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How to Improve Care for Patients With Multiple Chronic Conditions

Physician's Weekly

Caring for patients with multiple chronic conditions requires identifying those at risk, clear communication, and coordinated care to improve outcomes. Many of these patients are clinically complex and receive care from multiple professionals—which creates unique management hurdles.

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Pilot Testing of the Treatment Burden Screening in Diabetes Tool in Primary Care [Multimorbidity]

Annals of Family Medicine

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.

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Ambulatory Behavioral Health Referral Patterns in the Setting of Chronic Medical Conditions [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

Context: Patients with chronic medical conditions (CCs) and behavioral comorbidities have lower quality of life and increased healthcare expenses. Our work builds a foundation for cost-effective workflows to support patients with multimorbidity. 8% (n= 1,146) were ordered for medical condition management.

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The Evolution of Concierge Medicine: What 20 years in the industry have taught me

Concierge Choice Physicians

​By Wayne Lipton Managing Partner, Concierge Choice Physicians ​The Origin Story It was the early 1990s when I embarked on a career in concierge medicine. Perhaps their patient base was small, or they were practicing in a more rural, less wealthy area. ​The model took off. ​The model took off.

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Using EMR data to describe administrative workload of primary care providers in Nova Scotia, Canada [Secondary data analysis]

Annals of Family Medicine

Context: Primary care providers in Canada face significant workload challenges, including managing prescriptions, referrals, and laboratory tests alongside patient visits. Results: Clinicians with 500 or more patient contacts had an average of 2.7 0.9SD) encounters per patient since 2007. referrals, and 6.6 (2.8)

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Multisector Health Equity Coordination in a Midwestern Primary Care Practice, 2022-2023 [Social determinants and vulnerable populations]

Annals of Family Medicine

Multisector coordination is critical for effective screening and referral initiatives. Objective: To assess the function and impact of a new role, a Health Equity Coordinator, on the reach of the social needs screening and referral program. Contact hours included a mix of in-person visits and phone calls.

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Ep. 71: Agentic AI with Isaac Park of Keebler Health

Physician's Practice

71: Agentic AI with Isaac Park of Keebler Health June 30, 2025 By Austin Littrell Fact checked by Keith A. 71: Agentic AI with Isaac Park of Keebler Health June 30, 2025 By Austin Littrell Fact checked by Keith A. 71: Agentic AI with Isaac Park of Keebler Health June 30, 2025 By Austin Littrell Fact checked by Keith A.