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Ann Fam Med 2019 Mar;17(2):iii

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AAFP News.

Ann Fam Med 2019 Mar;17(2):178

Winding Waters Clinic, Enterprise, Oregon.

Ann Fam Med 2019 Mar;17(2):177

Immigrant and Refugee Health Program, Boston Medical Center, Boston, Massachusetts.

Ann Fam Med 2019 Mar;17(2):176

Ann Fam Med 2019 Mar;17(2):173-175

University of Minnesota, Minneapolis, Minnesota

I am a primary care physician diagnosed with breast cancer in 2016. After my diagnosis, I began to wonder, is it ever appropriate to disclose my situation, my diagnosis, any details about my cancer journey to my patients? On the one hand, physicians go to great lengths to protect privacy; on the other hand, patients appreciate the ability to share and connect, including knowing that their doctor has been through something similar. In this essay, I explore the nuances of over-sharing versus making a personal connection and how the two elements of this dual role might ultimately benefit each other. Read More

Ann Fam Med 2019 Mar;17(2):164-172

Department of Epidemiology and Biostatistics, College of Public Health, the University of Georgia, Athens, Georgia.

Purpose: To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS).

Methods: We searched Medline to identify studies of outpatients with clinically suspected ARS and sufficient data reported to calculate the sensitivity and specificity. Of 1,649 studies initially identified, 17 met our inclusion criteria. Read More

Ann Fam Med 2019 Mar;17(2):161-163

Agency for Healthcare Research and Quality, Rockville, Maryland.

Tobacco use, lack of physical activity and poor diet, and alcohol consumption are leading causes of death in the United States. We estimated screening and counseling rates by using a nationally representative sample of adults aged 35 years and older with a preventive care supplement to the 2014 Medical Expenditure Panel Survey. Receipt of the recommended level of services ranged from nearly two-thirds (64. Read More

Ann Fam Med 2019 Mar;17(2):158-160

Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Loneliness is associated with poor health outcomes, and there is growing attention on loneliness as a social determinant of health. Our study sought to determine the associations between community factors and loneliness. The Three-Item Loneliness Scale and zip codes of residence were collected in primary care practices in Colorado and Virginia. Read More

Ann Fam Med 2019 Mar;17(2):150-157

CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada

Purpose: Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. Read More

Ann Fam Med 2019 Mar;17(2):141-149

Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

Purpose: Time during primary care visits is limited. We tested the hypothesis that a waiting room health information technology (IT) tool to help patients identify and voice their top visit priorities would lead to better visit interactions and improved quality of care.

Methods: We designed a waiting room tool, the Visit Planner, to guide adult patients through the process of identifying their top priorities for their visit and effectively expressing these priorities to their clinician. Read More

Ann Fam Med 2019 Mar;17(2):133-140

HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.

Purpose: To evaluate a patient-report instrument for identifying adverse drug events (ADEs) in older populations with multimorbidity in the community setting.

Methods: This was a retrospective cohort study of 859 community-dwelling patients aged ≥70 years treated at 15 primary care practices. Patients were asked if they had experienced any of a list of 74 symptoms classified by physiologic system in the previous 6 months and if (1) they believed the symptom to be related to their medication, (2) the symptom had bothered them, (3) they had discussed it with their family physician, and (4) they required hospital care due to the symptom. Read More

Ann Fam Med 2019 Mar;17(2):125-132

Primary Care and Population Sciences Unit, University of Southampton, Southampton, United Kingdom (Little, Mullee, Stuart, O'Reilly, Moore, Geraghty, Santer); School of Psychological Science, University of Bristol, Bristol, United Kingdom (Yardley); Economics Division, Stirling Management School, University of Stirling, Stirling, UK (Douglas); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (Verheij, van der Velden); Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (Butler, Tonkin-Crine); Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom (Francis); South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, United Kingdom (Hood); Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK (Kelson); Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Łódź , Łódź , Poland (Godycki-Cwirko); Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Mierzecki); Ely Bridge Surgery, Ely, Cardiff, United Kingdom (Davies); Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-University of Barcelona (UB)-Ciber de Enfermedades Respiratorias (Ciberes) Villarroel, Barcelona, Spain (Torres); Department of Primary and Interdisciplinary Care (ELIZA), Department of Epidemiology and Social Medicine and Vaccine & Infectious Disease Institute (VAXIN-FECTIO), University of Antwerp, Antwerp, Belgium (Coenen); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium (Goossens); Department of Primary and Interdisciplinary Care (ELIZA), Universityof Antwerp, Antwerp, Belgium (Anthierens); University Rovira i Virgili, Tarragona, Spain, Spanish Society of Family Medicine (semFYC) (Llor); Maastricht University/CAPHRI, Maastricht, The Netherlands (Cals); and General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway (Melbye).

Purpose: C-reactive-protein (CRP) is useful for diagnosis of lower respiratory tract infections (RTIs). A large international trial documented that Internet-based training in CRP point-of-care testing, in enhanced communication skills, or both reduced antibiotic prescribing at 3 months, with risk ratios (RRs) of 0.68, 0. Read More

Ann Fam Med 2019 Mar;17(2):116-124

Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.

Purpose: Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined the trends in and determinants of the services provided in a cohort of primary care physicians in British Columbia, Canada.

Methods: We used physician-level payments for all primary care physicians practicing in British Columbia from 2006-2007 through 2011-2012. Read More

Ann Fam Med 2019 Mar;17(2):108-115

Department of Family Medicine and Community Health, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Purpose: Loneliness has important health consequences. Little is known, however, about loneliness in primary care patient populations. This study describes the prevalence of loneliness in patients presenting for primary care and associations with self-reported demographic factors, health care utilization, and health-related quality of life. Read More

Ann Fam Med 2019 Mar;17(2):100-107

Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

Purpose: Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged ≥75 years with or without complex health problems.

Methods: We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Read More

Ann Fam Med 2019 Jan;17(1):iii

Rush Medical College.

Ann Fam Med 2019 Jan;17(1):91-92

AAFP News Department.

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University of British Columbia, School of Nursing and Centre for Health Services and Policy Research.

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Oregon Health & Science University, Department of Family Medicine, Portland, Oregon.

Ann Fam Med 2019 Jan;17(1):85

Ann Fam Med 2019 Jan;17(1):82-84

Department of Family and Community Medicine, University of California, San Francisco, California

Before entering medicine, I was inspired by community organizing as a model for driving social change and improving public health. As a clinician, I remain inspired by this approach; however, I find that it has been more challenging to integrate into my day-to-day work than I expected. In this essay, I describe my journey from community organizer to primary care clinician and reflect on the lessons I've learned about the value of community organizing and ways that it can be incorporated into clinical practice. Read More

Ann Fam Med 2019 Jan;17(1):77-81

Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.

As a result of a large and compelling body of evidence documenting the impacts of social determinants, such as income and education, on health outcomes, health care systems are beginning to incorporate social and economic risk data into health care delivery decisions. But there is a risk that some of these efforts could worsen health and widen health inequities. We highlight 3 examples- including recent policy changes in Medicaid, social needs, informed risk prediction models, and advances in precision medicine-where the inclusion of social risk information threatens to reduce care quality or health care access for some groups of patients. Read More

Ann Fam Med 2019 Jan;17(1):70-76

Case Western Reserve University, Cleveland, Ohio

Although the generation of new knowledge through research is a hallmark of medical specialties, research was a low priority in family practice when it was established in 1969. Today, when a base of knowledge is crucial to the ability to lead health care change, the early relationship between family practice and research continues to influence the specialty. An examination of archival and secondary materials finds that the priority placed on research during family practice's early years was shaped by internal and external factors, including, (1) family physicians' desire to differentiate themselves from the prevailing specialty environment; (2) lack of a clear identity in family practice; (3) the non-laboratory nature of family medicine research; (4) reliance on information from other specialties; and, (5) a focus on establishing an academic presence. Read More

Ann Fam Med 2019 Jan;17(1):61-69

Center for General Practice at Aalborg University, Aalborg, Denmark.

Purpose: Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ultrasound (POCUS) by general practitioners.

Methods: We followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. Read More

Ann Fam Med 2019 Jan;17(1):52-60

Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom

Purpose: We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

Methods: We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Read More

Ann Fam Med 2019 Jan;17(1):49-51

School of Medicine, Department of General Practice, Sorbonne University, Paris, France

Research is a necessity for high-quality medicine. We used the MEDLINE database to conduct a bibliometric analysis of research output with respect to primary care by 21 countries. For the period 1974 to 2017, the United States and the United Kingdom stood out in terms of publication volume, and the UK, Canada, and Australia had the greatest percentage of publications in primary care. Read More

Ann Fam Med 2019 Jan;17(1):46-48

Family Medicine Residency Network, Department of Family Medicine, University of Washington, Seattle, Washington.

Family physicians' scope of practice is declining despite being well prepared to provide a range of clinical services. To evaluate whether this is a new phenomenon, we compared the proportions of regional family medicine residency graduates who report practicing and those who report feeling more than adequately prepared to practice various procedures and clinical services from 2 points in time-a survey in 2000 of graduates from 1996-1999 (n = 293) and a survey in 2012 or 2014 of graduates from 2010-2013 (n = 408). The recent graduates felt better prepared, but reported a narrower scope of practice than those who graduated more than a decade earlier. Read More

Ann Fam Med 2019 Jan;17(1):42-45

Department of Family & Community Medicine, University of California, San Francisco, California.

Recent studies have explored clinician impacts of health care-based interventions that respond to patients' social and economic needs. These studies were limited by available clinician data. We used the Commonwealth International Health Policy Survey of 890 primary care physicians to examine associations between clinic capacity to respond to patients' social needs and physician satisfaction, stress, and perceived medical care quality. Read More

Ann Fam Med 2019 Jan;17(1):36-41

Department of Family & Community Medicine, University of California San Francisco, San Francisco, California.

Purpose: Levels of burnout among primary care clinicians and staff are alarmingly high, and there is widespread belief that burnout and lack of employee engagement contribute to high turnover of the workforce. Scant research evidence exists to support this assertion, however.

Methods: We conducted a longitudinal cohort study using survey data on burnout and employee engagement collected in 2013 and 2014 from 740 primary care clinicians and staff in 2 San Francisco health systems, matched to employment roster data from 2016. Read More

Ann Fam Med 2019 Jan;17(1):31-35

Department of Primary and Community Care, Radboud Institute of Health Sciences, Nijmegen, The Netherlands.

Purpose: To identify and prioritize the needs for new research evidence for primary health care (PHC) in low-and middle-income countries (LMICs) about organization, models of care, and financing of PHC.

Methods: Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, via web-based surveys. Iterative literature review conducted in parallel. Read More

Ann Fam Med 2019 Jan;17(1):23-30

Department of Medicine, Section of General Internal Medicine, The University of Chicago, Chicago, Illinois

Purpose: The US Preventive Services Task Force recommends screening for depression in the general adult population. Although screening questionnaires for depression and anxiety exist in primary care settings, electronic health tools such as computerized adaptive tests based on item response theory can advance screening practices. This study evaluated the validity of the Computerized Adaptive Test for Mental Health (CAT-MH) for screening for major depressive disorder (MDD) and assessing MDD and anxiety severity among adult primary care patients. Read More

Ann Fam Med 2019 Jan;17(1):14-22

Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom.

Purpose: Describe the duration of symptoms, proportion of parents seeking primary care consultations, and costs for respiratory tract infections (RTIs) of children in the community.

Methods: Community-based, online, prospective inception cohort study. General practitioners from socioeconomically diverse practices posted study invitations to parents of 10,310 children aged ≥3 months and <15 years. Read More

Ann Fam Med 2019 Jan;17(1):7-13

Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands.

Purpose: Annual influenza immunization in medical risk groups is recommended in many countries. Recent evidence suggests that repeated inactivated influenza vaccine (IIV) immunization throughout childhood may impair long-term immunity against influenza. We assessed whether prior immunization altered the effect of IIV in children with preexisting medical conditions on primary care-diagnosed respiratory illness (RI) episodes during the influenza season. Read More

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Ann Fam Med 2019 Jan;17(1)

Professor Emeritus of Family Medicine, University of Washington School of Medicine, Seattle, Washington.

Ann Fam Med 2018 Nov;16(6):iii

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American Board of Family Medicine.

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AAFP News.

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