Search Our Scientific Publications & Authors

Ann Fam Med 2020 May;18(3):iii

Ann Fam Med 2020 May;18(3):285-286

Ann Fam Med 2020 May;18(3):284-285

Ann Fam Med 2020 May;18(3):282-284

AAFP News.

Ann Fam Med 2020 May;18(3):280-282

American Board of Family Medicine.

Ann Fam Med 2020 May;18(3):279-280

University of Houston, College of Medicine, Department of Health Systems and Population Health Sciences.

Ann Fam Med 2020 May;18(3):278

Ann Fam Med 2020 May;18(3):272-277

Case Western Reserve University, Cleveland, Ohio

In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. Read More

Ann Fam Med 2020 May;18(3):269-271

Veterans Affairs San Diego Health Care System, San Diego, California

A few years into my practice at the Veterans Affairs (VA) clinic, I was threatened by an angry patient when I had to discontinue his opioids. I placed a civil restraining order against him and when we met in court he admitted to the judge that stopping opioids improved his behavior. I discovered that the legal system could support the medical system's care of threatening patients but found the process stressful. Read More

Ann Fam Med 2020 May;18(3):262-264

Baylor College of Medicine, Houston, Texas

Firearm-related deaths are on the rise in the United States, especially among our youth. Tragically, proper firearm storage and safety could have prevented a great number of these deaths. Professional and public health organizations have thus encouraged physicians to provide direct patient counseling on firearm safety. Read More

Ann Fam Med 2020 05;18(3):259-261

Division of Primary Care, Raffles Medical Group, Singapore.

Coronavirus disease 2019 (COVID-19) is a rapidly progressing global pandemic against which nations are struggling for containment. Singapore is known to have promptly instituted aggressive public health and containment measures. A key pillar sustaining this is the response of its primary health care network. Read More

Ann Fam Med 2020 May;18(3):250-258

Departments of Epidemiology & Biostatistics, Computer Science, Schulich Interfaculty Program in Public Health, Statistical & Actuarial Sciences, Western University, London, Ontario, Canada.

Purpose: Rapid increases in technology and data motivate the application of artificial intelligence (AI) to primary care, but no comprehensive review exists to guide these efforts. Our objective was to assess the nature and extent of the body of research on AI for primary care.

Methods: We performed a scoping review, searching 11 published or gray literature databases with terms pertaining to AI (eg, machine learning, bayes* network) and primary care (eg, general pract*, nurse). Read More

Ann Fam Med 2020 May;18(3):243-249

Medical Data Research Center, Portland, Oregon.

Purpose: To address doubts regarding National Lung Screening Trial (NLST) generalizability, we analyzed over 6,000 lung cancer screenings (LCSs) within a community health system.

Methods: Our LCS program included 10 sites, 7 hospitals (2 non-university tertiary care, 5 community) and 3 free-standing imaging centers. Primary care clinicians referred patients. Read More

Ann Fam Med 2020 May;18(3):235-242

Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.

Purpose: To test the efficacy of intra-articular hypertonic dextrose prolotherapy (DPT) vs normal saline (NS) injection for knee osteoarthritis (KOA).

Methods: A single-center, parallel-group, blinded, randomized controlled trial was conducted at a university primary care clinic in Hong Kong. Patients with KOA (n = 76) were randomly allocated (1:1) to DPT or NS groups for injections at weeks 0, 4, 8, and 16. Read More

Ann Fam Med 2020 May;18(3):227-234

Centers for Medicare & Medicaid Services, Baltimore, Maryland.

Purpose: Practices in the 4-year Comprehensive Primary Care (CPC) initiative changed staffing patterns during 2012-2016 to improve care delivery. We sought to characterize these changes and to compare practice patterns with those in similar non-CPC practices in 2016.

Methods: We conducted an online survey among selected US primary care practices. Read More

Ann Fam Med 2020 May;18(3):218-226

Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.).

Purpose: Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions?

Methods: We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Academic and gray literature were evaluated for relevance and robustness. Read More

Ann Fam Med 2020 May;18(3):210-217

Department of Economics, University of South Carolina, Columbia, South Carolina.

Purpose: We undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.

Methods: We placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. Read More

Ann Fam Med 2020 May;18(3):202-209

Case Western Reserve University, Cleveland, Ohio.

Purpose: Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors.

Methods: We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Read More

Ann Fam Med 2020 May;18(3):201

Ann Fam Med 2020 May;18(3):196-201

Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.

Ann Fam Med 2020 May;18(3):194-195

Department of Computer Science, University of Houston, Houston, Texas.

Ann Fam Med 2020 03;18(2):181

Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Ann Fam Med 2020 03;18(2):180

Department of Family Medicine, NorthShore University Health-System, Lincolnwood, Illinois.

Ann Fam Med 2020 03;18(2):179

Ann Fam Med 2020 03;18(2):176-178

Doctors Without Borders, Paris, France

Hundreds of thousands of Rohingya refugees arrived in Bangladesh within weeks in fall 2017, quickly forming large settlements without any basic support. Humanitarian first responders provided basic necessities including food, shelter, water, sanitation, and health care. However, the challenge before them-a vast camp ravaged by diphtheria and measles superimposed on a myriad of common pathologies-was disproportionate to the resources. Read More

Ann Fam Med 2020 03;18(2):172-175

Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand

In 2016, Rose Lamont and Tana Fishman were the first patient-clinician dyad from outside North America to attend the North American Primary Care Research Group (NAPCRG) Patient and Clinician Engagement Program workshop. They returned to New Zealand inspired and formed the Pacific People's Health Advisory Group and a Pacific practice-based research network (PBRN). They are guided by the principles of co-design, and the Samoan research framework fa'afaletui, which emphasizes a collective approach and importance of reciprocity and relationships. Read More

Ann Fam Med 2020 03;18(2):169-171

University of Kansas Medical Center, Kansas City, Kansas

Few health care professionals receive comprehensive training in how to effectively help their patients with obesity. Yet patients are often wanting, needing, and looking for help when they go to the doctor. We, as a group of patients with obesity, share our common experiences and needs when going to the doctor from a place of honesty and hope, with the assumption that clinicians want to know what their patients really think and feel. Read More

Ann Fam Med 2020 03;18(2):159-168

Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Purpose: Operational failures are system-level errors in the supply of information, equipment, and materials to health care personnel. We aimed to review and synthesize the research literature to determine how operational failures in primary care affect the work of primary care physicians.

Methods: We conducted a critical interpretive synthesis. Read More

Ann Fam Med 2020 03;18(2):156-158

American Board of Family Medicine, Lexington, Kentucky.

The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5. Read More

Ann Fam Med 2020 03;18(2):148-155

General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom

Purpose: Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale. Read More

Ann Fam Med 2020 03;18(2):139-147

Department of Pharmacy, Faculty of Science, National University of Singapore

Purpose: We aimed to evaluate the efficacy and safety of use of the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) during Ramadan.

Methods: We performed a prospective, multicenter, randomized controlled trial. The inclusion criteria were age ≥21 years, baseline glycated hemoglobin (HbA) level ≤9. Read More

Ann Fam Med 2020 03;18(2):131-138

Purpose: Most real-world studies on anticoagulants have been based on health insurance databases or performed in secondary care. The aim of this study was to compare safety and effectiveness between patients treated with vitamin K antagonists (VKAs) and patients treated with direct oral anticoagulants (DOACs) in a general practice setting.

Methods: The CACAO study (Comparison of Accidents and their Circumstances with Oral Anticoagulants) is a multicenter prospective cohort study conducted among ambulatory patients taking an oral anticoagulant. Read More

Ann Fam Med 2020 03;18(2):127-130

American Board of Family Medicine, Lexington, Kentucky.

Purpose: General practitioners (GPs) are part of the US physician workforce, but little is known about who they are, what they do, and how they differ from family physicians (FPs). We describe self-identified GPs and compare them with board-certified FPs.

Methods: Analysis of data on 102,604 Doctor of Medicine and Doctor of Osteopathy physicians in direct patient care in the United States in 2016, who identify themselves as GPs or FPs. Read More

Ann Fam Med 2020 03;18(2):118-126

Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado

Purpose: Although cesarean delivery is the most common surgical procedure in the United States, postoperative opioid prescribing varies greatly. We hypothesized that patient characteristics, procedural characteristics, or both would be associated with high vs low opioid use after discharge. This information could help individualize prescriptions. Read More

Ann Fam Med 2020 03;18(2):110-117

Purpose: Online programs may help to engage patients in advance care planning in outpatient settings. We sought to implement an online advance care planning program, PREPARE (Prepare for Your Care; http://www.prepareforyourcare. Read More

Ann Fam Med 2020 03;18(2):100-109

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam, The Netherlands.

Purpose: The prognosis of older patients with dizziness in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness.

Methods: In a primary care prospective cohort study, 417 older adults with dizziness (mean age 79 years) received a full diagnostic workup in 2006-2008. Read More

Ann Fam Med 2020 03;18(2):98-99

Department of Family Medicine, University of Michigan, Ann Arbor, Michigan

Ann Fam Med 2020 Jan;18(1):83

Ann Fam Med 2020 01;18(1):80-82

Department of Counseling and Human Development, University of Haifa, Haifa, Israel.

In a previous story ("On Blindness and Blind Spots") I sought to understand the psychological causes of a long-time patient's myriad of seemingly inexplicable symptoms. Since then, I learned more of her story, which helped me understand my patient with a new perspective.Dana shared with me, and now with the readers, short poetic pieces she has written to describe her traumatic experiences as a child-and the efforts she makes as a grown woman to heal, like the phoenix rises from its ashes. Read More

Ann Fam Med 2020 01;18(1):73-79

Harvard Medical School, Boston, Massachusetts

Transgender and gender-diverse people face multiple barriers to accessing appropriate health care, including denial of service, harassment, and lack of clinician knowledge. This article presents a blueprint for planning and implementing a transgender health program within a primary care practice in order to enhance the capacity of the health care system to meet the medical and mental health needs of this underserved population. The steps described, with emphasis on elements specific to transgender care, include conducting a community needs assessment, gaining commitment from leadership and staff, choosing a service model and treatment protocols, defining staff roles, and creating a welcoming environment. Read More

Ann Fam Med 2020 01;18(1):66-72

University of Minnesota, Minneapolis, Minnesota.

Purpose: The purpose of this study was to assess whether primary care practices certified as medical homes differ in having the practice systems required for that designation and in attaining favorable outcomes for their patients with diabetes, and whether those systems are associated with better diabetes outcomes.

Methods: We undertook a cross-sectional observational study, Understanding Infrastructure Transformation Effects on Diabetes (UNITED), of 586 Minnesota adult primary care practices, comparing those that were certified vs uncertified as medical homes in 2017, with analyses supplemented by previously published studies of these practices. We collected survey information about the presence of medical home practice systems for diabetes care and obtained 6 standardized measures of diabetes care collected yearly from all Minnesota practices. Read More

Ann Fam Med 2020 01;18(1):59-65

Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California.

Purpose: Prior work suggests that there are competing demands between addressing pain and other issues in primary care, potentially lessening delivery of evidence-based cancer screening. We assessed the association between opioid therapy and cancer screening among women in a nationally representative US sample.

Methods: We conducted an observational analysis of the 2005-2015 Medical Expenditure Panel Surveys. Read More

Ann Fam Med 2020 01;18(1):50-58

Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.

Purpose: Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction.

Methods: We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Read More

Ann Fam Med 2020 01;18(1):42-49

Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.

Purpose: Without supporting evidence, clinicians commonly recommend that warfarin be taken in the evening. We conducted a randomized controlled trial to evaluate the effect of administration time (morning vs evening) on the stability of warfarin's anticoagulant effect.

Methods: A total of 236 primary care physicians serving 54 western Canadian communities mailed letters of invitation to all their warfarin-using patients. Read More

Ann Fam Med 2020 01;18(1):35-41

American Association of Medical Colleges, Washington, DC.

Purpose: Electronic consultation (eConsult), involving asynchronous primary care clinician-to-specialist consultation, is being adopted at a growing number of health systems. Most evaluations of eConsult programs have assessed clinical and financial impacts and clinician acceptability. Less attention has been focused on patients' opinions. Read More

Ann Fam Med 2020 01;18(1):30-34

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

Purpose: Despite the benefits of well-child care visits, up to one-half of these visits are missed. Little is known about why children miss them, so we undertook a qualitative study to elucidate these factors.

Methods: We interviewed 17 caregivers whose children had missed well-child visits and 6 clinicians, focusing on 3 areas: the value of well-child visits, barriers to attendance, and facilitators of attendance. Read More

Ann Fam Med 2020 01;18(1):24-29

Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Purpose: The quality of health care, including primary care, is influenced by the context in which care is delivered. We investigated the association between primary care practice location and patient experience with a focus on differences between hospital-based practices and community-based office practices.

Methods: We conducted a cross-sectional study in a primary care practice-based research network in Japan among 25 participating facilities: 6 small and medium-sized hospitals and 19 community-based offices. Read More

Ann Fam Med 2020 01;18(1):15-23

Department of Medicine, Weill Cornell Medicine, New York, New York

Purpose: Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. We tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain.

Methods: In this community-based, cluster-randomized controlled trial, intervention participants received a 3-month, peer-delivered, telephone-administered program. Read More

Ann Fam Med 2020 01;18(1):5-14

Department of Medicine, Stanford University School of Medicine, Palo Alto, California.

Purpose: Poor adherence to medications is more prevalent for chronic obstructive pulmonary disease (COPD) than for other chronic conditions and is associated with unfavorable health outcomes. Few interventions have successfully improved adherence for COPD medications; none of these use unlicensed health care personnel. We explored the efficacy of lay health coaches to improve inhaler adherence and technique. Read More