Annals of Family Medicine最新文献

{"title":"How Looking at Art Teaches Self-Discovery and Patient Care to Medical Students.","authors":"Florence Gelo","doi":"10.1370/afm.240318","DOIUrl":"10.1370/afm.240318","url":null,"abstract":"<p><p>As a former hospital chaplain and current museum docent, I have learned that looking at art can be a valuable tool for self-discovery and for enhancing medical education. This understanding led to creating a course to teach medical students to observe both art and patients deeply. In museums, the students practiced looking at paintings and describing what they saw and felt. By looking at artwork, they practiced observational skills, critical thinking, self-awareness, respect for difference, and communication. Facilitated museum visits like this can prompt the integration of heart and mind to enhance medical care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 3","pages":"269-270"},"PeriodicalIF":4.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163656","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":"Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care.","authors":"Nicole R Fowler, Dustin B Hammers, Anthony J Perkins, Diana Summanwar, Anna Higbie, Kristen Swartzell, Jared R Brosch, Deanna R Willis","doi":"10.1370/afm.240293","DOIUrl":"10.1370/afm.240293","url":null,"abstract":"<p><strong>Purpose: </strong>We assessed the feasibility and acceptability of implementing a digital cognitive assessment (DCA) for Alzheimer disease and related dementias (ADRD) screening into primary care. We also assessed the prevalence of positive screens and measured diagnostic and care outcomes after a positive DCA result.</p><p><strong>Methods: </strong>We conducted a single-arm pragmatic clinical demonstration project in 7 diverse primary care clinics to test implementation of the Linus Health Core Cognitive Evaluation and Digital Clock and Recall DCAs (Linus Health, Inc). Eligible patients were aged ≥65 years. Patients were ineligible if unable to see or hear, not English or Spanish speaking, or if they had a DCA in the past 12 months with an unimpaired or impaired result.</p><p><strong>Results: </strong>There were 16,708 eligible encounters during the 12-month study period (June 2022-May 2023). A total of 1,808 DCAs (10.8%) were completed by 1,722 unique patients; 3,727 (22.3%) declined, and at 9,232 encounters (55.3%) the physicians declined to have the patient complete the DCA or the encounter was deemed out of scope. Among those who completed DCAs, results for 762 (44.3%) were categorized as unimpaired, 628 (36.5%) borderline, 236 (13.7%) impaired, and 96 (5.6%) inconclusive. Among the 236 patients who were categorized as impaired, 2.1% received a new diagnosis of ADRD, and 5.1% received a new diagnosis of mild cognitive impairment within 90 days after the DCA.</p><p><strong>Conclusions: </strong>One-half of all patients scored impaired or borderline for cognitive impairment. Digital cognitive assessments can be implemented in primary care, have utility for early detection, and could represent the first step in identification of patients who could benefit from ADRD disease-modifying therapeutics, care management, or other interventions to improve patient and family caregiver outcomes.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"191-198"},"PeriodicalIF":4.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023995","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":"Addressing Research Pathway Gaps: Insights from a Needs Assessment at the AAFP Future Conference.","authors":"Nicole L Gentile, Amanda Weidner, Ian Bennett, Samantha Elwood","doi":"10.1370/afm.250096","DOIUrl":"10.1370/afm.250096","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"175-176"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701942","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":"Feasibility and Acceptability of the \"About Me\" Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment.","authors":"Stuart W Grande, Mikele Epperly, Karynn Yee-Huey Tan, Supriya Yagnik, Michael Ellenbogen, Jane Pederson, Alberto Villarejo-Galende, Rae Lynn Ziegler, Greg Kotzbauer","doi":"10.1370/afm.240165","DOIUrl":"10.1370/afm.240165","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to address fears and lived experiences of cognitive decline among adults via whole-person conversations that elicit problems and goals that matter most to patients. Currently, 6.7 million Americans have Alzheimer disease or related dementias, with an additional 28 million people reporting subjective cognitive decline-a possible indicator of Alzheimer disease and related dementias. A review of tools for older adults with cognitive impairment showed strong clinical specificity, with insufficient whole-person support for patients. We developed and tested the feasibility and acceptability of a tool to enhance conversations for adults with cognitive impairment at the point of care.</p><p><strong>Methods: </strong>We conducted a feasibility study to build a conversation tool, guided by principles of shared decision making, called the \"About Me\" Care Card. Informed by an environmental scan, we created and pilot-tested prototypes at implementation sites. All phases were overseen by a multidisciplinary steering committee.</p><p><strong>Results: </strong>Fourteen diverse clinicians consisting of 7 clinician types across 7 institutions piloted the card during in-person visits or by telephone. Observations showed that the card (1) allowed time to elicit what matters most to patients, (2) created space for personalized care conversations, (3) opened an examination of social care needs, and (4) moderated emotional relationships between families and individuals.</p><p><strong>Conclusion: </strong>A community-based codesign process led to a feasible tool for primary care teams to facilitate whole-person conversations with aging adults. The About Me Care Card appeared to broaden conversations compared with routine care. More work is needed to determine scalability and effects on outcomes.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"117-126"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702020","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":"What do Primary Care Patients Want?","authors":"Michael E Johansen","doi":"10.1370/afm.250081","DOIUrl":"10.1370/afm.250081","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"178"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702041","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":"When the Death of a Colleague Meets Academic Publishing: A Call for Compassion.","authors":"Catherine G Derington","doi":"10.1370/afm.240287","DOIUrl":"10.1370/afm.240287","url":null,"abstract":"<p><p>What would you do if someone approached you to sign a publishing form on your partner's behalf within mere weeks of their death? After my trusted, brilliant coworker died, I grappled daily between grieving her loss and driving productivity on her assigned projects. Because, after all, the world keeps spinning, research progresses, and manuscripts have to be published. In attempting to honor her memory through post-mortem authorship on publications, I was faced with a unique quandary of how to procure a signature on legal publishing forms, which is often requested during the publication process. Little guidance is available for corresponding authors on this issue, so I call on academic publishers to create post-mortem authorship policies that prioritize compassion, dignity, and rationality in the wake of grief.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"168-169"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702042","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":"Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease.","authors":"Wilson D Pace, Elisabeth Callen, Gabriela Gaona-Villarreal, Asif Shaikh, Barbara P Yawn","doi":"10.1370/afm.240030","DOIUrl":"10.1370/afm.240030","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to assess long-term inhaled corticosteroid (ICS) risks in chronic obstructive pulmonary disease (COPD) management.</p><p><strong>Methods: </strong>We extracted electronic health record data for individuals aged >45 years with COPD from a data repository. The prevalent cohort required a diagnosis of COPD any time during the observation period, and the inception cohort required a diagnosis of COPD made after entry into the database. A composite outcome of any new diagnosis of type 2 diabetes, cataracts, pneumonia, osteoporosis, or nontraumatic fracture; and recurrent event outcomes of repeated pneumonia or nontraumatic fracture were compared for long-term (>24 months) vs short-term (<4 months) ICS exposure.</p><p><strong>Results: </strong>We assessed outcomes for 318,385 and 209,062 individuals in the prevalent and inception cohorts, respectively. The composite dichotomous outcome was significantly greater for long-term vs short-term ICS use for the prevalent (hazard ratio [HR] = 2.65; 95% CI, 2.62-2.68; <i>P</i> <.001) and inception (HR = 2.60; 95% CI, 2.56-2.64; <i>P</i> <.001) cohorts. For the inception cohort, the absolute risk difference of the composite outcome was 20.26% (29.41% minus 9.15%), with a number needed to harm of 5. Hazard ratios were significantly increased in the prevalent and inception cohorts for recurrent pneumonia (HR = 2.88; 95% CI, 2.62-3.16; <i>P</i> <.001 and HR = 2.85; 95% CI, 2.53-3.22; <i>P</i> <.001, respectively) and recurrent fracture (HR = 1.77; 95% CI, 1.42-2.21; <i>P</i> <.001 and HR = 1.57; 95% CI, 1.20-2.06; <i>P</i> <.001).</p><p><strong>Conclusions: </strong>Long-term ICS use for COPD is associated with significantly greater rates of the composite outcome of type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fracture; recurrent pneumonia; and recurrent fracture.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"127-135"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701943","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 Advocacy Ambassadors Program Helps AAFP Members Engage With Their Legislators.","authors":"","doi":"10.1370/afm.250095","DOIUrl":"10.1370/afm.250095","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"173"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702035","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 General Public Vastly Overestimates Primary Care Spending in the United States.","authors":"Melissa Ma, Rebecca Etz, Andrew Bazemore, Kevin Grumbach","doi":"10.1370/afm.240413","DOIUrl":"10.1370/afm.240413","url":null,"abstract":"<p><p>This study assessed public perceptions of US primary care spending. An online survey was conducted using SurveyMonkey Audience (Symphony Technology Group), achieving a sample of 1,135 adult respondents reflective of the demographic distribution of the US adult population. Respondents' mean estimate of the percentage of US health care spending funding primary care was 51.8% (SD 24.8, interquartile range [IQR] 40). Respondents' mean estimate of the percentage of health care needs addressed by primary care was 58.7% (SD 22.2, IQR 28.5) These results reveal a tremendous disparity between current levels of primary care spending (4.7%) and public perceptions of primary care expenditure and value.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"165-167"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494736","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":"Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients.","authors":"Maram Khazen, Ligat Shalev, Avivit Golan-Cohen, Eugene Merzon, Ariel Israel, Shlomo Vinker, Adam J Rose","doi":"10.1370/afm.240176","DOIUrl":"10.1370/afm.240176","url":null,"abstract":"<p><strong>Purpose: </strong>Although studies have shown that more temporally regular (TR) primary care visits are associated with improved patient outcomes, none have examined what clinic staff can do to encourage greater TR visits. This study aims to increase understanding of factors related to health care staff dynamics that contribute to more TR primary care visits for adults with chronic health conditions.</p><p><strong>Methods: </strong>We conducted semistructured interviews with 15 primary care physicians, 12 nurses, 15 administrative staff, and 4 pharmacists at 12 clinics; one-half characterized as high-TR clinics where patients had regular follow-ups, and the other as low-TR clinics. Interviews were audiotaped, transcribed, and coded using Atlas qualitative data analysis software (Lumivero, LLC).</p><p><strong>Results: </strong>Themes emerged regarding best ways to promote regular follow-up of patients with chronic conditions. These strategies included having a system to encourage follow-up (beginning with administrative staff reaching out to patients and ending with recruiting the help of patients' family members), routine staff meetings, adaptive workflow, dealing with bureaucracy on patients' behalf, informal channels of communication with patients, and consulting social workers. Clinics with more regular follow-up emphasized teamwork, a peaceful approach toward challenging patients, and flat as opposed to hierarchical organizational structures for personal relationships among staff.</p><p><strong>Conclusions: </strong>Teamwork between staff members in primary care settings can contribute to more proactive care delivery, with greater potential to prevent long-term complications. The findings suggest that a high-functioning multidisciplinary care team that focuses on creating the right sorts of interactions and teamwork among members of the staff can contribute to engaging patients more effectively.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"100-107"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702039","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}