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

Rush Medical College.

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

AAFP News Department.

Ann Fam Med 2019 Jan;17(1):90-91

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

Ann Fam Med 2019 Jan;17(1):90

Ann Fam Med 2019 Jan;17(1):89

Ann Fam Med 2019 Jan;17(1):87-88

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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

Ann Fam Med 2019 Jan;17(1):5-6

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

Ann Fam Med 2018 Nov;16(6):573-575

American Board of Family Medicine.

Ann Fam Med 2018 Nov;16(6):572-573

AAFP News.

Ann Fam Med 2018 Nov;16(6):571

Ann Fam Med 2018 Nov;16(6):570

Ann Fam Med 2018 Nov;16(6):568-569

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Society of Teachers of Family Medicine.

Ann Fam Med 2018 Nov;16(6):566

Department of Family and Community Medicine, Saint Louis University, St Louis, Missouri.

Ann Fam Med 2018 Nov;16(6):563-565

Kaiser Permanente of Washington, Seattle, Washington

Empanelment in a "clinic first" residency has helped me develop competency in medicine and understand the value of primary care. Taking care of a panel of patients longitudinally aligns with education research on how we best learn; we learn best when learning sessions are longitudinal, spaced in time and interleaved with diverse topics. By caring for patients longitudinally, I have developed competency and proficiency in providing comprehensive care to my patients. Read More

Ann Fam Med 2018 Nov;16(6):559-562

National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts

The increasing visibility of transgender people and others who do not conform to traditional gender norms challenges us to think about gender in new ways, and to use new terminology when communicating with patients. People who describe themselves as nonbinary have a gender identity that is not exclusively girl/woman or boy/man. A small but growing body of research indicates they experience high levels of societal victimization and discrimination, and are misunderstood by health care clinicians. Read More

Ann Fam Med 2018 Nov;16(6):555-558

Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada.

Transgender patients report negative experiences in health care settings, but little is known about clinicians' willingness to see transgender patients. We surveyed 308 primary care clinicians in an integrated Midwest health system and 53% responded. Most respondents were willing to provide routine care to transgender patients (85. Read More

Ann Fam Med 2018 Nov;16(6):552-554

Fischell Department of Bioengineering and Director of Regulatory Science Initiative, University of Maryland, College Park, Maryland.

The purpose of our study was to clarify limitations of off-label use for low cost nonmedical use (NMU) pulse oximeters by primary care providers. These devices are widely marketed over the Internet and in drugstores but are not intended for medical use or reviewed by the Food and Drug Administration (FDA). Our study compared oxygen saturation (SpO) in patients from 1 medical use (MU) pulse oximeter to 8 NMU pulse oximeters. Read More

Ann Fam Med 2018 Nov;16(6):549-551

University of British Columbia, Vancouver, British Columbia, Canada

We aimed to determine if a history of recent imprisonment affects access to primary care. Using patient roles, we telephoned to request an initial appointment with all family physicians (n = 339) who were accepting new patients in British Columbia, Canada. We sequentially assigned patient scenarios: male or female recently released from prison; male or female control. Read More

Ann Fam Med 2018 Nov;16(6):546-548

Department of Medicine, MetroHealth System, Cleveland, Ohio.

Large panel sizes are often held responsible for worse access to appointments in primary care. We evaluated the relationship between appointment backlog, panel size, and primary care clinician time in clinic, using Spearman correlation and multiple regression in a retrospective analysis. We found no independent association between panel size and days until third next available appointment, but larger panel size adjusted for clinician time in clinic was associated with worse access. Read More

Ann Fam Med 2018 Nov;16(6):538-545

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Purpose: Access to a usual source of care (USC) is associated with better preventive health and chronic disease treatment. Although most older adults have a USC, loss of USC, and factors associated with loss of USC, have not previously been examined.

Methods: We followed 7,609 participants of the National Health and Aging Trends Study annually for up to 6 years (2011-2016). Read More

Ann Fam Med 2018 Nov;16(6):530-537

The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Purpose: Clinical practice guidelines recommend incorporating long-term life expectancy to inform a number of decisions in primary care. We aimed to examine older adults' preferences for discussing life expectancy in a national sample.

Methods: We invited 1,272 older adults (aged 65 or older) from a national, probability-based online panel to participate in 2016. Read More

Ann Fam Med 2018 Nov;16(6):521-529

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

Purpose: We performed a phase 2 randomized clinical trial to evaluate the preliminary effectiveness of a clinic-based patellar mobilization therapy (PMT) in patients with knee osteoarthritis.

Methods: We recruited 208 patients with knee osteoarthritis at primary care clinics in Hong Kong. Patients were randomly assigned (1:1) to the intervention group or the control group. Read More

Ann Fam Med 2018 Nov;16(6):515-520

Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.

Purpose: Polypharmacy is a key clinical challenge for primary care. Drugs that should be prescribed for an intermediate term (longer than 3 months, but not indefinitely) that are not appropriately discontinued could contribute to polypharmacy. We named this type of prescribing . Read More

Ann Fam Med 2018 Nov;16(6):507-514

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

Purpose: Up to one-third of female smokers with Medicaid deny tobacco use during pregnancy. Point-of-care urine tests for cotinine, a tobacco metabolite, can help to identify women who may benefit from cessation counseling. We sought to evaluate patient and clinician perspectives about using such tests during prenatal care to identify smokers, with particular focus on the impact of testing on clinical relationships and the potential for tobacco cessation. Read More

Ann Fam Med 2018 Nov;16(6):498-506

Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Purpose: The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians.

Methods: In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. Read More

Ann Fam Med 2018 Nov;16(6):492-497

American Board of Family Medicine, Lexington, Kentucky.

Purpose: Continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations. Read More

Ann Fam Med 2018 Nov;16(6):490-491

Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida

Ann Fam Med 2018 Nov;16(6):488-489

Ann Fam Med 2018 Sep;16(5):iii

Rush Medical College.

Ann Fam Med 2018 Sep;16(5):473-475

Communications and Programs, Society of Teachers of Family Medicine.

Ann Fam Med 2018 Sep;16(5):473

ABFM.