Annals of Family Medicine

NOVEMBER 20, 2024

Context: In May 2023, Mayo Clinic implemented a revised screening tool to assess social determinants of health (SDOH) for its patients. Setting or Dataset: Secondary data on social needs screening and referral generated through Epic. Setting or Dataset: Secondary data on social needs screening and referral generated through Epic.

Primary Care 130

Primary Care Referral Routine Screenings Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Participating clinic sites offered convenience sample frame, patients with legal needs were identified through universal and secondary screening approach. Setting or Dataset: Clinics: AF Williams Family Medicine, Lowry Internal Medicine; EPIC data; legal records. Semi-hybrid approach one day per week optimizes clinical participation.

Medical 130

Medical Referral Screening Internal Medicine 130

Annals of Family Medicine

NOVEMBER 20, 2024

Understanding each team member's role, fostering open communication channels, and establishing clear administrative procedures are highlighted as essential elements for fostering successful collaborative practices within the clinic. This tabletop flip menu is available in each exam room and to all administrative staff at the clinic.

Primary Care 130

Primary Care Healthcare Professional Family Physician Referral 130

Annals of Family Medicine

NOVEMBER 20, 2024

The American Academy of Pediatrics recommends universal screening; however studies have found inconsistencies in screening of FI, documentation of FI, and referral to appropriate resources. Population Studied Families of children ages 0-18yo at an urban pediatric primary care mobile medical clinic serving families in Washington, D.C.

Primary Care 130

Primary Care Screening Referral 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. Referral to counseling (7.5% Population Studied: 119,926 adult patients with one or more primary care visits during the 30-month study period.

Primary Care 130

Primary Care Referral Electronics Individual 130

Annals of Family Medicine

NOVEMBER 20, 2024

Early identification and intervention in behavioral aspects of chronic diseases leads to improved function with decreased healthcare utilization, yet we know little about referral patterns for behavioral support of chronic disease. 88% (n= 11,483) of BH referrals were created for the management of a mental health condition.

Referral 130

Referral Chronic Condition Medical Chronic Disease 130

Annals of Family Medicine

NOVEMBER 20, 2024

Setting: Two urban primary care clinics in Minnesota, USA. Population: 50 English-speaking adults with type 2 diabetes who engage in a participating primary care visit, clinicians participating in the intervention clinic visit.

Primary Care 130

Primary Care Diabetes Screening Patient-Centered 130

Annals of Family Medicine

NOVEMBER 20, 2024

Population Studied: Primary care clinics. Other suggestions included clinical documentation guidance to align with broader health system goals (e.g., Champions proposed methods to improve efficiency of documentation using novel techniques and templates, shared resources/referrals, and requested patient-facing materials.

Primary Care 130

Primary Care Referral Electronics Utilities 130

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

Context: Brief dermoscopy training has been shown to improve diagnostic accuracy on image recognition tests, but few, if any, studies have examined its effect on clinician behavior and clinical outcome measures. Conclusions: Brief dermoscopy training can improve primary care providers' skin lesion diagnostic accuracy in clinical practice.

Primary Care 130

Primary Care Provider Nurse Practitioner Clinical Practice 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: This study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long-COVID in an academic medical center referral clinic. However, beyond expressions of disempowerment, the patient’s perspective regarding the quality of long-COVID care is lacking.

Healthcare 130

Healthcare Primary Care Patients Patient-Centered 130

Annals of Family Medicine

NOVEMBER 20, 2024

Utilizing new electronic handgrip dynamometer and accelerometer technologies may allow for additional muscle function attributes to be feasibly measured, which in turn, may help elevate prognostic value and specificity for intervention referral.

Electronics 130

Electronics Primary Care Utilities Referral 130

Integrated Care News by CFHA

MARCH 21, 2025

On January 7, 2025, SAMHSA announced the award of one-year Certified Community Behavioral Health Clinics (CCBHCs) Demonstration planning grants to 14 states and Washington, D.C., Journal of clinical psychology in medical settings , 25 (2), 109–126. References Reiter, J. Dobmeyer, A. C., & Hunter, C.

Behavioral Health Services 130

Behavioral Health Services Primary Care Integrated Care Mental Health 130

Integrated Care News by CFHA

MAY 1, 2025

When used intentionally, AI can help us: draft progress notes or referral letters, suggest evidence‑based interventions or psycho‑educational handouts, and organize task lists, reminders and teaching materials so we can focus on patients and learners. How are you integrating AI into your clinical, teaching or supervisory work?

Patient-Centered 130

Patient-Centered Integrated Care Primary Care Healthcare Professional 130

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

At Mayo Clinic and Mayo Clinic Health Systems (MCHS), merely 28% of DO providers perform OMT, leading to long wait times of over three months for new patients seeking OMT referrals. Objective: This study investigates provider attitudes toward OMT and identifies barriers to referrals to address the unmet patient demand.

Doctor of Osteopathic Medicine 130

Doctor of Osteopathic Medicine Provider Management Referral 130

Annals of Family Medicine

NOVEMBER 20, 2024

Multisector coordination is critical for effective screening and referral initiatives. Objective: To assess the function and impact of a new role, a Health Equity Coordinator, on the reach of the social needs screening and referral program.

Primary Care 130

Primary Care Referral Screening Patient-Centered 130

Annals of Family Medicine

NOVEMBER 20, 2024

Providers were alerted of positive screens by rooming staff to either assess further or refer to our Pediatric SUD Clinic to manage. For patients screened positive, chart reviews were conducted and the number of referrals to SUD Clinic was tracked. No patients were referred to the SUD Clinic.

Primary Care 130

Primary Care Screening Referral Wellness Visit 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. RESULTS The intervention engaged 69 (63.8%) of 108 clinicians across the 7 clinics. Screening workflows were tailored to each clinic.

Primary Care 130

Primary Care Screening Referral Clinic 130

Annals of Family Medicine

NOVEMBER 20, 2024

CGM is associated with clinical and psychosocial benefits. Objective To compare practice characteristics collected at baseline between those choosing a practice-led, self-paced CGM implementation plan or a referral to a virtual implementation service. Context Most diabetes care occurs in primary care (PC).

Primary Care 130

Primary Care Diabetes Referral Clinic 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

NOVEMBER 20, 2024

Context: For over 25 years, the burden of clinical administrative services has been cited as contributing to the stress and burnout experienced by family physicians. At the system level, participants underscored the need for compensation for administrative time and funding to increase clinic staff (e.g.

Primary Care 130

Primary Care Nurse Practitioner Family Physician Referral 130

Canadian Family Physician

MAY 14, 2025

Objective To determine the major themes among clinical questions asked to addiction medicine specialists sent by primary care providers (PCPs) via the Champlain Building Access to Specialists through the eConsultation (BASE™) electronic consultation (eConsult) service and the PCP-perceived benefits of this service.

Primary Care 52

Primary Care Consulting Electronics Provider 52

Minnesota Academy of Family Physicians

FEBRUARY 20, 2025

Streamline Referrals: Utilize technology like the Hunger Vital Signs tool and the Minnesota Food Helpline to connect patients directly to mobile food units, emergency food programs or Supplemental Nutrition Assistance Program (SNAP) enrollment services. Park Nicollet Health Services combines nutrition education with SNAP referrals.

Family Physician 52

Family Physician Community Families Family 52

Mesa Family Physician

APRIL 15, 2025

If you suspect environmental triggers, you can even learn how to test allergens in your home to further limit exposure. What Happens After Testing?

Asthma 100

Asthma Healthcare Professional Integrated Care Referral 100

Physician's Weekly

JUNE 14, 2025

Referral from the emergency department (ED) was linked to a lower risk (IRR 0.78 [0.77, 0.86], P < 0.001). Investigators concluded that multiple demographic and clinical factors increased coercion risk, highlighting the need for targeted assessment and further study of institutional influences.

Referral 52

Referral Mental Health Hospital Diagnose 52

Hitchcock Family Medicine

AUGUST 26, 2024

Tip 1: Do Research and Obtain Referrals Start your search by asking friends, family, and colleagues for recommendations. Word-of-mouth referrals can provide valuable insights into a doctor's practice, professionalism, and bedside manner. Choose a clinic close to your home or workplace to make visits more convenient.

Family Doctor 52

Family Doctor Families Family Board-Certified 52

Physician's Weekly

JUNE 13, 2025

There is robust data regarding the importance of patient connection and engagement in the hospital and clinic setting. This can be done by maintaining a directory of community resources and making referrals during patient visits. Connect patients with local resources such as food banks, housing assistance, and mental health services.

Chronic Disease Management 52

Chronic Disease Management Community Chronic Disease Education 52

Annals of Family Medicine

NOVEMBER 20, 2024

Anyone suffering from pain could register for the program without needing a referral or formal diagnosis from a health care practitioner. Among the 151 participants (15% of the total sample) who completed a PAM survey at baseline and follow-up, 69% (104/151) experienced a clinically meaningful increase of four points on the PAM scale.

Management 130

Management Utilities Referral Individual 130

Physician's Weekly

JUNE 24, 2025

MASLD is the leading reason for referral to a hepatologist in many US medical centers. Referral to a weight management center can help. However, as the authors point out, it is likely that combining drugs with differing mechanisms of action will likely lead to greater clinical benefit.

Patient-Centered 52

Patient-Centered Diabetes Referral Primary Care Doctor 52

Medical Xpress

MAY 3, 2023

But fewer than 20 percent of at-risk patients utilize this testing, and even fewer engage in genetic counseling after referral, often due to clinical workflow challenges or barriers to care.

Referral 98

Referral Utilities Individual Families 98

The Clinical Problem Solvers

MAY 4, 2020

Hematologic abnormalities are common in SLE and are components of both the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) diagnostic criteria. Laboratory workup was concerning for a Coombs-positive autoimmune hemolytic anemia, possible immune thrombocytopenia, and polyclonal gammopathy.

Referral 52

Referral Patient-Centered Diagnosis Diagnose 52

Annals of Family Medicine

NOVEMBER 20, 2024

Insight in patient characteristics in both settings might invite to reflect upon referral strategies of general practitioners (GPs) and interpretation of study results from hospital care. Comparison was based on an estimation of potential clinical relevance.

Primary Care 130

Primary Care General Practitioner GP Diagnosis 130

Dr. Zaar

JUNE 1, 2025

Check credentials through reliable websites like: American Board of Internal Medicine (ABIM) American Association of Clinical Endocrinology (AACE) Don’t hesitate to ask the clinic or hospital about the doctor’s credentials. Firsthand referrals often lead to trusted and patient-focused providers.

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

Logansport Memorial Hospital

MARCH 4, 2024

“We have a strong need for pain management services in our community and opening this clinic will allow our patients to have convenient access to high quality, safe treatment methods for chronic pain.” A referral from a provider is not required but is recommended. To schedule an appointment, call 574-725-3001.

Management 52

Management Patient-Centered Community Referral 52

Annals of Family Medicine

NOVEMBER 20, 2024

clinical consensus, financing mechanisms) and the organization (e.g., referral networks, technology infrastructure) to drive the transformation needed to facilitate early detection for cognitive impairment in primary care.

Primary Care 130

Primary Care Screening Healthcare Finance 130

Annals of Family Medicine

NOVEMBER 20, 2024

We employed diverse strategies to solicit respondent participation in clinics, provider networks, community and, social media. Participants provided short reflections about their surgical journey or referral experiences, along with elaborations in quantitative categories.

Referral 130

Referral Healthcare Provider Utilities 130