Integrated Care News by CFHA

MAY 1, 2025

I believe that as clinicians, educators and supervisors, we are called to guide this shift. When used intentionally, AI can help us: draft progress notes or referral letters, suggest evidence‑based interventions or psycho‑educational handouts, and organize task lists, reminders and teaching materials so we can focus on patients and learners.

Patient-Centered 130

Patient-Centered Integrated Care Primary Care Healthcare Professional 130

Annals of Family Medicine

NOVEMBER 20, 2024

At Mayo Clinic and Mayo Clinic Health Systems (MCHS), merely 28% of DO providers perform OMT, leading to long wait times of over three months for new patients seeking OMT referrals. Objective: This study investigates provider attitudes toward OMT and identifies barriers to referrals to address the unmet patient demand.

Doctor of Osteopathic Medicine 130

Doctor of Osteopathic Medicine Provider Management Referral 130

Annals of Family Medicine

NOVEMBER 20, 2024

A recent review of national diabetes treatment guidelines recommended adjustments to DM to reduce financial strain (eg, selecting lower cost medications), as well as directly intervening in response to an identified social need (eg, referral to a community-based service).

Primary Care 130

Primary Care Diabetes Management Provider 130

Physician's Weekly

JUNE 22, 2025

Semi-structured interviews with practice staff were conducted to explore reasons for selecting a specific study arm. The results showed that out of 76 enrolled practices, 46 selected the self-paced approach using the TIPS modules, and 16 of these (35%) included a Diabetes Care and Education Specialist (DCES).

Primary Care 52

Primary Care Diabetes Family Physician Referral 52

Physician's Weekly

JUNE 13, 2025

Physicians can often literally meet patients where they are and address the broader social determinants of health, such as housing, education, and income, which significantly impact patient well-being and illness prevention. This can be done by maintaining a directory of community resources and making referrals during patient visits.

Chronic Disease Management 52

Chronic Disease Management Community Chronic Disease Education 52

Minnesota Academy of Family Physicians

FEBRUARY 20, 2025

Streamline Referrals: Utilize technology like the Hunger Vital Signs tool and the Minnesota Food Helpline to connect patients directly to mobile food units, emergency food programs or Supplemental Nutrition Assistance Program (SNAP) enrollment services. Park Nicollet Health Services combines nutrition education with SNAP referrals.

Family Physician 52

Family Physician Community Family Families 52

Dr. Zaar

JUNE 1, 2025

Certified Diabetes Educators (CDE): While not doctors, they play a key role in diabetes education and lifestyle support. Firsthand referrals often lead to trusted and patient-focused providers. Endocrinologist: A specialist trained in treating hormonal disorders, including diabetes.

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

Annals of Family Medicine

NOVEMBER 20, 2024

Intervention: LINK is a randomized controlled 2x2 factorial trial testing the effect of 2 distinct interventions on A1c: a 6-week culinary and nutrition education class and community referrals to address unmet social needs. All participants are referred to receive free produce ("standard of care").

Diabetes 130

Diabetes Clinic Transportation Internal Medicine 130

Louisville Lectures

MAY 5, 2023

We believe in the concept of Free Open Access Medical Education ( #FOAMed ) and we focus on internal medicine ( #FOAMIM ). Louisville Lectures has always been a multidisciplinary platform bringing top medical education resources. Are you a physician so excited about MOC that you want to get started studying right now?

Internal Medicine 52

Internal Medicine Patient-Centered Education Hospital 52

The Physicians Foundation

AUGUST 15, 2024

This prestigious award is part of The Physicians Foundation’s Leadership Award Program and honors a physician who has gone above and beyond to connect patients with the social, economic, educational and environmental resources necessary for their overall health. The award is named in honor of Richard (Buz) Cooper, M.D., As the U.S.

Primary Care 40

Primary Care Community Chronic Disease Management Education 40

Physician's Weekly

JUNE 17, 2025

The Quality of Autism-Related Services While autism-related services span many areas, the researchers highlighted physical health services, behavioral health services, educational services, and employment services as crucial for people with autism. Those from marginalized backgrounds often face difficulty accessing these services.

Board-Certified 52

Board-Certified Behavioral Health Services Diagnose Referral 52

Physicians Alliance of Connecticut

MARCH 22, 2025

They can offer extra support, like a referral to a diabetes self-management education and support (DSMES) program. A diabetes educator can teach you about how to eat and exercise with diabetes, and how to monitor your blood sugar and take your medications.

Treatment Plan 52

Treatment Plan Diabetes Consulting Management 52

Physician's Weekly

JUNE 25, 2025

Ensure the conversation addresses any care coordination needs, quality gaps, or other concerns identified by the data that may impact treatment decisions, referrals, or patient education opportunities. Conduct a daily morning huddle. Communicate clearly with appropriate non-clinical staff.

Chronic Condition 52

Chronic Condition Patients Management Primary Care Physician 52

CDOCS

MARCH 15, 2021

& We participate within our dental community in educational meetings and events, which builds our trust in the specialist. The question often becomes, how can we overcome this disparity in attitudes towards our professional network of referrals? & To us it seems simple; we work with our colleagues on a daily basis.&

Patients 52

Patients Finance Education Utilities 52

PEMBlog

MAY 28, 2025

ED referrals are often prompted by incidental findings of proteinuria or hematuria, or clinical concerns for hypertensive encephalopathy or PRES. Education, psychosocial support, and long-term follow-up remain critical in improving outcomes for children with cSLE. References Brunner HI, Huggins J, Klein-Gitelman MS.

Diagnosis 94

Diagnosis Hypertension Complication Referral 94

Tiny Physician

JULY 12, 2021

Experienced faculties Image taken from [link] The quantity and quality of the faculties matter as far as PG education is concerned. Casualty OP patient load decides the number of ward admission as the sick children often come at casualty and not at referral OP. I would share one anecdote here.

Internal Medicine 52

Internal Medicine Management ER Referral 52

Vascular Physician

JULY 11, 2021

Educating patients on the link between emotional stress and Raynaud's phenomenon is important and attention to mental health disorders should be considered. This includes avoidance of cold temperatures and sudden temperature changes, which can even occur when entering the frozen food section at the supermarket.

Referral 52

Referral Mental Health Patients Diagnose 52

Tiny Physician

FEBRUARY 15, 2022

There is an increasing trend in the number of medico-legal cases filed against doctors and doctors have started practicing defensive medicine (the ordering of tests, procedures, referrals, or avoidance of high-risk patients or procedures, to reduce medico-legal cases) for the sake of their safety. patients show their frustration at doctors.

Patient-Centered 52

Patient-Centered Government Referral Hospital 52

PEMBlog

MAY 20, 2025

I think it’s very important, almost an obligation, for us to provide outreach and education to our community ED colleagues so that they are given the tools needed to provide the right imaging to the right patient at the right time. They’re not just the test referral center. So I’ll give you a couple of examples.

Families 101

Families Family Hospital Patient-Centered 101

GeriPal

JUNE 12, 2025

During my training, I didn’t receive much education about radiation oncology, and I’m not entirely sure what some of the terms mean (hypofractionated means fewer sessions, right?). Anish 07:54 I would say sort of echoing what Emily was just referring to is education is key. So I think education is key.

Patient-Centered 103

Patient-Centered Referral Patients IT 103

GeriPal

OCTOBER 13, 2022

And they should be forced by doing research, followed by translating research into practice and continued education of a wide variety of individuals to then care for our aging population. That gave rise to the GEMSSTAR, which is grants for early medical and surgical specialists in aging research that’s supported by NIA.

Complication 97

Complication Patient-Centered IT Patients 97

PEMBlog

OCTOBER 2, 2024

But if they’re not improving, And that could be a cause for referral to gastroenterology. And I did put it in the title, but it’s what most people call it, and perhaps this was a bridge to education. A trial of four to eight weeks would be reasonable. Kids can get better on what we recommend. You should trust that.

Diagnosis 52

Diagnosis Management IT Patient-Centered 52

ABIM

JUNE 24, 2025

The group discussed policy shifts and potential implications for graduate medical education and health equity. Dr. McDonald acknowledged that recent executive orders have emphasized more competition in medical and legal education accreditation, but reaffirmed ABIM’s commitment to evidence-based practice and health equity.

Board-Certified 40

Board-Certified Board-Certified Physicians Government Community 40

GeriPal

FEBRUARY 15, 2024

Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Community 116

Community Transportation IT PCP 116

GeriPal

JUNE 5, 2025

The obstacles hindering referrals to palliative care services. We also take a dive into these 2 articles that Connie first authored: Palliative care in nursing homes: A qualitative study on referral criteria and implications for research and practice. And what does that referral process look like? So that part we know and I.

Nurse Practitioner 78

Nurse Practitioner Referral Consulting Board-Certified 78

GeriPal

FEBRUARY 22, 2024

Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Mental Health 123

Mental Health Patient-Centered Illness Screening 123

GeriPal

JULY 11, 2024

Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Patient-Centered 110

Patient-Centered IT Patients Clinic 110

GeriPal

JANUARY 18, 2024

Alex: We are delighted to welcome back to the GeriPal podcast, Katie Fitzgerald Jones, who’s a nurse scientist at the New England Geriatric Research Education and Clinical Center, and a palliative and addiction nurse practitioner at the VA in Boston. AMA PRA Category 1 credit(s) ™. Who do we have with us today? ” Thoughts on that?

Illness 137

Illness Patient-Centered Screening Clinic 137

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. ” Whether it’s referrals that need to be made, or whether they’re specific actions that the person at home needs to take, like a home safety change.

Patient-Centered 130

Patient-Centered IT Patients Clinic 130

PEMBlog

JANUARY 16, 2025

So pediatricians, Educators and parents all play a crucial role in prevention. Students should be educated about the dangers of inhalants. For those already misusing inhalants, referral to a substance use disorder program is essential. Again, I would call a toxicologist for help from this, because fortunately, its very rare.

Complication 52

Complication Patient-Centered Management Patients 52

GeriPal

MARCH 6, 2025

Just out of fellowship, Naheed built a palliative care program for homeless persons called the Palliative Education and Care for the Homeless (PEACH) Program. He’s the founder and leader of the Palliative Education and Care for the Homeless program in Toronto, Palliative care physician at St. Naheed 07:33 Yeah.

Healthcare 102

Healthcare IT Community Illness 102

GeriPal

JULY 21, 2022

Emmy: So I think shifting that a little bit is what helped me do a lot of the education that I do to therapists and physicians, just to have it on their radar. ” So some of it is education around driving habits and ways of getting places also. Just like Emmy was saying, just bring it up and make that an okay conversation to have.

Families 102

Families IT Family Diagnosis 102

GeriPal

APRIL 6, 2023

Practice-PC is an intentionally interprofessional and cutting edge year-long group continuing education course in palliative care for working professionals from all disciplines, in the Bay Area. In addition to that long list, I was also a chaplain educator. It meets in-person, once a month, over nine sessions. Where are my colleagues?”

IT 99

IT Patient-Centered Families Family 99

GeriPal

OCTOBER 17, 2024

And I think one key part is educating the field, not just my fellow cardiologists, but also primary care doctors, geriatricians, that there’s this heart failure syndrome that is kind of sneaky, and it’s kind of difficult to diagnose any. If you have access to that, I think, is the way to go. Eric 14:10 Yeah.

Primary Care 114

Primary Care Patient-Centered IT Patients 114

GeriPal

FEBRUARY 6, 2025

So I get all the referrals from my great colleagues in primary care. Nate 26:42 And so if we’re going to be using that term in a new way, there’s a lot that has to go into the education and reframing of that. Eric 41:31 Also worry that like part of this is the, the taint that educated me put over everything.

Primary Care 97

Primary Care Diagnosis Screening IT 97

GeriPal

MARCH 10, 2022

So we looked at hospital referral regions, and we looked at high- and low- intensity regions. Caroline: Again, just further educating on the front lines and families in particular, I think is really important as well as these policy implications. It’s way more complex than an educational program. This doesn’t work.”

Nurse Practitioner 60

Nurse Practitioner Hospital Families Family 60

GeriPal

OCTOBER 20, 2022

And they should be forced by doing research, followed by translating research into practice and continued education of a wide variety of individuals to then care for our aging population. That gave rise to the GEMSSTAR, which is grants for early medical and surgical specialists in aging research that’s supported by NIA.

Complication 52

Complication Patient-Centered IT Patients 52