Annals of Family Medicine最新文献

{"title":"Are Direct Primary Care Practices Located in Health Professional Shortage Areas?","authors":"Neal D Goldstein, Paul Yerkes","doi":"10.1370/afm.3168","DOIUrl":"10.1370/afm.3168","url":null,"abstract":"<p><p>Direct primary care (DPC) is a model of health care delivery that relies on membership fees for service; however, it has been criticized as potentially worsening the shortage of primary care physicians. We sought to compare the distribution of DPC practices in the United States to that of non-DPC primary care and assess the overlap with Health Resources and Services Administration designated health professional shortage areas (HPSAs). We mined data from publicly available sources on DPC practices, HPSAs, and other primary care physicians. We stratified analyses by degree of rurality and HPSA priority need scores. We found that DPC practices were less likely to be in HPSAs overall and less likely to be in a high-priority-need HPSA but more likely to be in a rural or partially rural HPSA compared to primary care physicians. There is ample opportunity to grow DPC presence in many HPSAs that remain underserved, especially high-priority HPSAs in urban areas.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"522-524"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717694","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":"Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners.","authors":"Juliette Pinot, Serge Gilberg, Cédric Laouénan, Toni Alfaiate, Marie Ecollan, Fanny Cussac, Raphaël Pecqueur, Marie-Pierre Revel, Cyrille Vartanian, Henri Partouche, Xavier Duval, Josselin Le Bel","doi":"10.1370/afm.3179","DOIUrl":"10.1370/afm.3179","url":null,"abstract":"<p><strong>Purpose: </strong>For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.</p><p><strong>Methods: </strong>We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.</p><p><strong>Results: </strong>A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (<i>P</i> < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.</p><p><strong>Conclusions: </strong>For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"509-517"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717759","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":"Enhancing First Trimester Obstetrical Care: The Addition of Point-of-Care Ultrasound.","authors":"Allison Newman, Mark Berg","doi":"10.1370/afm.3180","DOIUrl":"10.1370/afm.3180","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"569"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717733","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":"Exploring HIV Self-Testing: Barriers and Facilitators Among Undergraduate Students in Nairobi, Kenya.","authors":"Nicholas Kyalo Muendo, Joseph Thigiti, Osborn Tembu, Abdinoor Mohamed, Stephanie Audi, Muthoni Karanja","doi":"10.1370/afm.3169","DOIUrl":"10.1370/afm.3169","url":null,"abstract":"<p><strong>Purpose: </strong>Infection with HIV remains a global health challenge, with >36.9 million individuals living with HIV in 2017. Despite efforts to increase HIV testing and treatment, traditional services have not effectively reached marginalized communities. The use of HIV self-testing (HIVST) offers a discreet and accessible alternative, potentially improving testing rates among at-risk populations including university students in Kenya.</p><p><strong>Methods: </strong>We performed a cross-sectional analytical study using a multistage cluster sampling technique among undergraduate students at Kenyatta University. Clusters from various academic departments were randomly selected, and individual students were chosen for participation. Ethical approval was obtained from the Kenyatta University Ethics Review Committee and the National Commission for Science, Technology and Innovation. Participants were informed of the study's aims and their right to withdraw at any time. We collected data via questionnaires administered by trained enumerators.</p><p><strong>Results: </strong>Participants' age averaged 21.1 years, with a majority being single, female, and full-time students. Substantial HIV knowledge was observed, and nearly one-half were aware of preexposure prophylaxis. Facility-based testing was prevalent, with significant preference for the OraQuick self-test kit among those who self-tested. Fear of positive results and stigma were primary barriers, whereas motivations for self-testing included routine use and protecting loved ones. Media exposure, especially the \"Chukua Selfie\" campaign, correlated with greater HIVST usage.</p><p><strong>Conclusions: </strong>This study highlights the importance of school-based interventions and the critical role of academic institution support in HIV prevention. Participants' substantial knowledge of HIV contrasts with findings from other regions, underscoring the need for targeted education and safe-sex promotion. Addressing fear and stigma via comprehensive interventions is essential for improving HIVST uptake. Integrating HIVST into existing prevention programs can enhance HIV care frameworks in East Africa. Strategies to destigmatize HIV, ensure privacy in testing, and address misconceptions are vital for improving health outcomes among young individuals. Continuous efforts to strengthen self-testing programs are crucial to achieving global HIV targets.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"502-508"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717735","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":"Health-Related Social Needs Following Onset of the COVID-19 Pandemic in Oregon.","authors":"Jean Hiebert Larson, Anna L Steeves-Reece, Zoe Major-McDowall, Bruce Goldberg, Anne King","doi":"10.1370/afm.3167","DOIUrl":"10.1370/afm.3167","url":null,"abstract":"<p><strong>Purpose: </strong>Efforts during the COVID-19 pandemic to address the health-related social needs (HRSN) of Medicare and Medicaid beneficiaries, such as food and housing, were insufficient. We examined HRSN data from the Accountable Health Communities study collected in Oregon to understand changes in these needs at the onset and during the first 2 years of the pandemic.</p><p><strong>Methods: </strong>We conducted an interrupted time series analysis with data from 21,522 Medicare and Medicaid beneficiaries screened for overall HRSN between May 13, 2019 and December 24, 2021. Secondary interrupted time series analyses were conducted for each type of HRSN assessed with the Accountable Health Communities screening tool: food, housing, transportation, utilities, and interpersonal safety.</p><p><strong>Results: </strong>The interrupted time series analysis indicated an abrupt 17.7-percentage point increase in overall HRSN around March 23, 2020, which did not significantly decline during the subsequent 2 years. Food, housing, and interpersonal safety needs increased by 16.5, 15.9, and 4.4 percentage points, respectively, with no significant decline thereafter. Transportation and utility needs increased by 7.2 and 7.5 percentage points, respectively, but decreased significantly after the start of the pandemic (decreasing by 0.2 and 0.1 percentage points each week, respectively).</p><p><strong>Conclusions: </strong>The jump in HRSN following the start of the pandemic and the persistence of need, particularly in food and housing, highlight the importance of research to better understand which public health and health care interventions, investments, and policies effectively address HRSN.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"476-482"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717742","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":"Adult ADHD Diagnosis in a Family Medicine Clinic.","authors":"Ryan Heltemes, Dureeti Foge, Maren Wolf, Marina Kirkeide, Zach Merten, Gregory Dukinfield, Christine Morley, David Wilkins, Deborah M Mullen","doi":"10.1370/afm.3178","DOIUrl":"10.1370/afm.3178","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"568"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717687","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 AAFP President Charts Academy's Course at FMX.","authors":"","doi":"10.1370/afm.240541","DOIUrl":"10.1370/afm.240541","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"574-575"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717755","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":"Building Timely Consensus Among Diverse Stakeholders: An Adapted Nominal Group Technique.","authors":"Deniz Cetin-Sahin, Geneviève Arsenault-Lapierre, Clara Bolster-Foucault, Juliette Champoux-Pellegrin, Laura Rojas-Rozo, Amélie Quesnel-Vallée, Isabelle Vedel","doi":"10.1370/afm.3166","DOIUrl":"10.1370/afm.3166","url":null,"abstract":"<p><strong>Purpose: </strong>Building timely consensus among diverse stakeholders is important in primary health care research. Consensus can be obtained using the nominal group technique which includes 5 steps: (1) introduction and explanation; (2) silent generation of ideas; (3) sharing ideas; (4) discussion; and (5) voting and ranking. The main challenges in using this technique are a lack of representation of different stakeholder opinions and the amount of time taken to reach consensus. In this paper, we demonstrate how to effectively achieve consensus using an adapted nominal group technique that mitigates the challenges.</p><p><strong>Methods: </strong>This project aimed to reach consensus on the priority care domains for individuals aged 65 or older, using an adapted nominal group technique with 4 strategies: (1) recruit 4 stakeholders groups (older people, clinicians, managers, decision makers) by using maximum variation and snowballing sampling approaches; (2) use remote tools to ensure high participation; (3) add an individual pre-elicitation activity to increase effectiveness; and (4) adapt discussions to the stakeholders' preferences for meaningful engagement.</p><p><strong>Results: </strong>In total, 28 diverse stakeholders participated. After the pre-elicitation activity and 1 round of group discussion, we reached consensus on a priority domain called symptoms, functioning, and quality of care. Adaptive group discussions and remote tools were the most effective strategies. All participants strongly agreed that they were able to express their views freely. Some perceived a need for emphasizing the alignment between the research objectives and anticipated practice and policy implications.</p><p><strong>Conclusions: </strong>This adapted nominal group technique is an effective and enriching method when timely consensus is needed among diverse stakeholders. Health care researchers in various fields can benefit from using this research methodology.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"525-532"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717701","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":"Diabetes Management: A Case Study to Drive National Policy Change in Primary Care Settings.","authors":"Raveendhara R Bannuru, Francisco Prieto, Lisa Murdock, Elise Tollefson","doi":"10.1370/afm.3175","DOIUrl":"10.1370/afm.3175","url":null,"abstract":"<p><p>Despite medical advances, diabetes management remains a considerable challenge in the United States, with little to no improvement in patient outcomes and stark disparities in underserved communities. One acute challenge is that, as the US population with diabetes grows steadily-numbering 38.4 million people today-there are too few endocrinologists available to treat the disease and the burdens on primary care professionals, who treat more than 90% of cases currently, are staggering. This disconnect between need and care capacity presents what may be the greatest of many threats to the care of diabetic Americans. To understand what is required to solve this need-to-capacity mismatch, we examine the critical role of primary care professionals and propose national policy approaches to empower and improve the nation's primary care architecture for the nearly 12% of Americans who have diabetes. Policy recommendations encompass the integration of the chronic care model and the patient-centered medical home approach, expansion of workforce development initiatives, and payment reform to incentivize team-based care with the aim of ensuring equitable access to essential diabetes management tools. We urge policy makers to prioritize primary care workforce development, enhance reimbursement models, and implement strategies to mitigate disparities in diabetes care. Evidence reviewed here highlights the critical need for a comprehensive, multidimensional approach to diabetes management in primary care, emphasizing the importance of decisive action by policy makers to equip primary care professionals with the necessary resources and support to effectively address the nation's diabetes epidemic.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"550-556"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717729","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":"Health Care Utilization After a Visit to a Within-Group Family Physician vs a Walk-In Clinic Physician.","authors":"Christine Salahub, Peter C Austin, Li Bai, Simon Berthelot, R Sacha Bhatia, Cherryl Bird, Laura Desveaux, Tara Kiran, Aisha Lofters, Danielle Martin, Kerry McBrien, Rita K McCracken, J Michael Paterson, Bahram Rahman, Jennifer Shuldiner, Mina Tadrous, Niels Thakkar, Noah M Ivers, Lauren Lapointe-Shaw","doi":"10.1370/afm.3181","DOIUrl":"10.1370/afm.3181","url":null,"abstract":"<p><strong>Purpose: </strong>Primary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group.</p><p><strong>Methods: </strong>We conducted a population-based, retrospective cohort study using administrative data from Ontario, Canada, including all individuals formally enrolled with a family physician, from April 1, 2019 to March 31, 2020. We compared those visiting within-group physicians to those visiting walk-in clinic physicians using propensity score matching to account for differences in patient characteristics. The primary outcome was any emergency department visit within 7 days of the initial visit.</p><p><strong>Results: </strong>Matched patients who visited a within-group physician (N = 506,033) were 10% less likely to visit an emergency department in the 7 days after the initial visit compared to patients who saw a walk-in clinic physician (N = 506,033; 20,117 [4.0%] vs 22,320 [4.4%]; risk difference [RD] 0.4%; 95% CI 0.4-0.5; relative risk [RR] 0.90; 95% CI, 0.89-0.92). Restricting to visits occurring on weekends, the observed association was stronger (7,964 [3.7%] vs 10,055 [4.7%]; RD 1.0%; 95% CI 0.9-1.1; RR 0.79; 95% CI, 0.77-0.82). Those accessing after-hours within-group physician visits were more likely to have ≥1 additional virtual or in-person within-group physician visit within 7 days (virtual RR 1.86, in-person RR 1.87).</p><p><strong>Conclusions: </strong>Compared to visiting a walk-in clinic physician, seeing a within-group physician after hours might decrease downstream emergency department visits. This finding could be explained by better continuity of care and can inform primary care service models and the policies that support them.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"483-491"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717739","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}