1,649 results match your criteria Annals of Family Medicine[Journal]


A MESSAGE FROM THE PRESIDENT.

Authors:
James C Puffer

Ann Fam Med 2018 May;16(3):276-277

View Article

The Patient Profile: Improving Treatment Adherence.

Ann Fam Med 2018 May;16(3):271

Westminster Medical Clinic, Westminster, Colorado.

View Article

The Mid-Career Demon.

Ann Fam Med 2018 May;16(3):264-266

Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

For several months I have been trying to tag a greyness that has shaded my doctoring. I was not burned out but uncovered the desert experience of mind and soul known as acedia, which is called the noonday demon because it vexes those in the mid-stages of life. Grappling with the noonday demon has upended all of my assumptions about the workings of hope in the practice of medicine. Read More

View Article

White Privilege in a White Coat: How Racism Shaped my Medical Education.

Authors:
Max J Romano

Ann Fam Med 2018 May;16(3):261-263

MedStar Franklin Square Medical Center, Baltimore, Maryland

In this essay, I reflect on some of the ways racial privilege influenced my experience as a white physician in training. While white Americans often think of "racism" as a social construct primarily affecting people of color, "racism" is a system of both racial disadvantage as well as reciprocal racial advantage. Medical professionals are increasingly aware of how social determinants of health lead to important health disparities, however white physicians seldom ask how their own racial privilege reinforces a white supremacist culture and what effects this may have on our patients' health. Read More

View Article

Creating a Centralized Infrastructure to Facilitate Medical Education Research.

Ann Fam Med 2018 May;16(3):257-260

Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina.

Purpose: Building research capacity and increasing scholarly productivity are identified needs of the specialty of family medicine. The Accreditation Council for Graduate Medical Education (ACGME) has increased the scholarly requirements for residency programs, placing even more pressure on faculty to be productive in the scholarly realm. The Council of Academic Family Medicine Educational Research Alliance (CERA) was created by volunteer members of the specialty with shared interests in overcoming barriers and increasing scholarly production. Read More

View Article

Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain.

Ann Fam Med 2018 May;16(3):250-256

Columbia University School of Nursing, New York, New York.

Purpose: Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Read More

View Article
May 2018
1 Read

Free Children's Visits and General Practice Attendance.

Ann Fam Med 2018 May;16(3):246-249

Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.

Purpose: In July 2015, all children aged younger than 6 years gained free access to daytime and out-of-hours general practice services in the Republic of Ireland. Although 30% previously had free access, 70% did not.

Methods: To examine subsequent changes in service use, we retrospectively analyzed anonymized visitation data from 8 general practices in North Dublin providing daytime service and their local out-of-hours service, comparing the 1 year before and the 1 year after introduction of free care. Read More

View Article

Roles and Functions of Community Health Workers in Primary Care.

Ann Fam Med 2018 May;16(3):240-245

Kaiser Permanente Washington Health Research Institute, Seattle, Washington.

Community health workers have potential to enhance primary care access and quality, but remain underutilized. To provide guidance on their integration, we characterized roles and functions of community health workers in primary care through a literature review and synthesis. Analysis of 30 studies identified 12 functions (ie, care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, health education, and literacy support) and 3 prominent roles representing clusters of functions: clinical services, community resource connections, and health education and coaching. Read More

View Article

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study.

Ann Fam Med 2018 May;16(3):232-239

Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada.

Purpose: This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation.

Methods: We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. Read More

View Article

Care Transitions From Patient and Caregiver Perspectives.

Ann Fam Med 2018 May;16(3):225-231

Department of Family Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Mitchell, Laurens, Weigel, Howard, Jack); School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (Hirschman, Shaid); Department of Communication, University of Kentucky, Lexington, Kentucky (Scott); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California (Nguyen); Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts (Laird); Families and Health Care Project, United Hospital Fund, New York, New York (Levine); Department of Medicine and Pediatrics, Louisiana State University Health Sciences, New Orleans, Louisiana (Davis); Telligen, Quality Improvement, Des Moines, Iowa (Gass); Center for Health Services Research, University of Kentucky, Lexington, Kentucky (Li, Williams).

Purpose: Despite concerted actions to streamline care transitions, the journey from hospital to home remains hazardous for patients and caregivers. Remarkably little is known about the patient and caregiver experience during care transitions, the services they need, or the outcomes they value. The aims of this study were to (1) describe patient and caregiver experiences during care transitions and (2) characterize patient and caregiver desired outcomes of care transitions and the health services associated with them. Read More

View Article
May 2018
3 Reads

Association of the Social Determinants of Health With Quality of Primary Care.

Ann Fam Med 2018 May;16(3):217-224

Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada.

Purpose: In primary care, there is increasing recognition of the difficulty of treating patients' immediate health concerns when their overall well-being is shaped by underlying social determinants of health. We assessed the association of social complexity factors with the quality of care patients received in primary care settings.

Methods: Eleven social complexity factors were defined using administrative data on poverty, mental health, newcomer status, and justice system involvement from the Manitoba Population Research Data Repository. Read More

View Article

An Updated Analysis of Direct-to-Consumer Television Advertisements for Prescription Drugs.

Ann Fam Med 2018 May;16(3):211-216

Klein College of Media and Communication, Temple University, Philadelphia, Pennsylvania.

Purpose: In 2015, the American Medical Association called for a ban of direct-to-consumer advertising (DTCA) for prescription drugs. Yet, the pharmaceutical industry spends more than ever on broadcast advertisements, with national health care costs largely driven by drug spending. An evaluation of these ads is critical, as these advertisements can impact the frequency which patients ask their doctors about medications. Read More

View Article

Improving Prediction of Dementia in Primary Care.

Ann Fam Med 2018 May;16(3):206-210

Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Purpose: The Mini-Mental State Examination (MMSE) is one of the most widely used instruments to screen for cognitive deficits; however, this instrument alone is not sensitive enough to detect early symptoms of dementia. We aimed to investigate whether additionally using the Visual Association Test (VAT) improves the predictive value of the MMSE score for development of dementia.

Methods: Analyses were based on data from 2,690 primary care patients aged 70 to 78 years who participated in the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial. Read More

View Article
May 2018
1 Read

Burnout and Scope of Practice in New Family Physicians.

Ann Fam Med 2018 May;16(3):200-205

American Board of Family Medicine, Lexington, Kentucky

Purpose: Family physicians report some of the highest levels of burnout, but no published work has considered whether burnout is correlated with the broad scope of care that family physicians may provide. We examined the associations between family physician scope of practice and self-reported burnout.

Methods: Secondary analysis of the 2016 National Family Medicine Graduate Survey respondents who provided outpatient continuity care (N = 1,617). Read More

View Article

White Privilege in Health Care: Following Recognition With Action.

Authors:
Joseph Hobbs

Ann Fam Med 2018 May;16(3):197-198

Department of Family Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia

View Article

Forces for Integration.

Authors:
Kurt C Stange

Ann Fam Med 2018 May;16(3):192-194

View Article

Correction.

Authors:

Ann Fam Med 2018 May;16(3):191

View Article

Disruption is the Norm.

Authors:

Ann Fam Med 2018 Apr;16(Suppl 1):S80

View Article
April 2018
1 Read

Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

Ann Fam Med 2018 Apr;16(Suppl 1):S72-S79

HealthPartners Institute, Bloomington, Minnesota.

Purpose: The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care.

Methods: The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. Read More

View Article
April 2018
1 Read

Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.

Ann Fam Med 2018 Apr;16(Suppl 1):S65-S71

Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois.

Purpose: Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged.

Methods: We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Read More

View Article
April 2018
1 Read

A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health.

Ann Fam Med 2018 Apr;16(Suppl 1):S58-S64

Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.

Purpose: EvidenceNOW Southwest is a cluster-randomized trial evaluating the differential impact on cardiovascular disease (CVD) care of engaging patients and communities in practice transformation in addition to standard practice facilitation support. The trial included development of locally tailored CVD patient engagement materials through Boot Camp Translation (BCT), a community engagement process that occurred before practice recruitment but after cluster randomization.

Methods: We introduce a cluster randomization method performed before recruitment of small to medium-size primary care practices in Colorado and New Mexico, which allowed for balanced study arms while minimizing contamination. Read More

View Article
April 2018
1 Read

The Alarming Rate of Major Disruptive Events in Primary Care Practices in Oklahoma.

Ann Fam Med 2018 Apr;16(Suppl 1):S52-S57

University of Oklahoma School of Community Medicine, Tulsa, Oklahoma.

Purpose: In primary care practices, sustainability of performance improvements and ability to deliver continuity of care to patients can be adversely affected by major disruptive events, such as relocations and changes in ownership, clinicians, and key staff. This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma.

Methods: Practices were included if they had existed for 1 year before enrollment and remained in the project for at least 1 year after enrollment. Read More

View Article
April 2018
1 Read

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout.

Ann Fam Med 2018 Apr;16(Suppl 1):S44-S51

Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.

Purpose: Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout.

Methods: Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. Read More

View Article
April 2018
1 Read

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices.

Ann Fam Med 2018 Apr;16(Suppl 1):S35-S43

Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, Texas (Balasubramanian, Ward, Preston); Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (Marino, Cohen, Springer, Edwards); School of Public Health, Oregon Health & Science University - Portland State University, Portland, Oregon (Marino); Center for Health Systems Effectiveness, and Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon (Lindner, McConnell); Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (Crabtree); Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania (Miller); Center for Community Health Integration, Departments of Family Medicine and Community Health, Population and Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, Ohio (Stange); HealthPartners Institute, Minneapolis, Minnesota (Solberg); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon (Edwards).

Purpose: Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations.

Methods: In this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Read More

View Article
April 2018
1 Read

Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study.

Ann Fam Med 2018 Apr;16(Suppl 1):S29-S34

Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.

Purpose: Our purpose was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control.

Methods: We divided practices into quartiles of blood pressure control performance and considered the top quartile as the benchmark for comparison. Using abstracted clinical data from electronic health records, we performed a cross-sectional study to assess the association of top quartile hypertension control and (1) the baseline practice adaptive reserve (PAR) scores and (2) baseline practice leadership scores, using modified Poisson regression models adjusting for practice-level characteristics. Read More

View Article
April 2018
6 Reads

Quality of Cardiovascular Disease Care in Small Urban Practices.

Ann Fam Med 2018 Apr;16(Suppl 1):S21-S28

School of Medicine, New York University, New York, New York.

Purpose: We wanted to describe small, independent primary care practices' performance in meeting the Million Hearts ABCSs (aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling), as well as on a composite measure that captured the extent to which multiple clinical targets are achieved for patients with a history of arteriosclerotic cardiovascular disease (ASCVD). We also explored relationships between practice characteristics and ABCS measures.

Methods: We conducted a cross-sectional, bivariate analysis using baseline data from 134 practices in New York City. Read More

View Article
April 2018
1 Read

Finding a Parsimonious Path for Primary Care Practice Transformation.

Authors:
Asaf Bitton

Ann Fam Med 2018 Apr;16(Suppl 1):S16-S19

Ariadne Labs, Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts Center for Primary Care, Harvard Medical School, Boston, Massachusetts

View Article
April 2018
1 Read

Technical Assistance for Primary Care Practice Transformation: Free Help to Perform Unpaid Labor?

Ann Fam Med 2018 Apr;16(Suppl 1):S12-S15

Department of Healthcare Policy and Research, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York

View Article
April 2018
1 Read

EvidenceNOW: Balancing Primary Care Implementation and Implementation Research.

Ann Fam Med 2018 Apr;16(Suppl 1):S5-S11

Agency for Healthcare Research and Quality, Rockville, Maryland.

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to generate knowledge about how America's health care delivery system can provide high-quality care, and to ensure that health care professionals and systems understand and use this evidence. In 2015 AHRQ invested in the largest primary care research project in its history. EvidenceNOW is a $112 million effort to disseminate and implement patient-centered outcomes research evidence in more than 1,500 primary care practices and to study how quality-improvement support can build the capacity of primary care practices to understand and apply evidence. Read More

View Article
April 2018
1 Read

The Capacity of Primary Care for Improving Evidence-Based Care: Early Findings From AHRQ's EvidenceNOW.

Ann Fam Med 2018 Apr;16(Suppl 1):S2-S4

Division of General Medicine and Clinical Epidemiology, Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina.

View Article
April 2018
1 Read

Ordering Labs as a Team.

Authors:
Jeffrey Panzer

Ann Fam Med 2018 Mar;16(2):176

Iora Health, Chicago, Illinois. Dr Panzer is now with Heartland Health Centers & AllianceChicago, Chicago, Illinois

View Article
March 2018
1 Read

When It's Time to Retire: Notes From the Afterlife.

Authors:
David Loxterkamp

Ann Fam Med 2018 03;16(2):171-174

Seaport Community Health Center, Belfast, Maine

At the end of the Second World War, the US birth rate peaked at nearly 27 births per 1,000 population-a rate unparalleled in the previous 3 decades, and one that would not be repeated. That Boomer generation is now retiring. How do those of us caught in the wave feel about stepping back? Who will step in to replace us? And how will we replace the loss of purpose and fulfillment that comes from a career in medicine? A lengthening life expectancy has challenged many of us to consider the "second act" to our adult life. Read More

View Article
March 2018
1 Read

From Transactional Tasks to Personalized Care: A New Vision of Physicians' Roles.

Ann Fam Med 2018 03;16(2):168-169

Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.

Changes in health care delivery have affected the work that physicians are expected to perform and, in turn, their satisfaction. There is a gap between the professional mission-what physicians want to do (eg, caring relationships with patients, using intellectual and technical skills to help people, autonomy in their daily work) and what physicians spend a substantial portion of their time and energy doing (eg, data entry and forced function work). We believe that steps can be taken to align the current and future practice of medicine with the professional mission that motivates physicians and creates satisfaction. Read More

View Article
March 2018
1 Read

You Will Have a New Life.

Authors:
Adi Finkelstein

Ann Fam Med 2018 03;16(2):166-167

Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel

This narrative presents my personal reflections as a medical anthropology researcher, and my journey as a chronic patient suffering for 30 years from ulcerative colitis. My surgeon promised me "a new life" after recommending a total colectomy 20 years ago. Indeed, a new life did begin following surgery, but I find I must renegotiate the challenges and rewards of this new life nearly every day. Read More

View Article
March 2018
1 Read

A Narrative Approach to Healing Chronic Illness.

Authors:
Thomas R Egnew

Ann Fam Med 2018 03;16(2):160-165

Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington

Many clinicians may feel poorly prepared to manage patient suffering resulting from the travails of chronic illness. This essay explores the thesis that chronically and terminally ill patients can be holistically healed by transcending the suffering occasioned by the degradations of their illnesses. Suffering is conveyed as a story and clinicians can encourage healing by co-constructing patients' illness stories. Read More

View Article
March 2018
1 Read

Moving From Problem-Oriented to Goal-Directed Health Records.

Ann Fam Med 2018 03;16(2):155-159

Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.

Electronic health records (EHRs) have been in place for decades; however, most existing systems were designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs, and values of patients and clinicians. The goal-directed health care model was proposed more than 20 years ago, but no design principles have been developed for corresponding electronic record systems. Newly designed EHRs are needed to facilitate health care that is anchored by patient life and health goals. Read More

View Article
March 2018
1 Read

Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis.

Ann Fam Med 2018 03;16(2):149-154

Department of Family Medicine, McMaster University, Hamilton, Canada

Purpose: Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.

Methods: We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Read More

View Article
March 2018
1 Read

Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States.

Ann Fam Med 2018 03;16(2):139-144

Intramural Research Department, American Cancer Society, Atlanta, Georiga.

Purpose: Previous studies report infrequent use of shared decision making for prostate-specific antigen (PSA) testing. It is unknown whether this pattern has changed recently considering increased emphasis on shared decision making in prostate cancer screening recommendations. Thus, the objective of this study is to examine recent changes in shared decision making. Read More

View Article
March 2018
1 Read

A Core Outcome Set for Multimorbidity Research (COSmm).

Ann Fam Med 2018 03;16(2):132-138

Département de médecine de famille, Université de Sherbrooke, Sherbrooke (Québec), Canada.

Purpose: We aimed to develop a consensus-based set of core outcomes specifically for studies in multimorbidity.

Methods: We undertook a consensus study following the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines for the design and reporting of core outcome sets. A Delphi panel of experts completed a web-based survey with 2 rounds. Read More

View Article
March 2018
3 Reads