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Compass Rose for Generating Community-based Referrals via Epic: Best Practices and Lessons Learned [Social determinants and vulnerable populations]

Annals of Family Medicine

The workflows for use of the tool, including enrollment criteria, patient outreach, and use of the Findhelp platform for community-based referrals were standardized; however, each pilot site had different staff members responsible for using the tool.

Referral 130
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Changes in patterns and referrals of Nova Scotians seeking mental health care through 2-1-1 Referral Service [Health care services, delivery, and financing]

Annals of Family Medicine

Context 2-1-1 is a designated phone help line in Canada and the US that provides referrals for individuals to local government and community-based services for a wide variety of needs, including social, health care, and mental health services. 2-1-1 Nova Scotia has operated since 2013 as a nonprofit that offers 24/7 assistance.

Referral 130
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A Multi-Sector Pilot Design in the Northeast Ohio QI Hub: Engaging Community Based Organizations to Advance Diabetes Equity [Health care disparities]

Annals of Family Medicine

Population Studied: We conducted focus groups, key informant interviews, and in-depth interviews with leaders from ODM, CBOs, and regional health systems, triangulated with thematic review of community health needs assessments.

Community 130
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Risks and Needs: Lessons Learned from Assessing Patients Willingness to Receive Help for Social Risks in Primary Care [Social determinants and vulnerable populations]

Annals of Family Medicine

Setting or Dataset: Secondary data on social needs screening and referral generated through Epic. Outcome Measures: social risk factors, whether patients wanted assistance with their risk factors, and measures related to connection to community resources. Study Design and Analysis: Descriptive analysis of secondary data.

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Patient experience with Social Prescribing Program in Ontario, Canada [Social determinants and vulnerable populations]

Annals of Family Medicine

Context Social Prescribing (SP) is an approach to help individuals address their health and social needs wherein a healthcare practitioner refers patients to non-clinal services in the community. Models of SP vary, and the experience of patients across these models is less known.

Patients 130
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Effect of brief dermoscopy training on primary care providers' diagnostic accuracy on a test and in practice [Education and training]

Annals of Family Medicine

Study Design and analysis: Phase 1) Primary care providers completed a skin lesion identification test before and after brief dermoscopy training, and Phase 2) Diagnostic accuracy and biopsy and referral practices for the year prior to the course and the year following the course were compared.

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Three Practices, Three Stories: best practices and unique approaches to substance use screening in rural primary care [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

Context: Primary care (PC) practices that implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) can identify, reduce, and prevent problematic alcohol use that otherwise could go undetected. While screening and brief counseling in PC is considered best practice, it is not standard practice.