Annals of Family Medicine最新文献

{"title":"Vision, Voice, Leadership in Times of Change: A Mission-Driven Response Framework.","authors":"Jehni Robinson, Dean Seehusen, Colleen Fogarty, Samantha Elwood, Amanda Weidner","doi":"10.1370/afm.250511","DOIUrl":"10.1370/afm.250511","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"479-480"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126487","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":"Usual Source of Care Among Adults Aged 18-64 Years Post-ACA, 2010-2017.","authors":"Sara Shahbazi, John D Goodson","doi":"10.1370/afm.240620","DOIUrl":"10.1370/afm.240620","url":null,"abstract":"<p><p>This study assessed changes in self-reported usual source of care (USC) across income groups and rural-urban settings after Affordable Care Act implementation, using 2010-2017 Medical Expenditure Panel Survey data. Multivariable regression estimated adjusted percentage changes in USC and reasons for lacking one. Usual source of care prevalence rose modestly (67% to 68%), with significant gains among low-income adults (+4.96% rural, +2.45% urban) and a small decline among urban high-income adults. Affordability-related barriers decreased, while accessibility and individual preference barriers increased. Findings suggest that insurance expansion alone may not ensure continuous care, especially given persistent non-financial access challenges.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"457-459"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126521","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":"Lessons From a Grandfather's Care: A Journey Into Geriatric Medicine.","authors":"Meghana Rajashekara Swamy","doi":"10.1370/afm.240284","DOIUrl":"10.1370/afm.240284","url":null,"abstract":"<p><p>My passion for geriatric medicine was inspired by the compassionate care I witnessed in my grandfather's clinic in Vijayanagar, Bangalore, India. His integral, empathetic approach to treating older adults profoundly shaped my own practice as a physician. This reflection explores pivotal moments in my journey to becoming a geriatrician, from my encounters with my grandfather's patients to applying his methods of sincere listening. Through this lens, I examine the challenges and rewards of maintaining empathy within the constraints of modern health care, while emphasizing the importance of preserving human connection.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"472-473"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126372","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":"Automated Pre-Visit Test Ordering for the Complex Older Adult: From Chaos to Coordination.","authors":"Majken T Wingo, John C Matulis, Kyle A Tobin, Rajeev Chaudhry","doi":"10.1370/afm.240632","DOIUrl":"10.1370/afm.240632","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"477"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126418","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":"Patient-Oriented Quality Metrics Enhance Provider and Staff Engagement.","authors":"Stephen Brand, Christopher Heron, Matt Silvis, Tim Nye, Daniel Schlegel","doi":"10.1370/afm.250100","DOIUrl":"10.1370/afm.250100","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"478"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126553","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":"Measurement of Practice-Level Antibiotic Utilization in a Medicaid Patient-Centered Medical Home Program.","authors":"William Golden, Cheng Peng, E J Shoptaw, Jacob Painter, Ryan Dare, Jeremy Thomas, Holly Maples, Benjamin Teeter, Jill Johnson","doi":"10.1370/afm.240181","DOIUrl":"10.1370/afm.240181","url":null,"abstract":"<p><strong>Purpose: </strong>Outpatient antibiotic stewardship needs efficient strategies to remedy pervasive overuse. A claims-based measure of practice-specific antibiotic utilization in a Medicaid patient-centered medical home (PCMH) program was developed, implemented, and measured.</p><p><strong>Methods: </strong>This observational study analyzed outpatient antibiotic paid claims attributed to PCMH panels during 2019, 2020, and 2021. Practices received quarterly antibiotic prescribing rate report cards, as paid claims per 1,000 patients per year which included specific performance in comparison to other PCMHs. We identified high-, middle-, and low-utilization sites at baseline and then tracked prescribing during the observation period. Arkansas Medicaid data were compared with all-payer state and national data measured by the IQVIA and published annually by the Centers for Disease Control and Prevention.</p><p><strong>Results: </strong>In 2019, 176 of 216 PCMH sites met inclusion criteria. Cohort prescription rates were 1,089 in 2019, 785 in 2020, and 853 in 2021. Arkansas IQVIA all-payer rates for years 2019, 2020, and 2021 were 1,028, 844, and 927, while national IQVIA rates were lower at 765, 613, and 636, respectively. The Arkansas PCMH practice prescription rates in 2019 ranged from 720 to 1,491. By 2021, the range was 564 to 1,140. PCMH data showed reduced antibiotic prescribing in 2021 vs 2019 compared with national and state-specific IQVIA all-payer data analysis.</p><p><strong>Conclusions: </strong>Analysis of antibiotic prescriptions per 1,000 patients at the practice level is feasible. Regular report cards to PCMHs were associated with reduced prescribing rates in 2021 relative to IQVIA national and state data.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"407-411"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126424","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":"Reporting Guideline for Chatbot Health Advice Studies: Chatbot Assessment Reporting Tool (CHART) Statement.","authors":"","doi":"10.1370/afm.250386","DOIUrl":"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":"389-398"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459699/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Innovative Strategy for Collecting Family Health History: An Effectiveness-Implementation Trial in Primary Care Clinics.","authors":"June C Carroll, Michelle Greiver, Sahana Kukan, Erin Bearss, Sakina Walji, Rahim Moineddin, Babak Aliarzadeh, Sumeet Kalia, Judith Allanson, Eva Grunfeld, Karuna Gupta, Ruth Heisey, Doug Kavanagh, Raymond Kim, Michelle Levy, Shawna Morrison, Maria Muraca, Donatus Mutasingwa, Mary Ann O'Brien, Joanne Permaul, Frank Sullivan, Brenda Wilson","doi":"10.1370/afm.240472","DOIUrl":"10.1370/afm.240472","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate an innovative strategy to collect family history (FH) and explore patients' views of this strategy.</p><p><strong>Methods: </strong>We conducted a matched-pair effectiveness-implementation trial in family practices affiliated with the University of Toronto Practice-Based Research Network (UTOPIAN). The intervention group included family physicians (FPs) from randomly selected practices using electronic health records (EHRs) and an e-mailing platform, and randomly selected patients aged 30-69 years (4/FP/week) seen in clinic over a 6-month period. The matched control group included FPs (1:1) and patients (up to 5:1) from the UTOPIAN database. The intervention included patient and FP education, an e-mailed patient invitation to complete an FH questionnaire, automatic FH EHR upload, FP notification of completed FH questionnaire, and links to clinical support tools. Intervention patients were e-mailed a postvisit follow-up questionnaire. The assessed outcome was new documentation of FH in the EHR using mixed effects logistic regression and descriptive statistics for patient feedback.</p><p><strong>Results: </strong>Fifteen FPs and 576 patients were recruited from 3 multidisciplinary team practices to the intervention group, matched to 15 FPs and 2,203 patients in the control group. Within 30 days of visit, a new FH was documented in the EHR for 93/576 (16.1%) of intervention patients compared with 5/2,203 (0.2%) control patients (adjusted OR = 94.2; 95% CI, 36.8-240.8). New cancer FH documentation was greater in the intervention group compared with the control group (7.8% vs 0.1%; <i>P</i> < .01). Of patients who reported discussing FH (n = 296), 24.5% reported screening test recommended, 7.5% referral to a nongenetics specialist, and 2.4% referral to a genetics specialist. Most patients (60.5%) found this FH strategy helpful.</p><p><strong>Conclusions: </strong>This study showed improved collection/documentation of FH. Contributors to success of the intervention included being patient completed and seamless EHR integration with a reminder. This FH strategy needs tailoring to different contexts.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"399-406"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126396","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":"Artificial Intelligence in Graduate Medical Education.","authors":"","doi":"10.1370/afm.250512","DOIUrl":"10.1370/afm.250512","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"480-481"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126398","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 Care Access: A NAPCRG Report on the Practice-Based Research Network Conference.","authors":"Alex Singer, Natalie Gross, Leyla Haddad, Allison Cole","doi":"10.1370/afm.250513","DOIUrl":"10.1370/afm.250513","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 5","pages":"481"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126439","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}