Annals of Family Medicine

NOVEMBER 20, 2024

Instrument: The discussion guide included questions on 1) identifying shared social care priorities across the three groups, and 2) describing best practices, facilitators, and barriers around screening and referral for social needs learned from existing and past collaborative models.

Community 130

Community Diabetes Referral Screening 130

Physician's Weekly

JUNE 25, 2025

Caring for patients with multiple chronic conditions requires identifying those at risk, clear communication, and coordinated care to improve outcomes. Approximately 60% of American adults live with at least one chronic condition , and 40% of them have more than one. Have open gaps in care or medications not filled.

52

52

Dr. Zaar

JUNE 1, 2025

Consider Communication Style and Patient Rapport Diabetes is a chronic condition, so you need a doctor with whom you feel comfortable communicating. Firsthand referrals often lead to trusted and patient-focused providers. During your initial visits, observe: Do they listen carefully?

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

GeriPal

JULY 6, 2023

It’s that first place that you start where it may not be the AAAs job, but we’ve organized where they have to have the partnerships and they know who the players are and they know who to make a referral to. And that referral can be done in real time, a soft handoff. I think most states have them.

Community 89

Community Nurse Practitioner Provider IT 89