Annals of Family Medicine最新文献

{"title":"Clinically Important Benefits and Harms of Monoclonal Antibodies Targeting Amyloid for the Treatment of Alzheimer Disease: A Systematic Review and Meta-Analysis.","authors":"Mark H Ebell, Henry C Barry, Kanishka Baduni, Gabrielle Grasso","doi":"10.1370/afm.3050","DOIUrl":"10.1370/afm.3050","url":null,"abstract":"<p><strong>Purpose: </strong>We conducted a meta-analysis to evaluate clinically meaningful benefits and harms of monoclonal antibodies targeting amyloid in patients with Alzheimer dementia.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane CENTRAL, and 5 trial registries, as well as the reference lists of identified studies. We included randomized controlled trials comparing a monoclonal antibody with placebo at a dose consistent with that used in phase 3 trials or for Food and Drug Administration approval. Studies had to report at least 1 clinically relevant benefit or harm. Data were extracted independently by at least 2 researchers for random effects meta-analysis. Changes in cognitive and functional scales were compared between groups, and each difference was assessed to determine if it met the minimal clinically important difference (MCID).</p><p><strong>Results: </strong>We identified 19 publications with 23,202 total participants that evaluated 8 anti-amyloid antibodies. There were small improvements over placebo in the Alzheimer's Disease Assessment Scale (ADAS)-Cog-11 to -14 score (standardized mean difference = -0.07; 95% CI, -0.10 to -0.04), Mini Mental State Examination score (0.32 points; 95% CI, 0.13 to 0.50), and Clinical Dementia Rating-Sum of Boxes scale score (mean difference =-0.18 points; 95% CI, -0.34 to -0.03), and the combined functional scores (standardized mean difference = 0.09; 95% CI, 0.05 to 0.13). None of the changes, including those for lecanemab, aducanumab, and donanemab, exceeded the MCID. Harms included significantly increased risks of amyloid-related imaging abnormalities (ARIA)-edema (relative risk [RR] = 10.29; number needed to harm [NNH] = 9), ARIA-hemorrhage (RR = 1.74; NNH = 13), and symptomatic ARIA-edema (RR = 24.3; NNH = 86).</p><p><strong>Conclusions: </strong>Although monoclonal antibodies targeting amyloid provide small benefits on cognitive and functional scales in patients with Alzheimer dementia, these improvements are far below the MCID for each outcome and are accompanied by clinically meaningful harms.</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/PMC11233076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522183","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":"More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care Physicians, 2019-2023.","authors":"Brian G Arndt, Mark A Micek, Adam Rule, Christina M Shafer, Jeffrey J Baltus, Christine A Sinsky","doi":"10.1370/afm.3047","DOIUrl":"10.1370/afm.3047","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to evaluate recent trends in primary care physician (PCP) electronic health record (EHR) workload.</p><p><strong>Methods: </strong>This longitudinal study observed the EHR use of 141 academic PCPs over 4 years (May 2019 to March 2023). Ambulatory full-time equivalency (aFTE), visit volume, and panel size were evaluated. Electronic health record time and inbox message volume were measured per 8 hours of scheduled clinic appointments.</p><p><strong>Results: </strong>From the pre-COVID-19 pandemic year (May 2019 to February 2020) to the most recent study year (April 2022 to March 2023), the average time PCPs spent in the EHR per 8 hours of scheduled clinic appointments increased (+28.4 minutes, 7.8%), as did time in orders (+23.1 minutes, 58.9%), inbox (+14.0 minutes, 24.4%), chart review (+7.2 minutes, 13.0%), notes (+2.9 minutes, 2.3%), outside scheduled hours on days with scheduled appointments (+6.4 minutes, 8.2%), and on unscheduled days (+13.6 minutes, 19.9%). Primary care physicians received more patient medical advice requests (+5.4 messages, 55.5%) and prescription messages (+2.3, 19.5%) per 8 hours of scheduled clinic appointments, but fewer patient calls (-2.8, -10.5%) and results messages (-0.3, -2.7%). While total time in the EHR continued to increase in the final study year (+7.7 minutes, 2.0%), inbox time decreased slightly from the year prior (-2.2 minutes, -3.0%). Primary care physicians' average aFTE decreased 5.2% from 0.66 to 0.63 over 4 years.</p><p><strong>Conclusions: </strong>Primary care physicians' time in the EHR continues to grow. While PCPs' inbox time may be stabilizing, it is still substantially higher than pre-pandemic levels. It is imperative health systems develop strategies to change the EHR workload trajectory to minimize PCPs' occupational stress and mitigate unnecessary reductions in effective physician workforce resulting from the increased EHR burden.</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/PMC11233089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522212","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":"A Mixed Methods Evaluation of a Quality Improvement Model to Optimize Perinatal and Primary Care in the Community Health Setting.","authors":"Jena Wallander Gemkow, Ashlee Van Schyndel, Renee M Odom, Ananya Stoller, Lisa Masinter, Ta-Yun Yang, Patricia A Lee King, Abigail C Holicky, Arden Handler","doi":"10.1370/afm.3059","DOIUrl":"10.1370/afm.3059","url":null,"abstract":"<p><strong>Purpose: </strong>Many maternal deaths occur beyond the acute birth encounter. There are opportunities for improving maternal health outcomes through facilitated quality improvement efforts in community settings, particularly in the postpartum period. We used a mixed methods approach to evaluate a collaborative quality improvement (QI) model in 6 Chicago Federally Qualified Health Centers (FQHCs) that implemented workflows optimizing care continuity in the extended postpartum period for high-risk prenatal patients.</p><p><strong>Methods: </strong>The Quality Improvement Learning Collaborative focused on the implementation of a registry of high-risk prenatal patients to link them to primary care and was implemented in 2021; study data were collected in 2021-2022. We conducted a quantitative evaluation of FQHC-reported aggregate structure, process, and outcomes data at baseline (2020) and monthly (2021). Qualitative analysis of semistructured interviews of participating FQHC staff focused on the experience of participating in the collaborative.</p><p><strong>Results: </strong>At baseline, none of the 6 participating FQHCs had integrated workflows connecting high-risk prenatal patients to primary care; by the end of implementation of the QI intervention, such workflows had been implemented at 19 sites across all 6 FQHCs, and 54 staff were trained in using these workflows. The share of high-risk patients transitioned to primary care within 6 months of delivery significantly increased from 25% at baseline to 72% by the end of implementation. Qualitative analysis of interviews with 11 key informants revealed buy-in, intervention flexibility, and collaboration as facilitators of successful engagement, and staffing and data infrastructure as participation barriers.</p><p><strong>Conclusions: </strong>Our findings show that a flexible and collaborative QI approach in the FQHC setting can help optimize care delivery. Future evaluations should incorporate the patient experience and patient-level data for comprehensive analysis.</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/PMC11233081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522150","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 the Reporting of Primary Care Research: Consensus Reporting Items for Studies in Primary Care-the CRISP Statement.","authors":"William R Phillips, Elizabeth Sturgiss, Paul Glasziou, Tim C Olde Hartman, Aaron M Orkin, Pallavi Prathivadi, Joanne Reeve, Grant M Russell, Chris van Weel","doi":"10.1370/afm.3029","DOIUrl":"10.1370/afm.3029","url":null,"abstract":"<p><p>Primary care (PC) is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges for reporting, and despite the proliferation of reporting guidelines, none focuses specifically on the needs of PC. The Consensus Reporting Items for Studies in Primary Care (CRISP) Checklist guides reporting of PC research to include the information needed by the diverse PC community, including practitioners, patients, and communities. CRISP complements current guidelines to enhance the reporting, dissemination, and application of PC research findings and results. Prior CRISP studies documented opportunities to improve research reporting in this field. Our surveys of the international, interdisciplinary, and interprofessional PC community identified essential items to include in PC research reports. A 2-round Delphi study identified a consensus list of items considered necessary. The CRISP Checklist contains 24 items that describe the research team, patients, study participants, health conditions, clinical encounters, care teams, interventions, study measures, settings of care, and implementation of findings/results in PC. Not every item applies to every study design or topic. The CRISP guidelines inform the design and reporting of (1) studies done by PC researchers, (2) studies done by other investigators in PC populations and settings, and (3) studies intended for application in PC practice. Improved reporting of the context of the clinical services and the process of research is critical to interpreting study findings/results and applying them to diverse populations and varied settings in PC.<i>Annals \"Online First\"</i> article.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165955","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":"A Milestone for Promoting Research in Family Medicine.","authors":"Warren Newton, Irfan M Asif, Amanda Weidner","doi":"10.1370/afm.3067","DOIUrl":"10.1370/afm.3067","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446962","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":"New Resource Library Offers Tools, Techniques to Reduce Administrative Burden.","authors":"Cindy Borgmeyer","doi":"10.1370/afm.3060","DOIUrl":"10.1370/afm.3060","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446901","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":"A Randomized Trial of a Practice-Level Intervention for Integrated Primary and Behavioral Health Care.","authors":"Andrew S Detty, Michael E Johansen","doi":"10.1370/afm.3065","DOIUrl":"10.1370/afm.3065","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446963","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 Erectile Dysfunction Management Among Asian Men With Diabetes Using the Knowledge Translation Intervention.","authors":"Mohd Redhuan Abdul Muin, Saharuddin Ahmad, Mohd Hafidzul Jasman, Aznida Firzah Abdul Aziz, Mohd Fairuz Ali, Zulkifli Md Zainuddin","doi":"10.1370/afm.3030","DOIUrl":"10.1370/afm.3030","url":null,"abstract":"<p><strong>Purpose: </strong>Erectile dysfunction (ED) is frequently undermanaged due to communication barriers, particularly among Asian men. We looked at how ED discussion and treatment were affected by the patient's prompt sheet and the Knowledge Translation Tools in the Management of Erectile Dysfunction (LASTED).</p><p><strong>Methods: </strong>We conducted a quasi-experimental study in a primary care clinic in Kedah, Malaysia involving 120 Asian men with diabetes. In the intervention group, patients were given a prompt sheet to indicate their intention to discuss or receive ED treatment, and physicians were provided with LASTED to assist with ED consultation. The control group patients received standard care from their physicians.</p><p><strong>Results: </strong>The intervention increased the initiation of ED discussion up to 66.7% compared with 8.3% in the control group. In the intervention group, 57.5% of patients were prescribed phosphodiesterase-5 inhibitors and men with ED of moderate severity were more likely to be prescribed oral ED medication. Use of the LASTED flipchart was associated with prescription of phosphodiesterase-5 inhibitors (<i>P</i> = .011) and patient satisfaction with ED consultation (<i>P</i> <.001).</p><p><strong>Conclusion: </strong>Our study suggests that using the LASTED flipchart and patient's prompt sheet together may encourage ED conversation and medication prescription particularly when working with Asian men who frequently view ED as a taboo subject.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446899","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":"A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions.","authors":"Benjamin Littenberg, Jessica Clifton, Abigail M Crocker, Laura-Mae Baldwin, Levi N Bonnell, Ryan E Breshears, Peter Callas, Prama Chakravarti, Kelly Clark/Keefe, Deborah J Cohen, Frank V deGruy, Lauren Eidt-Pearson, William Elder, Chester Fox, Sylvie Frisbie, Katie Hekman, Juvena Hitt, Jennifer Jewiss, David C Kaelber, Kairn Stetler Kelley, Rodger Kessler, Jennifer B O'Rourke-Lavoie, George S Leibowitz, C R Macchi, Matthew P Martin, Mark McGovern, Brenda Mollis, Daniel Mullin, Zsolt Nagykaldi, Lisa W Natkin, Wilson Pace, Richard G Pinckney, Douglas Pomeroy, Paula Reynolds, Gail L Rose, Sarah Hudson Scholle, William J Sieber, Jeni Soucie, Terry Stancin, Kurt C Stange, Kari A Stephens, Kathryn Teng, Elizabeth Needham Waddell, Constance van Eeghen","doi":"10.1370/afm.3027","DOIUrl":"10.1370/afm.3027","url":null,"abstract":"<p><strong>Purpose: </strong>Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities.</p><p><strong>Methods: </strong>We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration.</p><p><strong>Results: </strong>Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (<i>P</i> ≤ .05) compared with other active practices (n = 7).</p><p><strong>Conclusion: </strong>Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446961","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":"Implications of Overturning Roe v Wade on Abortion Training in US Family Medicine Residency Programs.","authors":"Sarah Wulf, Kavita Vinekar, Christine Dehlendorf, Silpa Srinivasulu, Jody Steinauer, Diana N Carvajal","doi":"10.1370/afm.3042","DOIUrl":"10.1370/afm.3042","url":null,"abstract":"<p><p>In June 2022, the US Supreme Court overturned <i>Roe v Wade</i>, opening the door to state-level abortion bans. By August 2023, 17 states banned abortion or instituted early gestational age bans. We performed an analysis to assess the proportion of accredited US family medicine residency programs and trainees in states with abortion restrictions. Twenty-nine percent of family medicine residency programs (n = 201) and residents (n = 3,930) are in states with bans or very restrictive policies. Family medicine residency programs must optimize training and exposure to abortion within their contexts, so graduates are able to care for patients seeking abortions or needing follow-up care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446898","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}