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    1653 results match your criteria Annals of Family Medicine[Journal]

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    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

    Agriculture and Health Sectors Collaborate in Addressing Population Health.
    Ann Fam Med 2017 Sep;15(5):475-480
    University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico.
    Purpose: Population health is of growing importance in the changing health care environment. The Cooperative Extension Service, housed in each state's land grant university, has a major impact on population health through its many community-based efforts, including the Supplemental Nutrition Assistance Program - Education (SNAP-Ed) nutrition programs, 4-H youth engagement, health and wellness education, and community development. Can the agricultural and health sectors, which usually operate in parallel, mostly unknown to each other, collaborate to address population health? We set out to provide an overview of the collaboration between the Cooperative Extension Service and the health sector in various states and describe a case study of 1 model as it developed in New Mexico. Read More

    Health Care Disparities of Ohioans With Developmental Disabilities Across the Lifespan.
    Ann Fam Med 2017 Sep;15(5):471-474
    The Ohio State University, Nisonger Center, Ohio Disability & Health Program, Columbus, Ohio.
    We explored health care differences across the lifespan comparing people with developmental disabilities to people without developmental disabilities. Health care disparities are inequities occurring during the provision of and in access to health care that are experienced by socially disadvantaged populations. We discovered significant disparities between persons with and without developmental disabilities in health status, quality, utilization, access, and unmet health care needs. Read More

    Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England.
    Ann Fam Med 2017 Sep;15(5):462-470
    Population Health Research Institute, St George's University of London, United Kingdom.
    Purpose: Adults with intellectual disabilities experience poorer physical health and health care quality, but there is limited information on the potential for reducing emergency hospital admissions in this population. We describe overall and preventable emergency admissions for adults with vs without intellectual disabilities in England and assess differences in primary care management before admission for 2 common ambulatory care-sensitive conditions (ACSCs).

    Methods: We used electronic records to study a cohort of 16,666 adults with intellectual disabilities and 113,562 age-, sex-, and practice-matched adults without intellectual disabilities from 343 English family practices. Read More

    Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database.
    Ann Fam Med 2017 Sep;15(5):455-461
    Primary Care Patient Safety (PISA) Research Group, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales
    Purpose: A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. Read More

    Risk Stratification Methods and Provision of Care Management Services in Comprehensive Primary Care Initiative Practices.
    Ann Fam Med 2017 Sep;15(5):451-454
    Center for Medicare & Medicaid Innovation, Baltimore, Maryland.
    Purpose: Risk-stratified care management is essential to improving population health in primary care settings, but evidence is limited on the type of risk stratification method and its association with care management services.

    Methods: We describe risk stratification patterns and association with care management services for primary care practices in the Comprehensive Primary Care (CPC) initiative. We undertook a qualitative approach to categorize risk stratification methods being used by CPC practices and tested whether these stratification methods were associated with delivery of care management services. Read More

    Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer.
    Ann Fam Med 2017 Sep;15(5):443-450
    Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, Oxford, United Kingdom.
    Purpose: Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments.

    Methods: Using electronic primary care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time. Read More

    Uninsured Primary Care Visit Disparities Under the Affordable Care Act.
    Ann Fam Med 2017 Sep;15(5):434-442
    Oregon Health & Science University, Portland, Oregon.
    Purpose: Health insurance coverage affects a patient's ability to access optimal care, the percentage of insured patients on a clinic's panel has an impact on the clinic's ability to provide needed health care services, and there are racial and ethnic disparities in coverage in the United States. Thus, we aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity.

    Methods: We undertook a retrospective, observational study of visit payment type for CHC patients aged 19 to 64 years. Read More

    Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial.
    Ann Fam Med 2017 Sep;15(5):427-433
    Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
    Purpose: Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.

    Methods: We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Read More

    Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.
    Ann Fam Med 2017 Sep;15(5):419-426
    School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin.
    Purpose: Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. Read More

    Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST.
    Ann Fam Med 2017 Sep;15(5):413-418
    Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts.
    Background: Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). Read More

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