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    1675 results match your criteria Annals of Family Medicine[Journal]

    1 OF 34

    Where We Belong: An Open Letter to My Colleagues in Training.
    Ann Fam Med 2018 Jan;16(1):80-82
    Seaport Community Health Center, Belfast, Maine
    Although the American health care system seems forever in flux, the young doctors who enter it provide one constant: their desire to help others. How will this desire express itself in an evolving marketplace? This letter is a reassurance that meaning and purpose can still be found in caring for others and investing in their worthy lives. Read More

    The Day I Died.
    Ann Fam Med 2018 Jan;16(1):77-79
    Mercy Health St. Vincent Medical Center, Obstetrics & Gynecology Residency Program, Toledo, Ohio.
    When I began experiencing chest pain that was different from my usual heartburn symptoms, I denied I could possibly be having a heart attack, but chewed 4 baby aspirin just in case. Despite years of community education about the need to call 911 and seek immediate emergency care when experiencing signs and symptoms of a heart attack, more than 350,000 individuals experienced an out-of-hospital cardiac arrest in 2016. Of those, only 12% survived. Read More

    Medical Interpreters in Outpatient Practice.
    Ann Fam Med 2018 Jan;16(1):70-76
    Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, Arizona
    This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs. Read More

    Using State Administrative Data to Identify Social Complexity Risk Factors for Children.
    Ann Fam Med 2018 Jan;16(1):62-69
    Seattle Children's Research Institute, Seattle, Washington.
    Purpose: Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use.

    Methods: We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). Read More

    Medical Students' Views of Medicine as a Calling and Selection of a Primary Care-Related Residency.
    Ann Fam Med 2018 Jan;16(1):59-61
    American Medical Association, Chicago, Illinois.
    With the US health care system facing a primary care physician shortage, we evaluated whether medical students who saw medicine as a calling were more likely to enter a family medicine, internal medicine, or pediatrics residency program. Of the 591 4th-year medical students who responded to a survey item on medicine as a calling, 237 strongly agreed that the "practice of medicine is a calling." Students who strongly agreed that medicine was a calling had higher odds (=. Read More

    Predictors of Attrition From Family Medicine Board Certification.
    Ann Fam Med 2018 Jan;16(1):55-58
    American Board of Family Medicine, Lexington, Kentucky.
    Board certification is associated with higher quality care. We sought to determine the rates and predictors of attrition from certification among family physicians who achieved initial certification with the American Board of Family Medicine from 1980 through 2000. In this period, 5. Read More

    Features of Terra Firma-Forme Dermatosis.
    Ann Fam Med 2018 Jan;16(1):52-54
    Department of Pediatric Nephrology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
    Terra-firma-forme dermatosis (TFFD) is a little known hyperpigmented skin disease that is more common than expected. We examined retrospectively the medical records of 79 patients: 88.6% were children, the mean age was 10. Read More

    Family Physicians Managing Medical Requests From Family and Friends.
    Ann Fam Med 2018 Jan;16(1):45-51
    Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands.
    Purpose: Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients.

    Methods: We conducted a qualitative study with 7 focus groups with junior and senior physicians. Read More

    A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes.
    Ann Fam Med 2018 Jan;16(1):37-44
    School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand.
    Purpose: We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur.

    Methods: All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Read More

    The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study.
    Ann Fam Med 2018 Jan;16(1):28-36
    Biostatistics Unit, Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
    Purpose: Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system.

    Methods: We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Read More

    Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing.
    Ann Fam Med 2018 Jan;16(1):21-27
    Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service (GGD) South Limburg, Heerlen, The Netherlands.
    Purpose: Both chronic hepatitis C (HCV) and B virus (HBV) infections are generally asymptomatic, and many remain undetected or are diagnosed at a late stage. Studies that evaluate best practice hepatitis testing strategies are needed to better detect this hidden population.

    Methods: In this prospective cohort study, we aimed to determine the diagnostic yield (test uptake and rate of positive test results) of a combined public health and primary care birth cohort testing strategy in detecting hidden cases of HCV and HBV infections. Read More

    Integrating Community Health Workers Into Medical Homes.
    Ann Fam Med 2018 Jan;16(1):14-20
    Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
    Purpose: Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team.

    Methods: We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Read More

    Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions.
    Ann Fam Med 2018 Jan;16(1):6-13
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
    Purpose: In the current payment paradigm, reimbursement is partially based on patient satisfaction scores. We sought to understand the relationship between prescription opioid use and satisfaction with care among adults who have musculoskeletal conditions.

    Methods: We performed a cross-sectional study using nationally representative data from the 2008-2014 Medical Expenditure Panel Survey. Read More

    Hatpins.
    Ann Fam Med 2017 Nov;15(6):581-582
    University of Rochester, Rochester, New York
    Hatpins is a first-person narrative that delves into a physician's experience of a patient death during the early years of residency. The essay reflects on the conflicted physician-patient relationships that can develop even over the short tenure of residency. While residency seeks to create medically prepared and compassionate physicians, this piece speaks to the importance of the often subtle learning that comes from ethical, social, and cultural aspects of both the lives and deaths of our patients. Read More

    Caring for the Tribe: From Addiction to Zen.
    Ann Fam Med 2017 Nov;15(6):578-580
    Seaport Community Health Center, Belfast, Maine
    The culture of medicine is rapidly changing. The majority of primary care physicians are now employed, and the decisions that govern us are made farther and farther from the point of care. Our sense of well-being is threatened less by the demands of clinical practice than it is by the emptiness of our job: we have forgotten who we are working for, or working with, or why we are working at all. Read More

    The Foundations Framework for Developing and Reporting New Models of Care for Multimorbidity.
    Ann Fam Med 2017 Nov;15(6):570-577
    NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
    Purpose: Multimorbidity challenges health systems globally. New models of care are urgently needed to better manage patients with multimorbidity; however, there is no agreed framework for designing and reporting models of care for multimorbidity and their evaluation.

    Methods: Based on findings from a literature search to identify models of care for multimorbidity, we developed a framework to describe these models. Read More

    Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes.
    Ann Fam Med 2017 Nov;15(6):561-569
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
    Purpose: No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.

    Methods: From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. Read More

    Factors Influencing Allopurinol Initiation in Primary Care.
    Ann Fam Med 2017 Nov;15(6):557-560
    Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom.
    Despite guidance on appropriate initiation, urate-lowering therapy is prescribed for only a minority of patients with gout. Electronic health records for 8,142 patients with gout were used to investigate the effect of age, sex, comorbidities, number of consultations, and meeting internationally agreed eligibility criteria on time to allopurinol initiation. Time to first prescription was modeled using multilevel Cox proportional hazards regression. Read More

    Trends in Patient-Perceived Shared Decision Making Among Adults in the United States, 2002-2014.
    Ann Fam Med 2017 Nov;15(6):552-556
    Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    To ascertain changes in shared decision making (SDM), we analyzed data from the nationally representative Medical Expenditure Panel Survey. We aggregated responses to questions into a 7-point SDM composite score. Between 2002 and 2014, the mean SDM composite score increased from 4. Read More

    Multimorbidity and Decision-Making Preferences Among Older Adults.
    Ann Fam Med 2017 Nov;15(6):546-551
    Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland.
    Purpose: Understanding individuals' preferences for participating in health care decisions is foundational to delivering person-centered care. We aimed to (1) explore preferences for health care decision making among older adults, and (2) identify multimorbidity profiles associated with preferring less active, ie, passive, participation among older US adults.

    Method: Ours was a cross-sectional, nationally representative study of 2,017 National Health and Aging Trends Study respondents. Read More

    An Autoethnographic Examination of Postpartum Depression.
    Ann Fam Med 2017 Nov;15(6):540-545
    Lehigh Valley Health Network, Allentown, Pennsylvania.
    Purpose: This article examines postpartum depression (PPD) using autoethnography to explore the stigmatization of depression and cultural expectations of motherhood. Because the personal experiences of living with PPD are often absent from primary care literature, this article uses first-person narrative and analysis of intensive mothering to explore the barriers to seeking PPD treatment, the need for increasing physician confidence and comfort using screening tools, and the impact PPD stigma has on patients and their health care.

    Methods: Autoethnography, as a relatively unfamiliar methodology in primary care, is used to illuminate individual experiences of living with PPD. Read More

    General Practitioner-Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study.
    Ann Fam Med 2017 Nov;15(6):535-539
    Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali).
    Background: Patients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the management of symptomatic proximal DVT. Read More

    Exploring Attributes of High-Value Primary Care.
    Ann Fam Med 2017 Nov;15(6):529-534
    Clinical Excellence Research Center, Stanford University, Stanford, California
    Purpose: Medicare's merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians' and policy makers' interest in care delivery attributes associated with value as defined by payers.

    Methods: To help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organization patients attributed to over 53,000 primary care practice sites. We identified sites ranking favorably on both quality and low total annual per capita health care spending ("high-value") and sites ranking near the median ("average-value"). Read More

    Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children.
    Ann Fam Med 2017 Nov;15(6):523-528
    Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France.
    Purpose: The distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children.

    Methods: From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers. Read More

    Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England.
    Ann Fam Med 2017 Nov;15(6):515-522
    Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
    Purpose: Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults.

    Methods: We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. Read More

    Randomized Controlled Trial of Text Message Reminders for Increasing Influenza Vaccination.
    Ann Fam Med 2017 Nov;15(6):507-514
    Communicable Disease Control Directorate, Department of Health Western Australia, Perth, Western Australia.
    Purpose: Seasonal influenza vaccine is recommended and funded for groups at higher risk of serious infection, but uptake is suboptimal. We conducted a randomized controlled trial of short message service (SMS) reminders for influenza vaccination.

    Methods: Six weeks after seasonal influenza vaccinations began, we identified high-risk patients who had a mobile telephone number on record at 10 practices in Western Australia. Read More

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