2024

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Key Strategies to Foster Effective Champions for Continuous Quality Improvement in Primary Healthcare Clinics [Research capacity building]

Annals of Family Medicine

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).

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Key Facts GPs Should Know About GLP-1 Analogs

Family Medicine Initiative

Demand for new obesity medications like semaglutide (GLP-1 analogs) is high, but availability is low. So, which patients should get them first? What are the true benefits and side effects? Patients ask me these questions fairly often, so I know it’s important for GPs to know the key facts. I therefore reviewed the main research studies and guidelines and tried to summarize them briefly and clearly in this article. 1.

Diabetes 130
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Alabama Physicians and Advocates Rally to Reform Prior Authorization Process

Alabama Academy of Family Physicians

In Alabama, the call to reform the prior authorization system is reaching a crescendo, with numerous physicians and patient advocates pushing for substantial changes. Prior authorizations, a common practice requiring health care providers to obtain approval from insurance companies before proceeding with prescribed treatments or medications, has become a notable point of contention.

Insurance 130
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Do Masks Still Matter in Hospitals? Here’s What the Data Says

Dr. Shin's Notes

Imagine a hospital—a place where we go to heal, but also a hotspot for germs. Over the last few years, masks became a symbol of protection, a barrier between us and those pesky pathogens. But what happens when those masks come off? A recent study from Harvard Medical School offers some eye-opening insights. After hospitals… Read More » Do Masks Still Matter in Hospitals?

Hospital 130
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Aspirations for an Ideal Future in Medicine: Obstacles and Strategies

Joy in Family Medicine Coaching

We are continuing our series involving your ideal future in medicine. For those of you out there saying, “Enough with the dreaming and mindset stuff; I want to take action,” this is your month! If you haven’t already, write your goals and the vision behind them. You can use the steps I gave three weeks ago. Now, I’m going to encourage something contrary to my typical suggestions.

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How to Manage Chronic Diseases for a Healthier Life: Expert Tips from Edge Family Medicine

Edge Family Medicine

Taking Control of Your Health with Chronic Disease Management Chronic diseases such as diabetes, hypertension, and COPD can be challenging, but at Edge Family Medicine , we specialize in helping patients regain control of their health. We offer expert care and personalized treatment plans for the Upland, Rancho Cucamonga, and Montclair communities. Managing chronic conditions requires a proactive approach, and our experienced team is here to guide you every step of the way Understanding Chronic

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Vaccine News You Can Use

Colorado Academy of Family Physicians

Walt Larimore, MD This respiratory illness season is a busy one for immunization recommendations and guidelines. In addition to his frequent contributions and regular column in Colorado FP, Dr. Walt Larimore has compiled even more information and CME questions to support your learning and patient care. Keep an eye out for his article in the. The post Vaccine News You Can Use appeared first on Colorado Academy of Family Physicians.

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"We feel alone and not listened to": Somali, Hmong and Latin American Parents Perspectives on Pediatric Serious Illness [Child and adolescent health]

Annals of Family Medicine

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
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Implementation of a novel linkage of primary care electronic medical record data with hospital data in South Eastern Ontario [Big data]

Annals of Family Medicine

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.

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A Multisite CFIR Study of Readiness to Implement Collaboration Oriented Approach to Controlling High Blood Pressure (COACH) [Dissemination and implementation research]

Annals of Family Medicine

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

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Validation of the SPARK Tool to collect demographic and social needs data in healthcare [Social determinants and vulnerable populations]

Annals of Family Medicine

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.

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Evaluating the Impact of a Longitudinal Clerkship Lecture on Medical Students Knowledge and Response to Human Trafficking [Education and training]

Annals of Family Medicine

Context Healthcare sites provide an opportunity to identify and respond to human trafficking (HT). People who experience HT interact with the healthcare system before, during, and after the period of victimization, yet there remains limited knowledge and intervention among healthcare professionals. Few medical schools include this topic in their curriculum, and it is not standardized in undergraduate medical education.

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Perceived acceptability and feasibility of integrating breast and cervical cancer screening for women and providers in Kenya [Screening, prevention, and health promotion]

Annals of Family Medicine

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
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The Midwest Trans Health Education Network: Increasing Access to Gender Affirming Care Through Virtual Training Cohorts [Education and training]

Annals of Family Medicine

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
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Clinical outcomes of administering an ePROM of barriers to adherence to ART to people with HIV through a patient portal [Clinical research (other)]

Annals of Family Medicine

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
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The Impact of Integrated Care on Healthcare Utilization and Costs: Evidence from the Kansas Health Homes Medicaid Program [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

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.

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An umbrella review of mHealth tool implementation strategies: a 6-step guide to optimize patient, caregiver and clinician use [Dissemination and implementation research]

Annals of Family Medicine

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
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Coach McLungsSM, Facilitating Shared Decision Making for Asthma - Patients and Caregivers Perspectives [Health care informatics]

Annals of Family Medicine

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
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Bup-ing Up Residency: A Dose of Change for OUD Care [Education and training]

Annals of Family Medicine

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
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Enhancing Provider Confidence in Communicating with Patients with Limited English Proficiency (LEP) through Patient Letters [Health care disparities]

Annals of Family Medicine

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
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Development of a Multidisciplinary Clinic for the Treatment of Obesity in a Canadian University Family Medicine Group (U-FMG) [Obesity, exercise and nutrition]

Annals of Family Medicine

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.

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Translating complex clinical environments to virtual care: Standards of Care in Virtual Medicine in Canada [Health care services, delivery, and financing]

Annals of Family Medicine

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
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The Impact of a Health Professions Education Program on Concussion Management: A Multi-Methods Study of ECHO Concussion [Neurologic illness]

Annals of Family Medicine

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.

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Celebrating Ten Years of ECHO Ontario Chronic Pain and Opioid Stewardship [Pain management]

Annals of Family Medicine

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.

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Implementation Evaluation of a Community Health Worker Program for Patients with Type 2 Diabetes or Hypertension [Dissemination and implementation research]

Annals of Family Medicine

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.

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Predicting Likelihood of Missed Appointments in Primary Care [Health care informatics]

Annals of Family Medicine

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.

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Examining the role of Artificial Intelligence in Age-appropriate Cancer screening: A Scoping review [Systematic review, meta-analysis, or scoping review]

Annals of Family Medicine

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
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Training a diverse physician workforce: a survey of alumni of a medical education program focused on underserved populations [Education and training]

Annals of Family Medicine

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
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Unleashing the Potential of Primary Care Nurses in Chronic Pain Management: A Delphi Study on Priority Activities [Health care services, delivery, and financing]

Annals of Family Medicine

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.

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Secondary analysis of the SHaPED trial: shifting away from opioids to simple analgesics for emergency care of low back pain [Pain management]

Annals of Family Medicine

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).

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Sickle Cell Crises: A Deep Dive into Patterns of Readmissions at an Academic Medical Center [Health care services, delivery, and financing]

Annals of Family Medicine

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
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Development and Testing of an Interoperable e-care Plan for Person-Centered Care Planning for Multiple Chronic Conditions [Multimorbidity]

Annals of Family Medicine

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

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Profiling patterns of patient experiences of access to care and continuity at team-based primary healthcare clinics [Health care services, delivery, and financing]

Annals of Family Medicine

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.

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Lessons, Message, and Recommendations from Latina Survivor of Cervical Cancer for Healthcare Teams and Providers [Health care disparities]

Annals of Family Medicine

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.

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Patient Journey Mapping: How Attached and Unattached Community Members Access Primary Care [Health care services, delivery, and financing]

Annals of Family Medicine

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.

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Pap-HPV co-testing adoption trends for cervical cancer screening in a multi-state Practice Research Network (PBRN) 2012-2017 [Health care disparities]

Annals of Family Medicine

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
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Enhancing Primary Care: The Role of Occupationnal Therapy in Chronic Pain Self-Management [Pain management]

Annals of Family Medicine

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.