Annals of Family Medicine最新文献

{"title":"Nirmatrelvir/Ritonavir Regimen for Mild/Moderately Severe COVID-19: A Rapid Review With Meta-Analysis and Trial Sequential Analysis.","authors":"George N Okoli, Nicole Askin, Rasheda Rabbani","doi":"10.1370/afm.3120","DOIUrl":"10.1370/afm.3120","url":null,"abstract":"<p><strong>Background: </strong>The efficacy, effectiveness, and safety of the approved nirmatrelvir/ritonavir regimen for treatment of laboratory-confirmed mild/moderately severe COVID-19 remains unclear.</p><p><strong>Methods: </strong>We systematically identified randomized controlled trials (RCTs) and real-world studies (RWS; observational studies) of the efficacy/effectiveness and/or safety of the approved nirmatrelvir/ritonavir regimen for COVID-19. We pooled appropriate data (adjusted estimates for RWS) using an inverse variance, random-effects model. We calculated statistical heterogeneity using the <i>I</i> ² statistic. Results are presented as relative risk (RR) with associated 95% CI. We further assessed risk of bias/study quality and conducted trial sequential analysis of the evidence from RCTs.</p><p><strong>Results: </strong>We included 4 RCTs (4,070 persons) and 16 RWS (1,925,047 persons) of adults (aged ≥18 years). One and 3 RCTs were of low and unclear risk of bias, respectively. The RWS were of good quality. Nirmatrelvir/ritonavir significantly decreased COVID-19 hospitalization compared with placebo/no treatment (RR = 0.17; 95% CI, 0.10-0.31; <i>I</i> ² = 77.2%; 2 RCTs, 3,542 persons), but there was no significant difference for decrease of worsening severity (RR = 0.82; 95% CI, 0.66-1.01; <i>I</i> ² = 47.5%; 3 RCTs, 1,824 persons), viral clearance (RR = 1.19; 95% CI, 0.93-1.51; <i>I</i> ² = 82%; 2 RCTs, 528 persons), adverse events (RR = 1.41; 95% CI, 0.92-2.14; <i>I</i> ² = 70.6%; 4 RCTs, 4,070 persons), serious adverse events (RR = 0.82; 95% CI, 0.41-1.62; <i>I</i> ² = 0%; 3 RCTs, 3,806 persons), and all-cause mortality (RR = 0.27; 95% CI, 0.04-1.70; <i>I</i> ² = 49.9%; 3 RCTs, 3,806 persons), although trial sequential analysis suggested that the current total sample sizes for these outcomes were not large enough for conclusions to be drawn. Real-world studies also showed significantly decreased COVID-19 hospitalization (RR = 0.48; 95% CI, 0.37-0.60; <i>I</i> ² = 95.0%; 11 RWS, 1,421,398 persons) and all-cause mortality (RR = 0.24; 95% CI, 0.14-0.34; <i>I</i> ² = 65%; 7 RWS, 286,131 persons) for nirmatrelvir/ritonavir compared with no treatment.</p><p><strong>Conclusions: </strong>Nirmatrelvir/ritonavir appears to be promising for preventing hospitalization and potentially decreasing all-cause mortality for persons with mild/moderately severe COVID-19, but the evidence is weak. More studies are needed.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 4","pages":"336-346"},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749622","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":"Practice Transformation in the Transforming Clinical Practice Initiative and Emergency Department Use.","authors":"Lori Timmins, Suzanne Felt-Lisk, Wenjia Zhu, Angela Merrill, Jelena Zurovac, Shawan Johnson, Damian Everhart, Robert Flemming","doi":"10.1370/afm.3119","DOIUrl":"10.1370/afm.3119","url":null,"abstract":"<p><p>To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment. Transformation in 5 of 8 domains contributed to reduced ED visits.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 4","pages":"325-328"},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749624","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":"Is Prediabetes Overdiagnosed? No: A Clinician's Perspective.","authors":"Jonathan G Gabison","doi":"10.1370/afm.3101","DOIUrl":"10.1370/afm.3101","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"251-253"},"PeriodicalIF":4.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029513","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 Role of Primary Care in the Social Isolation and Loneliness Epidemic.","authors":"Rebecca A Mullen, Sebastian T Tong, Hillary D Lum, Kari A Stephens, Alex H Krist","doi":"10.1370/afm.3102","DOIUrl":"10.1370/afm.3102","url":null,"abstract":"<p><p>The United States is facing a social isolation and loneliness crisis. In response, the US Surgeon General issued an advisory in May 2023 recommending actions that health care, community programs, and social services can take to collaboratively improve social connection. Primary care has a critical role to play in implementing the Surgeon General's recommendations. We present social isolation and loneliness as medical issues and highlight next steps for the primary care sector to combat this epidemic.<i>Annals</i> Early Access article.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"244-246"},"PeriodicalIF":4.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013649","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":"Is Prediabetes Overdiagnosed? Yes: A Patient-Epidemiologist's Experience.","authors":"Rani Marx","doi":"10.1370/afm.3093","DOIUrl":"10.1370/afm.3093","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"247-250"},"PeriodicalIF":4.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029514","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":"Integrating Servant Leadership into the Fabric of NAPCRG.","authors":"Vivian R Ramsden, Tom Vansaghi","doi":"10.1370/afm.3124","DOIUrl":"10.1370/afm.3124","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"262-263"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162369","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":"Utilizing Medical Assistants to Manage Patient Portal Messages.","authors":"Jennifer N Lee, Laura Kurash, Max Yang, Joseph Teel","doi":"10.1370/afm.3105","DOIUrl":"10.1370/afm.3105","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"261"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162587","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 Wall of Evidence for Continuity of Care: How Many More Bricks Do We Need?","authors":"Otto R Maarsingh","doi":"10.1370/afm.3116","DOIUrl":"10.1370/afm.3116","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"184-186"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162556","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 Stratified Approach for Managing Patients With Low Back Pain in Primary Care (SPLIT Program): A Before-and-After Study.","authors":"Luís Antunes Gomes, Rita Fernandes, Carmen Caeiro, Ana Rita Henriques, Rute Dinis de Sousa, Jaime C Branco, Fernando Pimentel-Santos, Rubina Moniz, Lilia Vicente, Helena Canhão, Ana Maria Rodrigues, Eduardo Brazete Cruz","doi":"10.1370/afm.3104","DOIUrl":"10.1370/afm.3104","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care.</p><p><strong>Methods: </strong>We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points).</p><p><strong>Results: </strong>We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability (ß, -2.94; 95% CI, -3.63 to -2.24; <i>P</i> ≤ .001), pain (ß, -0.88; 95% CI, -1.18 to -0.57; <i>P</i> ≤ .001), perceived effect of treatment (ß, 1.40; 95% CI, 0.97 to 1.82; <i>P</i> ≤ .001), and health-related quality of life (ß, 0.11; 95% CI, 0.08 to 0.14; <i>P</i> ≤ .001) compared with UC.</p><p><strong>Conclusions: </strong>Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"195-202"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162095","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 Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada.","authors":"Terrence McDonald, Paul E Ronksley, Lisa L Cook, Alka B Patel, Seidel Judy, Brendan Cord Lethebe, Lee A Green","doi":"10.1370/afm.3107","DOIUrl":"10.1370/afm.3107","url":null,"abstract":"<p><strong>Purpose: </strong>Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians.</p><p><strong>Methods: </strong>We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations.</p><p><strong>Results: </strong>High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use.</p><p><strong>Conclusions: </strong>The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"223-229"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162472","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}