasize provider continuity, and combine virtual and in-person care may support self-management for individuals with MCC and social needs.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 2","pages":"172-179"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917366","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}

引用次数: 0

Differences in Receipt of Time Alone with Healthcare Providers Among US Youth Ages 12-17. 美国 12-17 岁青少年与医疗保健提供者独处时间的差异。

IF 2.9 3区医学

Journal of the American Board of Family Medicine Pub Date : 2024-03-01 DOI: 10.3122/jabfm.2023.230222R1

Marvin So

{"title":"Differences in Receipt of Time Alone with Healthcare Providers Among US Youth Ages 12-17.","authors":"Marvin So","doi":"10.3122/jabfm.2023.230222R1","DOIUrl":"https://doi.org/10.3122/jabfm.2023.230222R1","url":null,"abstract":"Background: Time to meet privately with a health care provider can support optimal adolescent health, but numerous barriers exist to implementing this practice routinely.Methods: We examined parent reports on their children aged 12 to 17 from a nationally generalizable sample to quantify the presence of time alone with health care providers at the state and national level, as well as socio-contextual correlates using logistic regression analysis.Results: We estimated that only 1 in 2 adolescents had a confidential discussion at their last medical visit. Certain child, family, and health care factors were associated with lower likelihood for having had confidential discussions. Specifically, adolescents who were Asian; did not have mental, emotional, or behavioral problems; were uninsured; or lived in households with parents who were immigrants, less educated, or did not speak English had significantly lower odds for having had time alone compared with referent groups.Discussion: Clinical and structural efforts to rectify these gaps may assist a broader share of youth in benefiting from private health care discussions with providers.","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"37 2","pages":"309-315"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917409","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}

引用次数: 0