Annals of Family Medicine最新文献

{"title":"Impact of Financial Incentives and Department Size on Scholarly Activity Output.","authors":"Dominique D Munroe, Jose Villalon-Gomez, Dean A Seehusen, Miranda A Moore","doi":"10.1370/afm.240061","DOIUrl":"10.1370/afm.240061","url":null,"abstract":"<p><strong>Purpose: </strong>Family medicine research is essential to improving population health. It has the unique ability to answer questions about health care outcomes and use those insights to impact communities. Increasing research capacity continues to be a challenge; however, recent literature has touted the success of incentivization in several academic medicine specialties. We used the 2022 CERA annual Family Medicine Department Chair survey to characterize the amount and type of scholarly activities by institutional financial incentive status (yes or no) and type (flat vs variable amount), to investigate the relationship between financial incentives and scholarly output.</p><p><strong>Methods: </strong>Questions included targeted demographic variables, institutional incentives, and family medicine department scholarly output. Summary statistics and logistical regression analyses were conducted.</p><p><strong>Results: </strong>The overall survey response rate was 47.1% (106/225). Respondents reported financial incentives were allowed at 41 (38.7%) of 106 institutions. Of these, 19 (17.9%) reported clinical faculty received cash-based incentives, while 34 (32.1%) received noncash-based incentives for engaging in scholarly activity. The main barriers to offering financial incentives were institutional budget constraints and department culture or tradition. Financial incentives were not statistically associated with scholarly output; however, faculty size was statistically significant for giving more than 6 presentations (adjusted odds ratio = 0.20; 95% CI, 0.054-0.739).</p><p><strong>Conclusions: </strong>Institutions aiming to increase their family medicine department scholarly productivity might benefit from focusing resources on increasing their faculty size such as adding consultants, statistical analysts, grant writers, or other research staff.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"66-72"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054080","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 Will Always be an Agent of Truth.","authors":"Jen Brull","doi":"10.1370/afm.240600","DOIUrl":"10.1370/afm.240600","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"88"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054135","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":"Interviews to Assess a Peer Health Navigator Service for People Who Are Transgender or Gender Diverse.","authors":"Emily Gulka, Gwen Rose, Michelle C McCarron, Mel Reid, Megan Clark, Stéphanie J Madill","doi":"10.1370/afm.3191","DOIUrl":"10.1370/afm.3191","url":null,"abstract":"<p><strong>Purpose: </strong>People who are transgender or gender diverse (PTGD) often experience difficulties navigating the health care system due to a variety of factors such as lack of knowledgeable and/or culturally competent clinicians, discrimination, and structural and/or socioeconomic barriers. We sought to determine whether a peer health navigator service in the Canadian province of Saskatchewan helped connect transgender and gender-diverse clients and health care practitioners (HCPs) to resources, and how this service changed their health care experiences.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 9 clients and 9 HCPs. Interview transcripts were then analyzed by researchers using an interpretative phenomenological approach, with qualitative data analysis software.</p><p><strong>Results: </strong>The most prevalent theme that emerged from interview data, from both clients and HCPs, was support for the navigators' work and a desire that the service should continue. It was reinforced by 3 subthemes: the importance that the navigators were PTGD, the ability of the navigators to connect people to services and reliable sources of information, and their skill in directly supporting clients. A fourth subtheme, primarily found among clients, was the navigators' ability to provide connections to affirming mental health care.</p><p><strong>Conclusions: </strong>Clients and HCPs alike emphasized that the navigator's lived experience was invaluable and allowed them to empathize with PTGD and provide support. Furthermore, the navigators acted as a direct connection to health care services, which helped improve access for clients. Our findings underscore the need for navigator positions to become permanent within the provincial health system to improve the health care experiences of PTGD in Saskatchewan.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"16-23"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054159","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":"Not Like They Used To: The Decline of Procedural Competency in Medical Training.","authors":"Eleanor R Menzin","doi":"10.1370/afm.240309","DOIUrl":"10.1370/afm.240309","url":null,"abstract":"<p><p>As a primary care pediatrician trained before work hour restrictions were enacted, I spent hours mastering procedures that trainees today rarely perform. The changing landscape of health care clinician roles, technology, and work hour restrictions have all contributed to a remarkable decline in trainees' procedural competence which has significant negative effects for patients, health care systems, and physicians themselves. I suggest simulation, live training, mentoring, and scheduled opportunities as ways to reemphasize the importance of learning these technical skills.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"81-82"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054161","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":"Returning to Our Values: How to Continue DEIA Efforts in an Ever-Changing Landscape.","authors":"Montgomery Douglas, Steven Zweig, Sam Elwood, Brian Park, Christina Kelly, Cleveland Piggott, Jehni Robinson","doi":"10.1370/afm.240596","DOIUrl":"10.1370/afm.240596","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"85-86"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054169","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":"Primary Care Physicians' Responses to Treatment Burden in People With Type 2 Diabetes: A Qualitative Video Analysis in China.","authors":"Kai Lin, Mi Yao, Lesley Andrew, Runqi Lin, Rouyan Li, Yilin Chen, Xinxin Ji, Jacques Oosthuizen, Moira Sim, Yongsong Chen","doi":"10.1370/afm.240171","DOIUrl":"10.1370/afm.240171","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to examine the approaches general practitioners (GPs) use to respond to the treatment burden faced by people with type 2 diabetes.</p><p><strong>Methods: </strong>We retrospectively analyzed 29 videos of GP-patient consultations in an academic general practice clinic in China. Thematic analysis and a framework matrix approach were used to identify patterns in GPs' responses to the identified issues.</p><p><strong>Results: </strong>The median length of the 29 video-recorded consultations was 23 minutes 54 seconds. We identified 77 segments focusing on discussions about treatment burden. In 37.7% of these segments, the GP elicited and responded to discussions about treatment burden, whereas in 23.4%, the patient initiated the discussion and the GP responded to it, leaving 39.0% in which the patient initiated the discussion but the GP did not respond. In thematic analysis, medication was the component of treatment burden most frequently identified by both patients and GPs, followed by personal resources, medical information, and administrative burden. General practitioners used 12 response approaches to address patients' treatment burden. The most frequently used included active listening and nonverbal skills, shared decision making, and confidence and self-efficacy support, which were broadly applied across various issues. In contrast, GPs typically reserved health record management, motivational interviewing, and awareness of the patient's background for specific issues.</p><p><strong>Conclusions: </strong>In clinical encounters, GPs used a wide variety of approaches to respond to different aspects of the treatment burden of type 2 diabetes. Our findings emphasize the need to improve GPs' response strategies through increased responsiveness and more rapid surfacing of issues during visits.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"52-59"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980606","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":"2024 AFMRD Salary Survey Results and Trends.","authors":"Sarah Cole, Kelsie Kelly","doi":"10.1370/afm.240601","DOIUrl":"10.1370/afm.240601","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"86-88"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054131","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 AI Moonshot: What We Need and What We Do Not.","authors":"José E Rodríguez, Yves Lussier","doi":"10.1370/afm.240602","DOIUrl":"10.1370/afm.240602","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"7-8"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980607","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":"Intervention Stage Completion and Behavioral Health Outcomes: An Integrated Behavioral Health and Primary Care Randomized Pragmatic Trial.","authors":"Kari A Stephens, Constance van Eeghen, Zihan Zheng, Tracy Anastas, Kris Pui Kwan Ma, Maria G Prado, Jessica Clifton, Gail Rose, Daniel Mullin, Kwun C G Chan, Rodger Kessler","doi":"10.1370/afm.230576","DOIUrl":"10.1370/afm.230576","url":null,"abstract":"<p><strong>Purpose: </strong>We performed a pragmatic, cluster randomized controlled trial of a comprehensive practice-level, multistage practice transformation intervention aiming to increase behavioral health integration in primary care practices and improve patient outcomes. We examined associations between completion of intervention stages and patient outcomes across a heterogeneous national sample of primary care practices.</p><p><strong>Methods: </strong>Forty-two primary care practices across the United States with colocated behavioral health and 2,945 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint, and 2-year follow-up. We examined effects of intervention on patient health and primary care integration outcomes using multilevel mixed-effects models, controlling for baseline outcome measurements.</p><p><strong>Results: </strong>No differences were found associated with the number of intervention stages completed and patient health outcomes including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social participation, and physical function. However, the completion of each intervention stage was associated with increases in Practice Integration Profile domain scores and confirmed with modeling using multiple imputation for the following: workflow 3.5 (95% CI, 0.9 to 6.1), integration methods 4.6 (95% CI, 1.5 to 7.6), patient identification 2.9 (95% CI, 0.9 to 5.0), and total integration 2.7 (95% CI, 0.7 to 4.7).</p><p><strong>Conclusion: </strong>A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogeneous primary care practices treating patients with multiple chronic conditions when accounting for completion of intervention stages. Interventions that allow practices to flexibly improve care have the potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at the population level.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"35-43"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054121","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 Qualitative Study of Primary Care Physicians' Approaches to Caring for Adult Adopted Patients.","authors":"Jade H Wexler, Elizabeth Toll, Roberta E Goldman","doi":"10.1370/afm.240146","DOIUrl":"10.1370/afm.240146","url":null,"abstract":"<p><strong>Purpose: </strong>Adoption has lifelong health implications for 7.8 million adopted people and their families in the United States. The majority of adoptees have limited family medical history (LFMH). Primary care physicians (PCPs) rarely receive training about adoptees including their mental health needs and increased suicide risk. The growing availability and popularity of direct-to-consumer genetic testing kits amplifies the need for PCPs to be prepared to address genetic testing for adoptees with LFMH. This study explores PCP training and approaches to adult adopted patients with LFMH.</p><p><strong>Methods: </strong>We used critical adoption studies as a theoretical framework for this study to understand how adoptive identity might shape clinical experiences. We recruited PCPs from Minnesota and Rhode Island via purposive, criteria-based, reputational sampling. We conducted hour-long semistructured qualitative interviews incorporating hypothetical clinical vignettes. Transcripts were coded via template organizing method and analyzed via Immersion-Crystallization.</p><p><strong>Results: </strong>We interviewed 23 PCPs. They reported receiving little training or resources on adult adoptees with LFMH and showed substantial knowledge gaps regarding mental health and genetic testing for this population. Many failed to adjust history-taking and primary care approaches, which they recognized as potentially resulting in inaccuracies, inappropriate clinical care, and microaggressions while inadvertently triggering anxiety, shame, and distrust among patients. A mismatch between adopted patients' and physicians' understandings of family medical history could strain the therapeutic relationship. Nearly all interviewees viewed additional training to care for adult adoptees with LFMH as beneficial.</p><p><strong>Conclusion: </strong>Future research should expand education and training for PCPs on adult adoptees with LFMH.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"24-34"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054134","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}