Annals of Family Medicine最新文献

{"title":"Reporting Guideline for Chatbot Health Advice Studies: Chatbot Assessment Reporting Tool (CHART) Statement.","authors":"Bright Huo","doi":"10.1370/afm.250386","DOIUrl":"https://doi.org/10.1370/afm.250386","url":null,"abstract":"<p><p>The Chatbot Assessment Reporting Tool (CHART) is a reporting guideline developed to provide reporting recommendations for studies evaluating the performance of chatbots driven by generative artificial intelligence when summarizing clinical evidence and providing health advice, referred to as chatbot health advice studies. CHART was developed in several phases after performing a comprehensive systematic review to identify variation in the conduct, reporting, and method in chatbot health advice studies. Findings from the review were used to develop a draft checklist that was revised through an international, multidisciplinary, modified, asynchronous Delphi consensus process of 531 stakeholders, 3 synchronous panel consensus meetings of 48 stakeholders, and subsequent pilot testing of the checklist. CHART includes 12 items and 39 subitems to promote transparent and comprehensive reporting of chatbot health advice studies. These include title (subitem 1a), abstract/summary (subitem 1b), background (subitems 2a,b), model identifiers (subitems 3a,b), model details (subitems 4a-c), prompt engineering (subitems 5a,b), query strategy (subitems 6a-d), performance evaluation (subitems 7a,b), sample size (subitem 8), data analysis (subitem 9a), results (subitems 10a-c), discussion (subitems 11a-c), disclosures (subitem 12a), funding (subitem 12b), ethics (subitem 12c), protocol (subitem 12d), and data availability (subitem 12e). The CHART checklist and corresponding diagram of the method were designed to support key stakeholders including clinicians, researchers, editors, peer reviewers, and readers in reporting, understanding, and interpreting the findings of chatbot health advice studies. KEY MESSAGES: CHART was developed by performing a systematic review, Delphi consensus of 531 international stakeholders, and several consensus meetings among an expert panel comprised of 48 membersThe CHART statement outlines 12 key reporting items for chatbot health advice studies in the form of a checklist and methodological diagramAll stakeholders including clinicians, researchers, and journal editors should encourage the transparent reporting of chatbot health advice studies.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coverage Checker: A Web-Based Tool to Navigate Diabetes Coverage and Prior Authorization.","authors":"Noa Kim, Shirley Cardinal, Jonathan Gabison, Lauren Oshman, Jacqueline Rau, Jacob Reiss, Larrea Young, Heidi L Diez","doi":"10.1370/afm.240633","DOIUrl":"10.1370/afm.240633","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"378"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Geographic Distribution of Family Physicians Providing Maternity Care and Opportunities for Expanding Access to Care in Rural Areas.","authors":"Michael Topmiller, Grace Walter, Anuradha Jetty, Crystal Pristell, Jennifer L Rankin, Mark A Carrozza, Alison N Huffstetler","doi":"10.1370/afm.240073","DOIUrl":"10.1370/afm.240073","url":null,"abstract":"<p><strong>Purpose: </strong>Family physicians (FPs) are an important segment of the maternity workforce, particularly in rural areas. This research explores the geographic distribution of family physicians providing maternity care and identifies opportunities for family physicians to expand access to maternity care.</p><p><strong>Methods: </strong>This cross-sectional study used a co-location mapping approach to identify 3 types of counties based on the following: (1) family physicians as the only clinician provider of maternity care along with at least 1 hospital providing obstetric care (FP with Hospital); (2) family physicians as the only clinician provider of maternity care with no hospital providing obstetric care (FP Only); (3) no clinician providers of maternity care but county has at least 1 hospital providing obstetric services (Only Hospital).</p><p><strong>Results: </strong>Most of the 325 counties across the 3 types are rural and concentrated in the central United States, the upper Midwest, and in Mississippi. More than one-third of these counties are found in just 4 states-Texas, Iowa, Nebraska, and Kansas. Although there are not clear differences in the geographic distribution of FP Only and FP with Hospital counties, Only Hospital counties are located primarily in a few states, including Mississippi, Missouri, Oklahoma, and Texas, and have significantly higher percentages of Black populations.</p><p><strong>Conclusions: </strong>Our findings demonstrate that while FPs are providing maternity care in rural areas across the United States, opportunities exist to expand their reach, particularly in Mississippi, Texas, and Oklahoma.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"302-307"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charting the Future: Progress in the National Family Medicine Research Strategy.","authors":"Irfan Asif, Shannon Robinson","doi":"10.1370/afm.250374","DOIUrl":"10.1370/afm.250374","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"385-386"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The HEAL Protocol in Brazilian Health Care: An Innovative Approach to Primary Care for Human Trafficking Survivors.","authors":"Marcella R Cardoso, Mona Lisa Dourado Neves, Yewon Lee, Hanni Stoklosa","doi":"10.1370/afm.240572","DOIUrl":"10.1370/afm.240572","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"379"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Health for People Experiencing Homelessness Within and Beyond the VA: From Cancer Screening to Integrated Preventive Health.","authors":"Katherine Diaz Vickery","doi":"10.1370/afm.250349","DOIUrl":"10.1370/afm.250349","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"283-284"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Pediatric Obesity Prevalence Among Community Health Center Patients by Latino Ethnicity and Nativity, 2012-2020.","authors":"Jennifer A Lucas, Miguel Marino, Steffani R Bailey, Kevin Espinoza, Roopradha Datta, David Boston, John Heintzman","doi":"10.1370/afm.240248","DOIUrl":"10.1370/afm.240248","url":null,"abstract":"<p><strong>Purpose: </strong>Latino pediatric patients have a higher prevalence of obesity, but less is known about how factors related to nativity are associated with obesity in youth. We examined the prevalence of childhood and adolescent obesity in primary care over time by nativity status for Latino and non-Hispanic White children.</p><p><strong>Methods: </strong>In this serial cross-sectional analysis, we used electronic health records from a multi-state network of community health centers which included data from clinics in 21 US states for patients aged 9 to 17 years from 2012 through 2020 in at least 1 of 4 nonmutually exclusive cross sections. We estimated the adjusted odds and prevalence of having obesity (ie, body mass index [BMI] at the 95th percentile or greater for age and sex) at all encounters during each cross section by ethnicity and nativity status.</p><p><strong>Results: </strong>The sample included a total of 147,376 patients. In the 2012-2013 cross section, 38,697 children and adolescents had at least 1 BMI measurement recorded compared with 72,747 in the 2018-2020 cross section. US-born Latino children had higher odds of having obesity than non-Hispanic White children. Foreign-born Latino and non-Hispanic White children had lower prevalence of obesity in each cross section compared with US-born Latino children (with a range from 20.4% [95% CI, 16.9%-23.8%] to 32.7% [95% CI, 31.6%-33.9%]).</p><p><strong>Conclusions: </strong>Differences in the prevalence of documented childhood and adolescent obesity by nativity status exist in this sample of community health center patients. This demonstrates opportunity for primary care practice to further consider patients' background and culture when providing obesity care and cardiovascular and metabolic disease prevention.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"325-329"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland.","authors":"Ann Sinéad Doherty, Lars Christian Lund, Frank Moriarty, Fiona Boland, Barbara Clyne, Tom Fahey, Seán P Kennelly, Denis O'Mahony, Emma Wallace","doi":"10.1370/afm.240383","DOIUrl":"10.1370/afm.240383","url":null,"abstract":"<p><strong>Purpose: </strong>Prescribing cascades occur when one medication is used to treat adverse effects of another medication. Older adults with polypharmacy are at higher risk for this phenomenon. We examined the prevalence, magnitude, and effect modification of 9 prescribing cascades (ThinkCascades) among older community-dwelling adults in a national prescription database.</p><p><strong>Methods: </strong>We used prescription sequence symmetry analysis to examine prescriptions for ThinkCascades medications dispensed in primary care under the General Medical Services scheme in Ireland. Analyses were based on prescriptions dispensed between 2017 and 2020 among 533,464 adults aged 65 years or older. Incident users of both medications in each ThinkCascades dyad were included. We used an observation window of 365 days and examined other windows in sensitivity analyses. Adjusted sequence ratios (aSRs) took into account secular prescribing trends. We also conducted analyses stratified by sex, age, and individual index medication.</p><p><strong>Results: </strong>Five prescribing cascades had significant positive aSRs, indicating that the patient was more likely to receive the index medication before the marker medication. The largest signal was identified for the calcium channel blocker to diuretic cascade (prevalence, 2.6%; aSR = 1.93; 95% CI, 1.79-2.09). Positive signals were also identified for the <i>α</i> ₁-receptor blocker to vestibular sedative cascade (prevalence, 3.0%; aSR = 1.63; 95% CI, 1.46-1.81); the selective serotonin reuptake inhibitor/selective norepinephrine reuptake inhibitor to sleep medication cascade (prevalence, 2.5%; aSR = 1.54; 95% CI, 1.40-1.69); the antipsychotic to antiparkinsonian cascade (prevalence, 0.4%; aSR = 1.20; 95% CI, 1.00-1.43); and the benzodiazepine to antipsychotic cascade (prevalence, 3.2%; aSR = 1.15; 95% CI, 1.08-1.21).</p><p><strong>Conclusions: </strong>To our knowledge, this study is the first to describe the prevalence of an expert consensus-based list of prescribing cascades, ThinkCascades, in a national population of older adults, and it identified 5 clinically relevant prescribing cascades. These findings highlight prescribing cascades as an important underresearched area contributing to complex polypharmacy among older people living with multimorbidity.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"315-324"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Care Delivery and Outcomes by Race and Ethnicity: Evaluation of an Enhanced Primary Care Practice Model in the US Upper Midwest.","authors":"Joseph R Herges, Lauren R Stonerock, Kristin Cole, Rozalina G McCoy","doi":"10.1370/afm.240210","DOIUrl":"10.1370/afm.240210","url":null,"abstract":"<p><strong>Purpose: </strong>The Enhanced Primary Care Diabetes (EPCD) model is nurse led and leverages interdisciplinary support to improve diabetes quality indicators. The model has been found to be effective overall; however, because narrowing health disparities is a key objective, we aimed to assess differential effectiveness of the model among various racial and ethnic groups.</p><p><strong>Methods: </strong>This retrospective cohort study compared the time to meeting the D5, a publicly reported quality measure (composite indicator of glycemic and blood pressure control, aspirin use for secondary prevention of cardiovascular disease, statin use, and documented abstinence from tobacco use), after enrollment in the EPCD program by Black, Hispanic/Latine, and Asian patients compared with White patients with diabetes (age 18-75 years) receiving care at 13 primary care practices by multivariable Cox proportional hazards regression. Patients enrolled in the program from January 1, 2020 to December 31, 2020; the study period end date was August 1, 2022.</p><p><strong>Results: </strong>The EPCD program enrolled 1,749 patients (none of whom met the D5 at entry) and 1,061 (60.7%) met the D5 during the study period. Black patients were less likely to meet the D5 compared with White patients (adjusted hazard ratio 0.68; 95% CI, 0.52-0.90; <i>P</i> = .007); there was no difference among Asian and Hispanic patients compared with White patients. Compared with White patients (median 1.1/year; interquartile range [IQR] 0.4, 2.7), Asian patients had fewer nurse touch points (median 0.8/year; IQR 0, 1.4) during the study period, whereas Black patients had more (median 2.2/year; IQR 0.6, 4.0) and Hispanic patients showed no significant difference.</p><p><strong>Conclusions: </strong>Time to meeting the D5 was longer for Black patients compared with White patients in the EPCD model, despite greater engagement with the care team. Further research is needed to identify factors driving these disparities.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"344-349"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Gaining Housing Associated With Higher Rates of Cancer Screening Among US Veterans Experiencing Homelessness?","authors":"Hannah Decker, Laura Graham, Ashley Titan, Hemal Kanzaria, Mary Hawn, Elizabeth Wick, Jack Tsai, Margot Kushel","doi":"10.1370/afm.240520","DOIUrl":"10.1370/afm.240520","url":null,"abstract":"<p><strong>Purpose: </strong>People experiencing homelessness have lower rates of cancer screening than housed people, contributing to later stages at cancer diagnosis and poor outcomes. We examined whether gaining housing increased rates of cancer screening in a cohort of homeless veterans.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study examining all veterans experiencing homelessness who were eligible for, but not up to date on, colorectal and breast cancer screening from 2011 to 2021. Our exposure was gaining housing in the 24 months after the index clinic visit, conceptualized as a time-varying covariate. Our primary outcome was undergoing breast or colorectal screening in the 24 months after that visit. We performed bivariate analysis and Cox proportional hazards analysis, clustering on the facility level and adjusting for clinical and demographic covariates.</p><p><strong>Results: </strong>Our cohort included 117,619 homeless veterans who were eligible for but not up to date on colorectal cancer screening at their index visit, of whom 57,705 (49.0%) gained housing over 24 months. The cohort included 6,517 homeless veterans who were eligible for but not up to date on breast cancer screening, of whom 3,101 (47.5%) gained housing over 24 months. Compared with peers who remained homeless, veterans who gained housing were more than twice as likely to undergo colorectal cancer screening (adjusted hazard ratio, 2.3; 95% CI, 2.2-2.3; <i>P</i> <.001) and breast cancer screening (adjusted hazard ratio, 2.4; 95% CI, 2.2-2.7; <i>P</i> <.001).</p><p><strong>Conclusions: </strong>Veterans experiencing homelessness who gain housing have higher rates of cancer screening. This finding supports promotion of housing to improve health outcomes for homeless individuals.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 4","pages":"330-336"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}