Annals of Family Medicine

NOVEMBER 20, 2024

Context: Medical legal partnerships (MLP) are an effective intervention for social determinants of health, like housing, education, and employment status. Descriptive analysis utilized primary legal record and secondary electronic health record sources. Dual coders provided inter-coder reliability with inductive themes.

Medical 130

Medical Referral Screening Internal Medicine 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. Referrals were not placed for patients being discharged to another facility or who already had an outside primary care provider.

Appointment 130

Appointment Hospital Management Family Medicine 130

Annals of Family Medicine

NOVEMBER 20, 2024

Population Studied: Patients with recent hemoglobin A1c levels of ≥8% were invited to join the Diabetes Navigator program, identified through the electronic health record at two academic primary care clinics. Results: We identified 176 patients with recent hemoglobin A1c ≥8%.

Primary Care 130

Primary Care Diabetes Referral Integrated Care 130

Integrated Care News by CFHA

MAY 1, 2025

I believe that as clinicians, educators and supervisors, we are called to guide this shift. Traylor and colleagues (2025) show that generative‑AI tools can boost health literacy by translating medical jargon into plain language. Below, I share three reasons why.

Patient-Centered 130

Patient-Centered Integrated Care Primary Care Healthcare Professional 130

Dr. Zaar

JUNE 1, 2025

Managing Type 2 diabetes requires more than just medication—it demands a long-term partnership with a skilled healthcare provider who understands your individual needs. Certified Diabetes Educators (CDE): While not doctors, they play a key role in diabetes education and lifestyle support.

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

Physician's Weekly

JUNE 25, 2025

For example, although documenting in the electronic health record (EHR) can improve access to organized information, a lack of EHR interoperability may hinder communication among physicians who use disparate EHR systems. Have open gaps in care or medications not filled. Have clinical indicators of disease complexity or advancement.

Chronic Condition 59

Chronic Condition Patients Management Primary Care Physician 59

GeriPal

SEPTEMBER 7, 2023

So I would say that a lot of the education we received were on cutting edge research and the latest drugs in clinical trials, the latest cellular therapies that are coming out. So pretty soon, I hope, we’ll be able to do this all electronically by anyone who wants to. Mazie: That’s a really nuanced question. Mazie: Yes.

Patient-Centered 129

Patient-Centered IT Patients Clinic 129