Annals of Family Medicine

NOVEMBER 20, 2024

Context: Nearly all patients with type 2 diabetes have comorbid chronic conditions, adding complexity to self-management. Study Design and Analysis: Single-arm pilot trial of adults with diabetes. Descriptive statistics of baseline patient demographics and post-encounter surveys, and of clinician post-encounter surveys.

Primary Care 130

Primary Care Diabetes Screening Patient-Centered 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: This work was done in the context of a regional quality improvement (QI) collaborative funded by the Ohio Department of Medicaid (ODM) focused on advancing diabetes equity through cross-sectoral QI infrastructure. We are one of 6 regional QI collaboratives statewide.

Community 130

Community Diabetes Referral Screening 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Diabetes management (DM) for patients with Type 2 Diabetes (T2D) can be hindered by non-medical, health-related social needs. Population Studied: Purposive sample of care team members (eg, physicians, social workers, diabetes educators, dietitians, community health workers).

Primary Care 130

Primary Care Diabetes Management Provider 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Type 2 Diabetes (T2D) impacts 35 million Americans. Population Studied: Adults (≥18 years) who receive care at an affiliated clinic, screen positive for food insecurity, have a T2D diagnosis, and an A1c level > 7.5%. All participants are referred to receive free produce ("standard of care").

Diabetes 130

Diabetes Clinic Transportation Internal Medicine 130

Annals of Family Medicine

MARCH 24, 2025

Nonphysician health workers delivered the comprehensive package of interventions, which included annual screening for cardiovascular risk factors, structured lifestyle modification sessions, referral to a primary health care facility for individuals with established risk factors, and active follow-up to evaluate self-care adherence.

Family 130

Family Families Management Referral 130

The Physicians Foundation

AUGUST 15, 2024

The clinic offers referrals to specialists, conducts free cancer screenings, provides medication vouchers and engages in extensive public health education efforts. His dedication to this cause should serve as an inspiration to the entire medical community.” a refinement of the CHFC Community Health Worker program.

Primary Care 40

Primary Care Community Chronic Disease Management Education 40

Edge Family Medicine

APRIL 10, 2025

From lab work to screenings, consistent care means catching problems before they escalate. Support with Chronic Condition Management If you’re living with a chronic condition like high blood pressure or diabetes, you’ll benefit greatly from continuity of care. Preventive Care that Works Primary care is your first line of defense.

Primary Care 130

Primary Care Relationship PCP PCP 130