Annals of Family Medicine最新文献

{"title":"Continuity of Primary Care in Community Health Centers.","authors":"Rose Goueth, Claudia Der-Martirosian, Nicole Cook, Matthew W H Jones, Stephen J Zyzanski, Suparna M Navale, Rae Crist, Anna R Templeton, Yui Nishiike, Kurt C Stange","doi":"10.1370/afm.250413","DOIUrl":"10.1370/afm.250413","url":null,"abstract":"<p><strong>Purpose: </strong>We conducted a cross-sectional cohort study to assess how continuity of primary care within community-based health centers (CHCs) might have changed during the years surrounding the COVID-19 pandemic and how continuity varied by patient and visit characteristics.</p><p><strong>Methods: </strong>In a national sample of CHCs providing primary care, we assessed the usual provider of care (UPC) index-the fraction of patient visits to the patient's most frequently seen clinician within the CHC-for patients with at least 2 primary care encounters within a calendar year during 2019-2023. We used age-stratified multilevel logit analyses to assess patient, clinic, and visit characteristics associated with the perfect UPC index of 1 in 2023.</p><p><strong>Results: </strong>Among an annual average of 353,608 patients seen in an average of 186 CHCs, the median UPC index was 1 in each year, with the mean index varying from a low of 0.822 in 2020 to a high of 0.831 in 2021. In the 2023 sample, logit analyses adjusted for clustering of patients within clinics found that among adults, the likelihood of achieving a UPC index of 1 was higher for patients who were middle-aged or older and had an income greater than 138% of the federal poverty level or an unknown income, whereas it was lower for patients who were of Hispanic ethnicity, were of Black/African American race, had multimorbidity, had a telehealth visit, and received care at large clinics. Among children, the likelihood of achieving a UPC of 1 was lower for those who were of Hispanic ethnicity, had a telehealth visit, and received care at large clinics.</p><p><strong>Conclusions: </strong>In a large national sample of patients seen at CHCs, continuity of primary care within CHCs remained high before, during, and after the COVID-19 pandemic, and was associated with practice and patient characteristics that provide targets for systemic intervention. Although health care systems explore different approaches to balance continuity with easy access, CHCs continue to value and deliver high-continuity care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"124-130"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516468","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":"Charlson Comorbidity Health Analytics (CCHA) and Needs-Based Segmentation (NBS): A Strategy for Managing Primary Care Panel Complexity.","authors":"Bobbie Johannes, Cybele Pacheco, Sierra Hawthorne, Maria Kobylinski, Greg Strevig, Teena Kubasti, Mary Charlson","doi":"10.1370/afm.250420","DOIUrl":"10.1370/afm.250420","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"169"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516509","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":"Dad Days: The Joys and Challenges of Extended Partial Parental Leave.","authors":"Brandon H Hidaka","doi":"10.1370/afm.250195","DOIUrl":"10.1370/afm.250195","url":null,"abstract":"<p><p>With 2 careers and 2 children already, my wife and I were unsure how we would manage adding another child to the mix. After meticulous policy review and planning, I proposed a year of partial parental leave. With 2 \"dad days\" a week, I bonded with our third child more deeply than I had known possible. Our marriage strengthened and domestic duties continue with a more balanced distribution. Research finds that paid parental leave policies benefit children, women, institutions, and societies with economic return on investment. Supportive institutional parental leave policies should be fair and flexible to promote gender equity, intergenerational health, and retention of talent. Patient needs and research questions are boundless, but family expansion is a critical period that requires extra time and attention as a parent. I am grateful that my partial parental leave plan permitted me to be where I was needed most.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"159-161"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516538","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":"<i>Annals</i> Journal Club: EHR-Integrated Social Clinical Decision Support in Community-Based Primary Care.","authors":"Michael E Johansen, Kevin Gulley","doi":"10.1370/afm.260097","DOIUrl":"10.1370/afm.260097","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"178"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516270","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":"AAFP: AAFP Residency Initiative Leads Impactful Changes for 2027 Match.","authors":"David Mitchell","doi":"10.1370/afm.260099","DOIUrl":"10.1370/afm.260099","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"173-174"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516278","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":"Antithrombotic Therapy Discontinuation, Bleeding, and Thromboembolic Events in Patients With Cancer During the Last Phase of Life: Insights From Primary Care Records.","authors":"Denise Abbel, Geert-Jan Geersing, Emmy M Trinks-Roerdink, Sarah J Aldridge, Adrian Edwards, Eric C T Geijteman, Jamilla Goedegebuur, Jacobijn Gussekloo, Eva K Kempers, Frederikus A Klok, Marieke J H A Kruip, Isabelle Mahé, Simon P Mooijaart, Simon Noble, Anne G Ording, Johanneke E A Portielje, Sebastian Szmit, Mette Søgaard, Stella Trompet, Suzanne C Cannegieter, Carline J van den Dries","doi":"10.1370/afm.250461","DOIUrl":"10.1370/afm.250461","url":null,"abstract":"<p><strong>Purpose: </strong>It is unclear whether patients with cancer continue to benefit from antithrombotic therapy (ATT) during the last phase of life. We estimated the incidences of ATT discontinuation, bleeding, and venous thromboembolic (VTE) and arterial thromboembolic (ATE) events among patients with cancer during the last phase of life.</p><p><strong>Methods: </strong>We included patients aged ≥18 years with cancer during the period 2018 to 2022 at the time a reimbursement claim for general practitioner (GP) palliative care was made. We manually identified ATT discontinuation, along with reasons, and the incidences of bleeding events, VTE events, and ATE events in free-text reports of routine primary care consultations until death.</p><p><strong>Results: </strong>Among the 2,860 included patients, 32.5% used ATT at the index date. The median follow-up was 43 (interquartile range [IQR] 14-190) days for ATT users and 42 (IQR 13-149) days for nonusers. During follow-up, 22.1% of ATT users discontinued ATT, with a median of 8 (IQR 3-26) days before death. The most common reason for discontinuation was recognition of the terminal phase (22.9%). Bleeding occurred for 28.5% (95% CI, 25.7%-31.5%) of ATT users and 22.0% (95% CI, 20.2%-23.9%) of nonusers. Venous thromboembolic events occurred for 3.1% (95% CI, 2.2%-4.4%) of ATT users and 3.0% (95% CI, 2.3%-3.9%) of nonusers, and ATE events occurred for 2.5% (95% CI, 1.7%-3.7%) of ATT users and 1.9% (95% CI, 1.4%-2.6%) nonusers.</p><p><strong>Discussion: </strong>One-third of patients with cancer used ATT at the initiation of GP palliative care, with most continuing treatment until death or discontinuing shortly before death. Bleeding events largely outnumbered ATE and VTE events among both ATT users and non-users. These findings provide new insights into ATT management by GPs and inform future research on optimizing ATT use for patients with cancer during the last phase of life.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"104-110"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516373","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":"Leveraging the Role of Chaplaincy to Enhance Care for Patients With Opioid Use Disorder.","authors":"April D Newton, Dustin Hite, Seth Hunter, Maeg Sauers","doi":"10.1370/afm.250481","DOIUrl":"10.1370/afm.250481","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"170"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516491","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 Team-Based Approach to Fair and Patient-Centered Dismissals in Family Medicine.","authors":"Traci C Terrance, Elizabeth H Naumburg, Mechelle Sanders, Colleen T Fogarty","doi":"10.1370/afm.250626","DOIUrl":"10.1370/afm.250626","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"171"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516334","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":"Association Between Loneliness and Patient Experience in a Primary Health Care Setting.","authors":"Emily Hamovitch, Kaileah McKellar, Grace Spiro, Walter P Wodchis","doi":"10.1370/afm.250417","DOIUrl":"10.1370/afm.250417","url":null,"abstract":"<p><p>Loneliness is increasingly recognized as a public health concern with implications for health care experiences. This cross-sectional study surveyed 2,673 adult patients from a primary care practice in Ontario, Canada. Using the University of California-Los Angeles 3-item Loneliness Scale and 6 patient experience indicators, we examined associations between loneliness and patient experience via a Bayesian multivariate cumulative logit model. Lonely patients had significantly lower odds of reporting positive experiences across multiple domains. Findings suggest that loneliness may negatively influence how patients perceive care. Primary care clinicians are well positioned to identify loneliness and implement interventions that promote connection and improve patient experience.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"149-152"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516448","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":"Loneliness in Primary Care Patients-From Understanding the Risk to Actionable Clinical Priority.","authors":"Sebastian T Tong, Brennan Keiser","doi":"10.1370/afm.260053","DOIUrl":"10.1370/afm.260053","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"24 2","pages":"86-87"},"PeriodicalIF":5.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516504","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}