Annals of Family Medicine

NOVEMBER 20, 2024

Context: Healthcare must evolve to overcome challenges and take advantage of opportunities. Continuous quality improvement (CQI) is a promising method for improving the healthcare system and responding effectively to changing patient needs. Champions in CQI refer to individuals who lead or facilitate such initiatives, and they seem to be a key ingredient in promoting quality improvement in Primary healthcare Clinics (PHC).

Healthcare 130

Healthcare Clinic Individual Management 130

NPR Health

NOVEMBER 19, 2024

Many U.S. hospitals are conserving critical intravenous fluids to cope with a supply shortage caused by Hurricane Helene. They're changing protocols for administering drugs and hydration through IVs.

Hospital 145

Hospital Management Patients 145

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Nearly all patients with type 2 diabetes have comorbid chronic conditions, adding complexity to self-management. A tool to more efficiently relay points of patient-perceived treatment burden during a primary care visit may lead to more patient-centered care plans and improved outcomes. Objective: To test the acceptability and usability of the Treatment Burden Screening in Diabetes (TBSD), a novel brief screening questionnaire that identifies domains of high burden in patients with diabe

Primary Care 130

Primary Care Diabetes Screening Patient-Centered 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: The experience of ethnically diverse parents of children with serious illness in the US healthcare system has not been well studied. Listening to families from these communities about their experiences could identify modifiable barriers to quality pediatric serious illness care and facilitate the development of potential improvements. Objective: Identify parents’ perspectives about good healthcare, poor healthcare and needed improvements in healthcare for children’s serious

Illness 130

Illness Medical Staff Community Healthcare 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Currently, primary care data, community data, and hospital data are not linked in Ontario, resulting in a disconnect in continuity of care. Combining these datasets in a consolidated data repository could result in an improved understanding of the care journey, support the healthcare needs of Ontario Health Team priority populations, promote continuity of care improvements across sectors, and decrease burden on emergency departments (EDs) and primary care providers.

Primary Care 130

Primary Care Electronics Hospital Medical 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Evaluating organizational readiness for implementing digital health solutions can identify potential barriers and increase the likelihood of sustained adoption. In the context of hypertension management, the Collaboration Oriented Approach to Controlling High blood pressure (COACH) application intends to support guideline-based home blood pressure monitoring by providing patients and clinicians with visualizations and recommendations to achieve blood pressure goals and reduce risks of h

Electronics 130

Electronics Patient-Centered Hypertension Primary Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Despite evidence that social determinants (e.g. income, housing) affect health, there is no standardized tool or approach in Canada for the routine collection of demographic and social information in healthcare settings. Objective: To validate the SPARK Tool using concurrent validity by assessing agreement between the SPARK Tool and well-established national survey questions (e.g. census) that are currently used for policy decisions and to identify health inequities.

Healthcare 130

Healthcare Individual 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Breast cancer (BC) and cervical cancer (CC) account for nearly 50% of all cancers among women in sub-Saharan Africa (SSA). Integrated screening for BC and CC can maximize the number of women screened and optimize limited resources. Few efforts have been made to integrate BC and CC screening in Kenya. Objective This study assesses the acceptability and feasibility of integrating BC screening into the CC screening program in Kenya.

Screening 130

Screening Provider Hospital Government 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Gender affirming medical care is associated with long term benefits for transgender and non-binary patients but access to such care does not meet the current need. This mismatch is worsened in rural communities. Many practicing providers receive no training in gender affirming hormone care, working competently with gender diverse patients, or ensuring an affirming care environment.

Education 130

Education Primary Care Provider Community 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Adherence to antiretrovirals (ART) by people with HIV (PWH) is crucial, however, many face obstacles that go undiscussed with health professionals. We used the patient portal (Opal) to administer the I-Score, a 7-item electronic patient-reported outcome measure (ePROM) of barriers to ART adherence. Objective: To describe patient and service-related outcomes of the I-Score intervention and outline adherence barrier management by physicians.

Clinic 130

Clinic Patients Electronics Management 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Individuals with complex conditions—those with multiple physical, mental, or behavioral health conditions--require numerous health and social services that are not effectively co-delivered by the current healthcare system. These individuals are often high utilizers of health care services, with some of the costliest services being hospital admissions and emergency department (ED) visits.

Integrated Care 130

Integrated Care Utilities Illness Healthcare 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: mHealth refers to the use of mobile and wireless technologies to support the achievement of health objectives. Targeted users of mHealth tools include clinicians, patients, and caregivers. In clinical settings, uptake of mHealth tools has varied, with limited use explained, in part, by suboptimal adaptation of the tool and the implementation processes.

Patients 130

Patients Clinical Practice Electronics Clinic 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. Addressing these inequities is a complex endeavor, with shared decision making (SDM) emerging as a promising strategy. SDM involves a collaborative process between patients and providers to make informed healthcare choices. Despite its proven benefits in enhancing patient outcomes, real-world constraints such as time, training, and staff availability hinder its widesprea

Asthma 130

Asthma Patients Primary Care Chronic Disease 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context With buprenorphine prescribing restrictions lifted, primary care physicians (PCP) are frequently the first contact for patients who have opioid use disorder (OUD) and require treatment with buprenorphine. To prepare family medicine (FM) residents for OUD care post graduation, it is critical they receive robust residency training in OUD diagnosis and management.

Education 130

Education Primary Care Physician Primary Care DO 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Effective communication with patients with limited English proficiency (LEP) is a significant challenge in healthcare, often leading to poorer health outcomes and patient dissatisfaction. Objective This study aims to assess healthcare providers' confidence and practices in using patient letters to communicate with patients with LEP, enhance communication strategies, and improve health outcomes.

Provider 130

Provider Patients Patient-Centered Healthcare 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context In 2018, 63.1% of Canadians were at greater risk of chronic diseases due to their BMI, including type 2 diabetes, atherosclerosis, and hypertension. The prevalence of obesity (BMI > 30) among adults was 26.8%, and the prevalence of overweight adults (BMI > 25) was 36.3%. Pathways offered by Quebec’s public system are heterogeneous, often providing limited services, especially in a preventive setting.

Family Medicine 130

Family Medicine DO Nurse Practitioner Family 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Rapid adoption of virtual care in early 2020, meant there was little time to develop or plan integrated virtual health care services, resulting in an urgency to establish governance for quality-based virtual care in Canada. Improvements in implementation of virtual care are needed across Canada for safer, equitable and accessible healthcare.

Finance 130

Finance Telemedicine Relationship Government 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Concussions, or mild traumatic brain injuries, are diagnosed in 150,000 Ontarians annually, resulting in disruptions to work, school, and sport. Concussion management is complex: variable onset of symptoms, urban/rural disparities, and the many professionals involved in case management. The ECHO (Extensions for Community Healthcare Outcomes) model is an ideal platform for dissemination of best practice guidelines and standards of care in common, complex, acute and chronic conditions.

Management 130

Management Education Illness Chronic Condition 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Chronic pain is a common, complex, and costly condition that is managed primarily in primary care in Canada. Extension for Community Healthcare Outcomes (ECHO) is a health professions education model that uses telehealth technology to bridge specialists to community clinicians to disseminate best practices and foster interprofessional collaboration.

Management 130

Management Telehealth Education Community 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Disparities in type 2 diabetes mellitus (T2D) and hypertension (HTN) control are well-described. Community health worker (CHW) interventions show promising outcomes for T2D and HTN control particularly among low income and historically marginalized patients. However, studies on the generalizability and implementation of CHW interventions in clinical and community settings are limited.

Hypertension 130

Hypertension Community Diabetes Primary Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Optimizing continuity of care improves care quality, outcomes, and costs. Despite efforts to improve patient-clinician relationships, access to care, and healthcare workflows, annual rates of missed appointments (MA) in the U.S remain between 15-30%, costing $150 billion annually. Therefore, identifying appointments at risk of being missed is a crucial prevention strategy to optimize care quality, ensure continuity, and reduce costs.

Appointment 130

Appointment Primary Care DO Family Medicine 130

Annals of Family Medicine

NOVEMBER 20, 2024

Background: Artificial intelligence (AI) tools are playing an increasingly important role in improving healthcare across various specialties. This review focuses on the application of AI in age-appropriate cancer screening tests. Study design: We conducted a scoping review of various AI tools aimed at enhancing screening rates and cancer detection. A comprehensive search of Google Scholar and PubMed identified 26,090 articles.

Screening 130

Screening Education Healthcare Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Concerns about declining diversity among medical students have emerged due to the Supreme Court’s 2023 ruling against race-based affirmative action in college admissions. Medical schools must now eliminate race or ethnicity considerations, making it imperative to develop innovative approaches to preserve recent progress. Notably, California has been navigating this landscape since it banned affirmative action in 1996.

Education 130

Education Medical Student Medical DO 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Chronic pain stands as a leading cause of disability globally, with patients often reporting inadequate access to primary care. Relevant primary care nursing activities for CP management remain poorly defined, limiting the full utilization of nurses' competencies and expertise in chronic disease management. Objective: To identify and prioritize nursing activities for chronic pain management in primary care by adopting nurse and patient perspectives.

Primary Care 130

Primary Care Management Chronic Disease Management Finance 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: The SHaPED trial implemented a model of care for low back pain in emergency departments and resulted in a 12.3% reduction in the prescription of opioids (OR 0.57, 95% CI 0.38–0.95) without compromising patient outcomes. However, the original analyses did not look if the decrease in opioid use led to a greater use of the recommended analgesics (e.g. non-steroidal anti-inflammatory drugs-NSAIDs).

Management 130

Management Referral Education Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Sickle cell disease (SCD) was identified as one of our hospital's most common causes of readmission. We noted that a small number of patients are readmitted multiple times. This indicates poor quality of life (QOL) for SCD patients and a high financial burden on the healthcare system. Objective: Describe the trends in sickle cell admissions between Jan 2020 and Dec 2023 at an academic medical center (AMC) in Augusta, Georgia.

Finance 130

Finance Medical Patient-Centered Healthcare 130

Annals of Family Medicine

NOVEMBER 20, 2024

Background: Multiple chronic conditions (MCC) the most common condition seen in practice are present in 33% of adults and 80% of individuals age > 65. Central tenets of primary care are essential to the delivery of effective MCC care: person & family-centered, comprehensive, equitable, team-based, collaborative, coordinated and integrated. Because people with MCC typically see multiple providers in multiple care settings often using different EHRs, critical information is difficult to ob

Chronic Condition 130

Chronic Condition Patient-Centered Primary Care Electronics 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Access to primary healthcare services is a core lever for reducing health inequalities. The ability to reach and engage in the care process varies considerably depending on patients’ socio-demographic characteristics which we need to understand to address inequitable access issues. Objective: To identify different profiles of access to care and continuity experiences of patients registered at team-based primary healthcare clinics.

Healthcare 130

Healthcare Clinic Chronic Condition Finance 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Most of the existing research in cervical cancer and healthcare systems is based on large scale quantitative data and primarily focuses on younger reproductive-age women. There is a significant lack of understanding regarding the healthcare system experiences of middle-aged and older Latina women concerning cervical cancer, as well as their perceptions and experiences with preventive services.

Healthcare 130

Healthcare Provider Healthcare Experience Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: This study aims to understand the current primary care access experience of both attached and unattached community members, using the established qualitative technique of journey mapping. Objective: Journey mapping is a visual user engagement tool employed in service design and increasingly in a medical context, focusing on identifying opportunities for improvement.

Primary Care 130

Primary Care Community Finance Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: In 2012, the United States cervical cancer screening (CCS) guidelines changed to add co-testing (Papanicolaou [Pap] and human papillomavirus [HPV] test) to Pap-only. Little is known about variation in adoption of CCS modalities in federally qualified health centers (FQHCs) in communities where cervical cancer disparities persist. Objective: Describe adoption of co-testing as a CCS modality in FQHCs serving socioeconomically disadvantaged populations.

Screening 130

Screening Insurance Patient-Centered Primary Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: One in five Canadians lives with chronic pain which significantly affects their daily activities and quality of life. Necessary healthcare services to manage chronic pain remain difficult to access in primary care. Occupational therapists play a central role in supporting patients in the adoption and daily use of pain self-management strategies and in learning how to adapt to their chronic condition to maintain their quality of life.

Primary Care 130

Primary Care Management Chronic Condition Education 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Respiratory infections are a prevalent health issue that concerns patients and stresses healthcare resources. Vaccines can prevent several respiratory infections, but the uptake is variable. To improve preventive first line healthcare, we need to understand the uptake and perspective of patients on vaccines. Objectives: 1) Measure the uptake of publicly-funded vaccines against respiratory infections; 2) Understand the hesitancy towards these vaccines in a population of adults followed i

Primary Care 130

Primary Care Vaccination Family Doctor Healthcare 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. The pre-intervention no-show rate of TCM appointments at Wellstar MCG Health was 44% per month. Objective: Our objective was to improve the TCM clinic no-show rate and thereby improve patient outcomes.

Appointment 130

Appointment Hospital Management DO 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Timely access is crucial for high-quality primary healthcare delivery, yet remains a pervasive challenge globally, including in Canada. The Advanced Access (AA) model, designed to support timely access, has faced implementation and sustainability hurdles. In Quebec, efforts to implement AA in Family Medicine Groups (FMGs) yielded partial success, necessitating comprehensive change strategies to ensure a tangible impact of the model.

Healthcare 130

Healthcare Nurse Practitioner Finance Appointment 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Community health services constitute the cornerstone of China's primary healthcare system. Since the recent healthcare reforms, significant strides have been made in the development of community health services across the country. However, facing the challenges brought by China's national health strategy, aging population, and high incidence of chronic diseases, there is an urgent need to improve the service capacity of China's primary medical institutions.

Healthcare 130

Healthcare Management Finance Chronic Disease 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Despite a joint recommendation in 2003 by the AAMC and CDC that bioterrorism and mass-casualty training be included in the medical school curriculum, few medical schools have incorporated formal disaster training. COVID-19's impact surpasses previous pandemics, disrupting medical education by delaying clinical rotations and necessitating a rapid transition to telemedicine due to isolation and PPE shortages.

Telemedicine 130

Telemedicine Education Telehealth Mental Health 130