Annals of Family Medicine最新文献

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What AHRQ Learned While Working to Transform Primary Care. AHRQ 在改革初级保健时学到了什么。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-03-01 DOI: 10.1370/afm.3090
David Meyers, Therese Miller, Jan De La Mare, Jessie S Gerteis, Gail Makulowich, Gabrielle H Weber, Chunliu Zhan, Janice Genevro
{"title":"What AHRQ Learned While Working to Transform Primary Care.","authors":"David Meyers, Therese Miller, Jan De La Mare, Jessie S Gerteis, Gail Makulowich, Gabrielle H Weber, Chunliu Zhan, Janice Genevro","doi":"10.1370/afm.3090","DOIUrl":"10.1370/afm.3090","url":null,"abstract":"<p><p>Building on previous efforts to transform primary care, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in 2015. This 3-year initiative provided external quality improvement support to small and medium-size primary care practices to implement evidence-based cardiovascular care. Despite challenges, results from an independent national evaluation demonstrated that the EvidenceNOW model successfully boosted the capacity of primary care practices to improve quality of care, while helping to advance heart health. Reflecting on AHRQ's own learnings as the funder of this work, 3 key lessons emerged: (1) there will always be surprises that will require flexibility and real-time adaptation; (2) primary care transformation is about more than technology; and (3) it takes time and experience to improve care delivery and health outcomes. EvidenceNOW taught us that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to a specific disease or initiative. We believe these lessons argue for a national primary care extension service that provides ongoing support for practice transformation.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289548","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}
引用次数: 0
"It Can't Hurt!": Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening. "不会疼的!":为什么许多预期寿命有限的患者决定接受肺癌筛查?
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-03-01 DOI: 10.1370/afm.3081
Eduardo R Núñez, Rendelle E Bolton, Jacqueline H Boudreau, Samantha K Sliwinski, Abigail N Herbst, Lauren E Kearney, Tanner J Caverly, Renda Soylemez Wiener
{"title":"\"It Can't Hurt!\": Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening.","authors":"Eduardo R Núñez, Rendelle E Bolton, Jacqueline H Boudreau, Samantha K Sliwinski, Abigail N Herbst, Lauren E Kearney, Tanner J Caverly, Renda Soylemez Wiener","doi":"10.1370/afm.3081","DOIUrl":"10.1370/afm.3081","url":null,"abstract":"<p><strong>Purpose: </strong>Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS.</p><p><strong>Methods: </strong>We interviewed 40 people with multimorbidity and limited life expectancy, as determined by high Care Assessment Need scores, which predict 1-year risk of hospitalization or death. Patients were recruited from 6 Veterans Health Administration facilities after discussing LCS with their clinician. We conducted a thematic analysis using constant comparison to explore factors that influence LCS decision making.</p><p><strong>Results: </strong>Patients commonly held positive beliefs about screening and perceived LCS to be noninvasive. When posed with hypothetical scenarios of limited benefit, patients emphasized the nonlongevity benefits of LCS (eg, peace of mind, planning for the future) and generally did not consider their health status or life expectancy when making decisions regarding LCS. Most patients were unaware of possible additional evaluations or treatment of screen-detected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures.</p><p><strong>Conclusions: </strong>Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289530","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}
引用次数: 0
Qualitative Study of Black Birthing People Experiencing Preterm Birth. 对早产黑人的定性研究。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3074
Michael E Johansen
{"title":"Qualitative Study of Black Birthing People Experiencing Preterm Birth.","authors":"Michael E Johansen","doi":"10.1370/afm.3074","DOIUrl":"10.1370/afm.3074","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522222","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}
引用次数: 0
Communication and Birth Experiences Among Black Birthing People Who Experienced Preterm Birth. 经历过早产的黑人分娩者的沟通和分娩经历。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3048
Emily F Gregory, Geminesse T Johnson, Alejandra Barreto, Arthurine K Zakama, Adya I Maddox, Lisa D Levine, Scott A Lorch, Alexander G Fiks, Peter F Cronholm
{"title":"Communication and Birth Experiences Among Black Birthing People Who Experienced Preterm Birth.","authors":"Emily F Gregory, Geminesse T Johnson, Alejandra Barreto, Arthurine K Zakama, Adya I Maddox, Lisa D Levine, Scott A Lorch, Alexander G Fiks, Peter F Cronholm","doi":"10.1370/afm.3048","DOIUrl":"10.1370/afm.3048","url":null,"abstract":"<p><strong>Purpose: </strong>Physically or psychologically distressing birth experiences can influence postpartum health, parenting efficacy, and future pregnancy plans. Communication deficits contribute to negative birth experiences. This qualitative analysis explored themes related to communication and negative birth experiences among Black birthing people who experienced preterm birth.</p><p><strong>Methods: </strong>We conducted qualitative interviews with non-Hispanic Black, English language-proficient birthing people with Medicaid-insured preterm infants. Interviews were designed to explore experiences with health care access and well-being after birth. Interviews were audio recorded, transcribed, and coded following an integrated approach where we applied a priori codes and captured emergent themes from the data.</p><p><strong>Results: </strong>We interviewed 30 participants from October 2018 to July 2021. Median gestational age at birth was 30 weeks (range 22-36 weeks). Interviews occurred a median of 7 months postpartum (range 2-34 months). Themes emerged related to negative birth experiences and communication: (1) communication gaps during urgent or emergent intrapartum procedures contributed to negative birth experiences; (2) postpartum opportunities to share birth experiences, particularly with peers, sometimes mitigated the psychological consequences of negative birth experiences; (3) participants did not consistently discuss concerns about future pregnancy risk related to negative birth experiences with clinical teams.</p><p><strong>Conclusions: </strong>Themes from this sample of Black birthing people who experienced preterm birth suggest 3 ways health systems might intervene to improve communication to mitigate the consequences of negative birth experiences. Improvement efforts in these areas may improve postpartum health, future pregnancy outcomes, and long-term health.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522189","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}
引用次数: 0
STFM Offers Support and Resources to New and Transitioning Residency Learning Networks. STFM 为新建和转型中的驻校学习网络提供支持和资源。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3089
Mary Theobald
{"title":"STFM Offers Support and Resources to New and Transitioning Residency Learning Networks.","authors":"Mary Theobald","doi":"10.1370/afm.3089","DOIUrl":"10.1370/afm.3089","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522202","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}
引用次数: 0
From Cradle to Grave: Health During Pregnancy and Over a Lifetime. 从摇篮到坟墓:孕期和一生的健康。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3084
Carolyn F Pearce, Mary Beth Sutter
{"title":"From Cradle to Grave: Health During Pregnancy and Over a Lifetime.","authors":"Carolyn F Pearce, Mary Beth Sutter","doi":"10.1370/afm.3084","DOIUrl":"10.1370/afm.3084","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522209","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}
引用次数: 0
New AAFP President Calls on Family Physicians to be "Servant Leaders". 全美家庭医生协会新任主席呼吁家庭医生成为 "服务型领导者"。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3085
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引用次数: 0
Celebrating the Election of Dr Gerardo Moreno to the National Academy of Medicine. 庆祝杰拉尔多-莫雷诺博士当选美国国家医学科学院院士。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3082
José E Rodríguez
{"title":"Celebrating the Election of Dr Gerardo Moreno to the National Academy of Medicine.","authors":"José E Rodríguez","doi":"10.1370/afm.3082","DOIUrl":"10.1370/afm.3082","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522154","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}
引用次数: 0
Enhancing Patient-Centered Care Through Firsthand Experience With Continuous Glucose Monitoring in Rural Wyoming. 通过在怀俄明州农村地区使用连续血糖监测仪的亲身体验,加强以患者为中心的护理。
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3055
Drew Mahoney, Lavinia Salama
{"title":"Enhancing Patient-Centered Care Through Firsthand Experience With Continuous Glucose Monitoring in Rural Wyoming.","authors":"Drew Mahoney, Lavinia Salama","doi":"10.1370/afm.3055","DOIUrl":"10.1370/afm.3055","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522195","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}
引用次数: 0
The Color of Medicine. 医学的色彩
IF 4.4 2区 医学
Annals of Family Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3054
John E Ukadike
{"title":"The Color of Medicine.","authors":"John E Ukadike","doi":"10.1370/afm.3054","DOIUrl":"10.1370/afm.3054","url":null,"abstract":"<p><p>During my family medicine residency training, I was the junior doctor on the wards team when we encountered a young Black man who was hesitant to begin a new medication. I was also the only Black person on the team. After some initial trepidation about speaking up, I discussed my experiences with the patient and his mother and helped them see that the medication was not something to be feared. Later I faced criticism from a senior team member for bringing up the topic of race. Race is in fact an important consideration when treating patients. Understanding patients' lived experiences, especially when it comes to race, is essential in providing equitable health care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522306","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}
引用次数: 0
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