Annals of Family Medicine

NOVEMBER 20, 2024

Economic analysis utilized "difference in difference" methodology comparing individuals who received legal services to control groups: a) in the same clinic; b) in 12 other primary care clinics within the same health system. Clinics: AF Williams Family Medicine, Lowry Internal Medicine.

Primary Care 130

Primary Care Medical Behavioral Health Services Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Setting or Dataset: Electronic health record data from 11 community-based clinics within a safety-net system in the Midwest from 07/01/2021-3/31/2024. Results: Among 119,926 patients, 40% did not have SDOH assessed; 31% had 3 or more social needs identified during screening, 11% had 2, 7% had 1, and 11% had no social needs.

Primary Care 130

Primary Care Referral Electronics Individual 130

Annals of Family Medicine

NOVEMBER 20, 2024

SUD screening is not universally done in primary care (PC). In our institution, screenings are completed for patients ≥15 years during well visits; those not presenting for well visits and under 15 may represent missed opportunities. A score ≥2 constitutes a positive screen for possible substance misuse.

Primary Care 130

Primary Care Screening Referral Wellness Visit 130

Common Sense Family Doctor

MARCH 15, 2025

Michelle Rockwell and colleagues at the Carilion Clinic in Roanoke, Virginia, performed a sludge audit of their colorectal cancer (CRC) screening services in 2021 and 2022. In contrast, patients who reported no or minimal sludge were more likely to complete screenings and less likely to report distrust in the health system.

Screening 52

Screening Insurance Primary Care Referral 52

Minnesota Academy of Family Physicians

FEBRUARY 20, 2025

Through food pharmacies, food insecurity screenings and innovative community partnerships, health care providers are ensuring patients get the nourishment they need to thrive. The Minnesota Academy of Family Physicians (MAFP) adopted a resolution (policy guidance) in 2024 related to addressing food insecurity in Minnesota.

Family Physician 52

Family Physician Community Family Families 52

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: To explore participants’ barriers to and facilitators of engagement in a multilevel, cross-sector clinical trial designed to address social needs and improve health-related outcomes for individuals with T2D experiencing food insecurity. Setting: Ambulatory clinics (e.g., their 3-month endpoint visit).

Diabetes 130

Diabetes Clinic Transportation Internal Medicine 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: The rise in social needs screening in primary care settings has led to questions about program design and implementation strategies. Multisector coordination is critical for effective screening and referral initiatives.

Primary Care 130

Primary Care Referral Screening Patient-Centered 130

Annals of Family Medicine

NOVEMBER 20, 2024

A recent review of national diabetes treatment guidelines recommended adjustments to DM to reduce financial strain (eg, selecting lower cost medications), as well as directly intervening in response to an identified social need (eg, referral to a community-based service). Setting: Ambulatory clinics (e.g.,

Primary Care 130

Primary Care Diabetes Management Provider 130

Annals of Family Medicine

MAY 27, 2025

METHODS We used agile implementation principles to integrate a DCA tool into routine workflows across 7 primary care clinics. A brain health navigator role was established to support patients with positive or borderline screenings, and assist primary care clinicians with follow-up assessment.

Primary Care 130

Primary Care Screening Referral Clinic 130

Annals of Family Medicine

NOVEMBER 20, 2024

Davos Alzheimer’s Collaborative Healthcare System Preparedness (DAC-SP) aims to catalyze global healthcare system transformation, providing Alzheimer’s patients and their families quicker access to life-changing innovations and therapies. clinical consensus, financing mechanisms) and the organization (e.g.,

Primary Care 130

Primary Care Screening Healthcare Finance 130

GeriPal

JANUARY 18, 2024

After discussing screening options for substance use disorder, we go on to talk about both the treatments for it and the issues that arise. So, we are not screening for substance use in cancer care, so we don’t get good estimates among people with cancer, which is really how we would prefer to ask the question. Katie: Yeah.

Illness 136

Illness Patient-Centered Screening Clinic 136

GeriPal

SEPTEMBER 7, 2023

Based on this surge in evidence, the American Society of Clinical Oncologists recently updated their guidelines for care of older adults to state that all older adults receiving systemic therapy (including chemo, immuno, targeted, hormonal therapy) should receive geriatric assessment guided care. Alex: How is your family doing?

Patient-Centered 129

Patient-Centered IT Patients Clinic 129

GeriPal

FEBRUARY 6, 2025

How should we screen for cognitive impairment? So let’s just say you have a healthy 55 year old or 65 year old in your clinic. Who do you think we should be screening and how should we be screening them for these symptoms? Well, so I guess it depends on what you say screening. Nate 05:29 Ooh.

Primary Care 95

Primary Care Diagnosis Screening IT 95

GeriPal

FEBRUARY 22, 2024

Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life (related study here ). We saw that around 60% of people were screening positive for depression in the last month before death. Or is it that I’m just not screening? That’s a lot.

Mental Health 122

Mental Health Patient-Centered Illness Screening 122

GeriPal

JULY 3, 2025

We’ve invited two palliative care doctors to talk about survivorship with us: Laura Petrillo , a physician-researcher at Mass General Hospital and Harvard Medical School, and Laura Shoemaker , an outpatient palliative care doctor at the Cleveland Clinic. Alex 03:45 This came up because I was in Cleveland Clinic doing grand rounds.

Patient-Centered 71

Patient-Centered Illness Clinic IT 71

GeriPal

JULY 21, 2022

Often the work of the certified driving rehab specialist is to assess the older drivers goals, assess prognosis for driving, and help the family navigate discussions around driving cessation (hmmm…sounds like an approach to family meetings). Were those people self referring, or family members calling you asking? Eric: Yeah.

IT 102

IT Families Family Diagnosis 102

GeriPal

JUNE 5, 2025

The obstacles hindering referrals to palliative care services. We also take a dive into these 2 articles that Connie first authored: Palliative care in nursing homes: A qualitative study on referral criteria and implications for research and practice. So we see a lot of problems with symptom management, a lot of family conflict.

Nurse Practitioner 78

Nurse Practitioner Referral Consulting Board-Certified 78

GeriPal

APRIL 6, 2023

It is a screening? That’s why we use the terms assessment and intervention and we think of assessment as a skill of a very advanced skill that chaplains have of doing an in-depth evaluation of a patient or family member, and then the interventions should certainly follow naturally from that. I guess FICA is not as cool as SKY.

IT 99

IT Patient-Centered Families Family 99

GeriPal

FEBRUARY 15, 2024

Eric: Well, what are the odds that two family members focus on a similar topic and do research together? laughter] Alex: We love the family theme. So one of the big pieces of this is that idea of a referral at a second time when they’re less overwhelmed and stressed to figure out what happened. It works really well for us.

Community 114

Community Transportation IT PCP 114

GeriPal

OCTOBER 27, 2022

As Alex Lee says on our podcast today, all prognostic models will be wrong (in some circumstances and for some patients); our job is to make prognostic models that are clinically useful. As Sei Lee notes, the argument for developing prognostic models has won the day, and we increasingly use prognostic scores in clinical decision making.

IT 95

IT Clinic Screening Patients 95

GeriPal

MARCH 10, 2022

Now when I say variation, I’m not talking about small little clinically questionable variations. The Lived Experience of Providing Feeding Assistance to a Family Member with Dementia. Whereas the home with the low rate of feeding tube use involved families in decision making. Archives of Internal Medicine 2010.

Nurse Practitioner 60

Nurse Practitioner Hospital Families Family 60

GeriPal

AUGUST 24, 2023

Harvey is probably best known for his work in developing dignity therapy, a psychological intervention designed specifically to address many of the psychological, existential, and spiritual challenges that patients and their families face as death approaches. But once I got into medicine, I found myself attracted to the field of psychiatry.

Patient-Centered 98

Patient-Centered Patients IT Illness 98

GeriPal

FEBRUARY 24, 2022

Should we focus on something else, both from a clinical and a research perspective? We see our patients and our families throughout the illness trajectory into the hospital. It’s hard for your family to know. It’s part of our family mythology. Like, should we be doing advance care planning? Is that right?

Illness 98

Illness Patient-Centered IT Patients 98

GeriPal

JULY 20, 2023

She sought me out to come and tell me a story because about 10 years earlier, she and her family, their loved one was dying in a hospital in Florida and they tried to access palliative care and they couldn’t get the doctor to refer them to palliative care. I think you’re a loving family doing the best you can.”

Telemedicine 73

Telemedicine Telehealth Patient-Centered Board-Certified 73