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Transitional Care Management care team impact on no-show rates to hospital discharge appointments [Patient education/adherence]

Annals of Family Medicine

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. Population Studied: Inpatients were referred if they were being discharged from the Family Medicine service to home.

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Advancing Primary Care through a Model Unit for Innovative Practice Enhancement [Practice management and organization]

Annals of Family Medicine

Setting or Dataset: Data includes secondary data gathered through Epic electronic medical records system as well as primary data collected from physicians, APPs, and staff working in the MU. Results: We observed an increase in telehealth visits from 4% to 9% and uptake of ambient documentation by 9 of 10 providers during a pilot period.

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Utilization of Treatment for Chlamydia and Gonorrhea in the Primary Care Setting Using the American Family Cohort [Infectious diseases (not respiratory tract)]

Annals of Family Medicine

Setting or Dataset: Electronic health records from the PRIME Registry, years 2018-2022. The electronic health records are stored in the American Family Cohort, the largest national United States primary care database. Efforts are needed to develop management plans for better quality of STI-related care and health equity.

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Describing Differences Across Place and Provider in Canadian Team-Based Care Settings Using Electronic Health Records [Health care informatics]

Annals of Family Medicine

In both cases, TBC can help by providing a collaborative approach to care that can better manage the complex needs of patients. We also observed that family physicians and nurses tend to use more clinically-oriented codes, while mental health care providers and therapists use more codes related to social determinants of health.

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Pain-Related Medication in Adults with Intellectual Disability: a systematic review [Pain management]

Annals of Family Medicine

Intervention/Instrument: No intervention; study included if reported any analgesic or non-analgesic medication used to manage pain or treat a painful condition. Measures: Varied by study design; self/carer-report or electronic health records (EHR). Results: 21,603 articles identified.

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Cardiovascular risk management of patients with depression in Dutch general practices [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

In the Netherlands GPs are also responsible for cardiovascular risk management (CVRM), for which a guideline is made. Objective: To investigate whether the cardiovascular risk management of Dutch GPs differs in patients with and without depression. Outcome Measures: Registration of cardiovascular risk management.

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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

Setting: Three academic health systems with EPIC and Oracle electronic health records. Population Studied: Primary care team members involved in high blood pressure management. Intervention: COACH — a patient-facing decision support tool integrated into the electronic record. Study design: Deductive qualitative analysis.