Annals of Family Medicine

NOVEMBER 20, 2024

Context: While hypertension is the most common chronic disease cared for during adult primary care visits, it is challenging to know which hypertensive patients have the highest risk of cardiovascular complications in the future. A total of 269,411 patients were used for model training.

Hypertension 130

Hypertension Primary Care Primary Care Physician Chronic Disease 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Social prescribing has been linked to better access, improved health and wellbeing, and decreased health care utilization (HCU). Population Primary care providers in 12 Ottawa and Sudbury (Ontario, Canada) practices referred their patients with health or social needs to access needed SP services.

Patient-Centered 130

Patient-Centered Utilities ER Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: Describe codesign methods to implement actionable strategies for breast cancer survivorship follow-up care. The resulting intervention was a care quality improvement project that engaged practice champions (n=18) from 6 primary care practices in bi-weekly virtual facilitation and monthly learning collaboratives over 3 months.

Primary Care 130

Primary Care Referral Electronics Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Patients with diabetes who receive structured and integrated care have better control and outcomes; however, care may shift between multiple settings making coordination challenging. Outcome Measures: Number of patients engaged, resulting referrals, Navigator time per patient, and hemoglobin A1c measures across 2-years.

Primary Care 130

Primary Care Diabetes Referral Integrated Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective To examine utilization of the screening, and prevalence of FI at two time points in a pediatric clinic an urban pediatric practice that has implemented universal FI screening and response. Comparison of FI for paired patients in 2022 and 2023. 164 unique patients received well-child checks in both 2022 and 2023.

Primary Care 130

Primary Care Screening Referral Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Stigma surrounding addiction and substance use disorders (SUDs) hinders access to intervention and treatment, directly impacting primary care efforts. Study Design: We utilized a scoping review approach, which is a non-exhaustive selection of literature pertaining to and examining a specific topic.

Primary Care 130

Primary Care Individual Utilities IT 130

Annals of Family Medicine

NOVEMBER 20, 2024

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 Female patients had lower rates of NS, but higher rates of SDC. for CA, 0.85

Appointment 130

Appointment Primary Care Family Medicine DO 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: Evaluate the economic impact of receiving tele-legal services from Medicaid’s perspective with regard to a) fee- for service (FFS) total cost of care; b) FFS cost of primary care; c) utilization for FFS primary care; d) utilization for FFS and capitated behavioral health (BH) and BH emergency department encounters.

Primary Care 130

Primary Care Medical Behavioral Health Services Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

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. The survey was anonymous both before and after the rotation.

Education 130

Education Primary Care Physician Primary Care DO 130

Annals of Family Medicine

NOVEMBER 20, 2024

Patients with the worst outcomes often lack continuity of primary care and receive care at emergency departments during exacerbations. Improved asthma outcomes are associated with effective communication between patients and providers, such as using shared decision-making. to 0.08, p=0.44), 5% to 2% ([95%]CI -0.03

Primary Care 130

Primary Care Asthma Utilities Provider 130

Annals of Family Medicine

NOVEMBER 20, 2024

Study Design and Analysis: We used information gathered from site visits and team meetings to understand how Compass Rose was being utilized across sites. We also assessed patterns of social risks and need for assistance among our patient populations. Of those patients with an episode (i.e.,

Referral 130

Referral Community Transportation Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: American Indian/Alaskan Native (AI/AN) patients are disproportionately affected by deleterious health outcomes for many preventable disease when compared to their non-indigenous counterparts. Population Studied: AI/AN patients residing in the USA. Results: All hypotheses were supported.

Primary Care 130

Primary Care Utilities Community Preventive Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: High-utilizer patient populations reflect poor health for those patients and high resource use for health systems. Few studies of high-utilization patient programs found improvements in the intervention groups compared to controls. Patients in both groups averaged approximately 12 ED visits, 5.7

Utilities 130

Utilities Primary Care Finance Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Project ECHO (Extension for Community Healthcare Outcomes) is a virtually-delivered health professions education model, designed to improve patient care by enhancing primary care capacity in specialty topics. Conclusion The burden of rheumatic disease is rising.

Primary Care 130

Primary Care Management Diagnose Clinical Practice 130

Annals of Family Medicine

NOVEMBER 20, 2024

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. Setting or Dataset A pretestposttest survey design was utilized to assess the intervention. This mismatch is worsened in rural communities.

Education 130

Education Primary Care Provider Community 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Hospice aims to manage a patient’s symptoms as they near end of life. While not the ideal case, patients may be discharged alive from hospice for a number of reasons, including: patient revocation of care, improved prognosis, or transfer of care to a different facility or geographic area.

Primary Care Physician 130

Primary Care Physician Utilities PCP PCP 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Efforts to understand patient spirituality and implement spiritual history-taking tools have yet to consider the specific needs of refugee populations. For example, many Burmese immigrants and refugees have faced religious persecution, which may affect the process of spiritual history-taking for enhancing patient care.

Primary Care 130

Primary Care Physicals Appointment Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Primary healthcare is the front door to the health system, facilitating access to diagnostic testing and specialist care. Patients without a regular primary care provider (a family physician or nurse practitioner) are considered "unattached,". Population studied: Unattached patients in ON, QC, and NS.

Primary Care 130

Primary Care Nurse Practitioner Finance Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Continuity of care between a patient and their primary care practitioner (PCP) is a cornerstone of primary care (PC) and is associated with many positive health outcomes including decreased utilization of ER services and lower costs for some populations. or low (< 0.7).

PCP 130

PCP PCP ER Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: COPD patient self-management plans, including rescue packs (antibiotic and steroid combinations), are effective in reducing respiratory related emergency department (ED) visits and hospital readmissions. Utilization of action plans/rescue packs within our health system remains relatively limited.

Utilities 130

Utilities Education Management Healthcare 130

Annals of Family Medicine

MAY 27, 2025

PURPOSE Primary care is the foundation of any health care system. Primary care improves the health of communities and decreases health inequities. METHODS We used the 2019 Virginia All-Payers Claims Database to identify primary care physicians (PCPs) and the number of distinct patients seen by each physician.

Primary Care 130

Primary Care PCP PCP Primary Care Physician 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective To introduce the novel approach of using a T-Connector between a patient’s HBPM and their physician’s office sphygmomanometer to permit a simultaneous blood pressure reading. there appears to be reasonable utility for using a T-Connector to qualitatively declare a HBPM to be inaccurate for its user.

Hypertension 130

Hypertension Family Physician Family Medicine DO 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Administrative activities, including work related to caring for individual patients and clinic administration, may play a substantial role in understanding changes to primary care workload. Results/Findings Information management is central to health care delivery, but often not valued or actively supported.

Primary Care 130

Primary Care Management Nurse Practitioner Family Physician 130

Annals of Family Medicine

MAY 27, 2025

PURPOSE We assessed the feasibility and acceptability of implementing a digital cognitive assessment (DCA) for Alzheimer disease and related dementias (ADRD) screening into primary care. We also assessed the prevalence of positive screens and measured diagnostic and care outcomes after a positive DCA result.

Primary Care 130

Primary Care Diagnosis Screening Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Telehealth became an essential tool to assist care delivery in the outpatient primary care settings during the COVID-19 pandemic. Previous studies documented that the type of insurance coverage was associated with the likelihood of a patient receiving care through telehealth.

Telehealth 130

Telehealth Primary Care Finance Insurance 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Despite the many well-established benefits of primary care (PC), the percentage of Americans with a source of usual care or with an ongoing PC relationship is declining. Measures were further categorized into 13 access domains.

Primary Care 130

Primary Care Insurance Utilities Relationship 130

Annals of Family Medicine

NOVEMBER 20, 2024

We utilized AI tools in the qualitative software program Atlas.ti to complete an analysis of qualitative data collected from primary care clinician and staff perspectives on the use of anti-obesity medications. Objective: To describe the use of AI tools and a targeted analytic technique in supporting qualitative data analysis.

Primary Care 130

Primary Care Electronics Provider Management 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Diabetes management (DM) for patients with Type 2 Diabetes (T2D) can be hindered by non-medical, health-related social needs. Objective: To describe how primary care clinics have considered social needs in DM, and identify opportunities to support primary care clinics.

Primary Care 130

Primary Care Diabetes Management Provider 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Pre-consultation telemedicine tools have been proposed as an effective solution to optimize the care of the growing number of older patients with chronic conditions. However, little information exists on how to successfully implement these tools in the primary care setting.

Primary Care 130

Primary Care Consulting Telemedicine Chronic Condition 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: In Ontario, patients who move increasingly keep their family physician (FP) because no one in their new community is accepting new patients, creating long distances to seek primary care. Study Design: A cross-sectional analysis of patients and FPs in Ontario from April 1, 2021, to March 31, 2023.

Family Physician 130

Family Physician Primary Care Families Family 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Patient Safety Objective: Identify Patients at High Risk for Falls using an AI/ML model. Falls among elderly patients are costly and potentially preventable. Overtreatment of hypertension has been identified as a major risk factor for putting patients at risk for falls in patients with low blood pressures.

Patients 130

Patients Hypertension Primary Care Chronic Condition 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context In the post-discharge period from hospital acute inpatient care, the older patient is at risk from a lack of joined-up care. Though patients/carers are often copied in, they seldom get a plain English version or space to discuss its contents. A subset of ~24 patients/their carers will be interviewed.

GP 130

GP DO Hospital Family Medicine 130

Barton Associates

MAY 8, 2025

Across the United States, tens of millions of Americans live in areas with shortage s of primary care, dental, and mental health professionals. These professionals play a vital role in maintaining essential services and ensuring continuity of patient care.

Medical Staff 52

Medical Staff Medical Patients Healthcare 52

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: This study aimed to characterize populations with COVID-19 and LCS, describes symptoms, and health care utilization by presenting symptoms. Study Design and Analysis: Two survey’s captured acute COVID-19 symptoms, LCS symptoms, and health care utilization. Among online respondents, 15.2%

Healthcare 130

Healthcare Community Primary Care Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: To describe a decade-long implementation process for genomic and precision medicine embedded in a primary care community hospital network. Population Studied: Ambulatory patients who participated in Endeavor Health Center for Personalized Medicine genomic services.

Community 130

Community Patient-Centered Primary Care Electronics 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Continuity of care between a patient and their primary care practitioner (PCP) is a cornerstone of primary care (PC) and is associated with many positive health outcomes. Many proposed methods for measuring continuity utilize an aggregation of patient visits.

PCP 130

PCP PCP Finance Nurse Practitioner 130

Annals of Family Medicine

JANUARY 27, 2025

PURPOSE Mental health screening is recommended by the US Preventive Services Task Force for all patients in areas where treatment options are available. Still, it is estimated that only 4% of primary care patients are screened for depression. 95% CI, 69.0-73.5) and a specificity of 73.5 (95% 95% CI, 71.5-75.5).

Primary Care 130

Primary Care Screening Mental Health Utilities 130