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Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 4)
ABCS Health Sciences     Open Access   (Followers: 1)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Full-text available via subscription   (Followers: 39)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access   (Followers: 1)
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access  
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 2)
Addiction Science & Clinical Practice     Open Access   (Followers: 7)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 8)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 5)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
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Advances in Medical Sciences     Hybrid Journal   (Followers: 6)
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Advances in Medicine     Open Access   (Followers: 2)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
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Advances in Virus Research     Full-text available via subscription   (Followers: 5)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
African Health Sciences     Open Access   (Followers: 2)
African Journal of Biomedical Research     Open Access  
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 1)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 1)
African Journal of Trauma     Open Access  
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access  
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 11)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 6)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 5)
American Journal of Clinical Medicine Research     Open Access   (Followers: 6)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 13)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 1)
American Journal of Medicine     Hybrid Journal   (Followers: 45)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access  
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 9)
American Medical Journal     Open Access   (Followers: 4)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 4)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 2)
Anatomical Science International     Hybrid Journal   (Followers: 2)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 8)
Annals of Family Medicine     Open Access   (Followers: 13)
Annals of Fundeni Hospital     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 11)
Annals of Medicine and Surgery     Open Access   (Followers: 5)
Annals of Microbiology     Hybrid Journal   (Followers: 10)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 18)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 11)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Biomedical Sciences     Open Access   (Followers: 7)
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Trauma Research     Open Access   (Followers: 2)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 10)
Arterial Hypertension     Open Access  
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
Asia Pacific Family Medicine     Open Access  
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 1)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 2)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 1)
Asian Journal of Transfusion Science     Open Access   (Followers: 2)
Asian Medicine     Hybrid Journal   (Followers: 4)
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Audiology - Communication Research     Open Access   (Followers: 8)
Auris Nasus Larynx     Full-text available via subscription  
Australasian Medical Journal     Open Access   (Followers: 3)
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Aviation, Space, and Environmental Medicine     Full-text available via subscription   (Followers: 9)
Avicenna     Open Access   (Followers: 2)
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 2)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Bangladesh Medical Research Council Bulletin     Open Access  
Basal Ganglia     Hybrid Journal  
Basic Sciences of Medicine     Open Access   (Followers: 2)
BBA Clinical     Open Access  
BC Medical Journal     Free  
Benha Medical Journal     Open Access  
Bijblijven     Hybrid Journal  
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 1)
Bioelectromagnetics     Hybrid Journal   (Followers: 1)
Bioengineering & Translational Medicine     Open Access  
Bioethics     Hybrid Journal   (Followers: 14)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
Biologics in Therapy     Open Access  
Biology of Sex Differences     Open Access   (Followers: 4)
Biomarker Research     Open Access   (Followers: 2)

        1 2 3 4 5 6 7 8 | Last

Journal Cover Annals of Family Medicine
  [SJR: 3.311]   [H-I: 78]   [13 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1544-1709 - ISSN (Online) 1544-1717
   Published by Annals of Family Medicine Homepage  [1 journal]
  • Tethered to the EHR: A Physician Workload Assessment [article-commentary]

    • Authors: Amin, R. P; Johansen, M. E.
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2147
      Issue No: Vol. 15, No. 5 (2017)
  • In This Issue: Tools to Help Focus on What is Valuable [Editorials]

    • Authors: Stange; K. C.
      Pages: 402 - 404
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2145
      Issue No: Vol. 15, No. 5 (2017)
  • Clinical Population Medicine: Integrating Clinical Medicine and Population
           Health in Practice [Editorials]

    • Authors: Orkin, A. M; Bharmal, A, Cram, J, Kouyoumdjian, F. G, Pinto, A. D, Upshur, R.
      Pages: 405 - 409
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2143
      Issue No: Vol. 15, No. 5 (2017)
  • From Authority- to Evidence-Based Medicine: Are Clinical Practice
           Guidelines Moving us Forward or Backward' [Editorials]

    • Authors: LeFevre; M.
      Pages: 410 - 412
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2141
      Issue No: Vol. 15, No. 5 (2017)
  • Developing a Clinician Friendly Tool to Identify Useful Clinical Practice
           Guidelines: G-TRUST [Original Research]

    • Authors: Shaughnessy, A. F; Vaswani, A, Andrews, B. K, Erlich, D. R, DAmico, F, Lexchin, J, Cosgrove, L.
      Pages: 413 - 418
      Abstract: BACKGROUNDClinicians 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).METHODSA modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring.RESULTSTwenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful.CONCLUSIONThe 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians.
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2119
      Issue No: Vol. 15, No. 5 (2017)
  • Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR
           Event Log Data and Time-Motion Observations [Original Research]

    • Authors: Arndt, B. G; Beasley, J. W, Watkinson, M. D, Temte, J. L, Tuan, W.-J, Sinsky, C. A, Gilchrist, V. J.
      Pages: 419 - 426
      Abstract: PURPOSEPrimary 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.METHODSWe conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non–face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours.RESULTSClinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%).CONCLUSIONSPrimary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation.
      Keywords: Mixed methods, Health policy, Health services, Professional practice, Health informatics, Organizational / practice change
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2121
      Issue No: Vol. 15, No. 5 (2017)
  • Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and
           Charting Efficiency: A Randomized Controlled Trial [Original Research]

    • Authors: Gidwani, R; Nguyen, C, Kofoed, A, Carragee, C, Rydel, T, Nelligan, I, Sattler, A, Mahoney, M, Lin, S.
      Pages: 427 - 433
      Abstract: PURPOSEScribes 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.METHODSWe 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. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians’ perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close.RESULTSScribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values
      Keywords: Quantitative methods, Health services, Professional practice, Organizational / practice change, Patient perspectives
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2122
      Issue No: Vol. 15, No. 5 (2017)
  • Uninsured Primary Care Visit Disparities Under the Affordable Care Act
           [Original Research]

    • Authors: Angier, H; Hoopes, M, Marino, M, Huguet, N, Jacobs, E. A, Heintzman, J, Holderness, H, Hood, C. M, DeVoe, J. E.
      Pages: 434 - 442
      Abstract: PURPOSEHealth 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.METHODSWe undertook a retrospective, observational study of visit payment type for CHC patients aged 19 to 64 years. We used electronic health record data from 10 states that expanded Medicaid and 6 states that did not, 359 CHCs, and 870,319 patients with more than 4 million visits. Our analyses included difference-in-difference (DD) and difference-in-difference-in-difference (DDD) estimates via generalized estimating equation models. The primary outcome was health insurance type at each visit (Medicaid-insured, uninsured, or privately insured).RESULTSAfter the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states (rate ratio [RR] = 1.77; 95% CI, 1.56–2.02) and the largest gains in privately insured visit rates in nonexpansion states (RR = 3.63; 95% CI, 2.73–4.83). In expansion states, non-Hispanic white patients had twice the magnitude of decrease in uninsured visits compared with Hispanic patients (DD = 2.03; 95% CI, 1.53–2.70), and this relative change was more than 2 times greater in expansion states compared with nonexpansion states (DDD = 2.06; 95% CI, 1.52–2.78).CONCLUSIONThe lower rates of uninsured visits for all racial and ethnic groups after ACA implementation suggest progress in expanding coverage to CHC patients; this progress, however, was not uniform when comparing expansion with nonexpansion states and among all racial and ethnic minority subgroups. These findings suggest the need for continued and more equitable insurance expansion efforts to eliminate health insurance disparities.
      Keywords: Vulnerable populations, Quantitative methods, Health policy, Health services, Access, Disparities in health and health care
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2125
      Issue No: Vol. 15, No. 5 (2017)
  • Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder,
           or Upper Aerodigestive Tract Cancer [Original Research]

    • Authors: Farley, A; Koshiaris, C, Oke, J, Ryan, R, Szatkowski, L, Stevens, R, Aveyard, P.
      Pages: 443 - 450
      Abstract: PURPOSESmoking 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.METHODSUsing 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. We assessed differences in the proportion for whom physicians updated smoking status, advised quitting, and prescribed cessation medications, as well as the proportion of patients who stopped smoking within a year of diagnosis. We further examined whether any differences arose because the physicians were offered incentives to address smoking in patients with CHD and not cancer.RESULTSAt diagnosis, 32.0% of patients with cancer and 18.2% of patients with CHD smoked tobacco. Patients with cancer were less likely than patients with CHD to have their general practitioners update smoking status (OR = 0.18; 95% CI, 0.17–0.19), advise quitting (OR = 0.38; 95% CI, 0.36–0.40), or prescribe medication (OR = 0.67; 95% CI, 0.63–0.73), and they were less likely to have stopped smoking (OR = 0.76; 95% CI, 0.69–0.84). One year later 61.7% of patients with cancer and 55.4% with CHD who were smoking at diagnosis were still smoking. Introducing incentive payments was associated with more frequent interventions, but not for patients with CHD specifically.CONCLUSIONSGeneral practitioners were less likely to support smoking cessation in patients with cancer than with CHD, and patients with cancer were less likely to stop smoking. This finding is not due to the difference in incentive payments.
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2100
      Issue No: Vol. 15, No. 5 (2017)
  • Risk Stratification Methods and Provision of Care Management Services in
           Comprehensive Primary Care Initiative Practices [Original Research]

    • Authors: Reddy, A; Sessums, L, Gupta, R, Jin, J, Day, T, Finke, B, Bitton, A.
      Pages: 451 - 454
      Abstract: PURPOSERisk-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.METHODSWe 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.RESULTSCPC practices reported using 4 primary methods to stratify risk for their patient populations: a practice-developed algorithm (n = 215), the American Academy of Family Physicians’ clinical algorithm (n = 155), payer claims and electronic health records (n = 62), and clinical intuition (n = 52). CPC practices using practice-developed algorithm identified the most number of high-risk patients per primary care physician (282 patients, P = .006). CPC practices using clinical intuition had the most high-risk patients in care management and a greater proportion of high-risk patients receiving care management per primary care physician (91 patients and 48%, P =.036 and P =.128, respectively).CONCLUSIONSCPC practices used 4 primary methods to identify high-risk patients. Although practices that developed their own algorithm identified the greatest number of high-risk patients, practices that used clinical intuition connected the greatest proportion of patients to care management services.
      Keywords: Chronic illness, Prevention, Vulnerable populations, Mixed methods, Personalized care, Health informatics, Quality improvement
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2124
      Issue No: Vol. 15, No. 5 (2017)
  • Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis
           of a National Database [Original Research]

    • Authors: Cooper, J; Edwards, A, Williams, H, Sheikh, A, Parry, G, Hibbert, P, Butlin, A, Donaldson, L, Carson-Stevens, A.
      Pages: 455 - 461
      Abstract: PURPOSEA 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.METHODSWe characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame.RESULTSHealth care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%–47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated.CONCLUSIONSThe high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others’ behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture.
      Keywords: Quantitative methods, Health policy, Professional practice, Communication / decision making, Education, Social / cultural context
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2123
      Issue No: Vol. 15, No. 5 (2017)
  • Preventable Emergency Hospital Admissions Among Adults With Intellectual
           Disability in England [Original Research]

    • Authors: Hosking, F. J; Carey, I. M, DeWilde, S, Harris, T, Beighton, C, Cook, D. G.
      Pages: 462 - 470
      Abstract: PURPOSEAdults 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).METHODSWe 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. Incident rate ratios (IRRs) from conditional Poisson regression were analyzed for all emergency and preventable emergency admissions. Primary care management of lower respiratory tract infections and urinary tract infections, as exemplar ACSCs, before admission were compared in unmatched analysis between adults with and without intellectual disabilities.RESULTSThe overall rate for emergency admissions for adults with vs without intellectual disabilities was 182 vs 68 per 1,000 per year (IRR = 2.82; 95% CI, 2.66–2.98). ACSCs accounted for 33.7% of emergency admissions among the former compared with 17.3% among the latter (IRR = 5.62; 95% CI, 5.14–6.13); adjusting for comorbidity, smoking, and deprivation did not fully explain the difference (IRR = 3.60; 95% CI, 3.25–3.99). Although adults with intellectual disability were at nearly 5 times higher risk for admission for lower respiratory tract infections and urinary tract infections, they had similar primary care use, investigation, and management before admission as the general population.CONCLUSIONSAdults with intellectual disabilities are at high risk for preventable emergency admissions. Identifying strategies for better detecting and managing ACSCs, including lower respiratory and urinary tract infections, in primary care could reduce hospitalizations.
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2104
      Issue No: Vol. 15, No. 5 (2017)
  • Health Care Disparities of Ohioans With Developmental Disabilities Across
           the Lifespan [Research Brief]

    • Authors: Prokup, J. A; Andridge, R, Havercamp, S. M, Yang, E. A.
      Pages: 471 - 474
      Abstract: 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. Our results highlight the need to educate health care clinicians on the care of patients with developmental disabilities of all ages.
      Keywords: Vulnerable populations, Quantitative methods, Health services, Access, Disparities in health and health care
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2108
      Issue No: Vol. 15, No. 5 (2017)
  • Agriculture and Health Sectors Collaborate in Addressing Population Health
           [Special Report]

    • Authors: Kaufman, A; Boren, J, Koukel, S, Ronquillo, F, Davies, C, Nkouaga, C.
      Pages: 475 - 480
      Abstract: PURPOSEPopulation 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.METHODSWe conducted a literature review and personally contacted states in which the Cooperative Extension Service is collaborating on a "Health Extension" model with academic health centers or their health systems. We surveyed 6 states in which Health Extension models are being piloted as to their different approaches. For a case study of collaboration in New Mexico, we drew on interviews with the leadership of New Mexico State University’s Cooperative Extension Service in the College of Agricultural, Consumer and Environmental Sciences; the University of New Mexico (UNM) Health Science Center’s Office for Community Health; and the personal experiences of frontline Cooperative Extension agents and UNM Health Extension officers who collaborated on community projects.RESULTSA growing number of states are linking the agricultural Cooperative Extension Service with academic health centers and with the health care system. In New Mexico, the UNM academic health center has created "Health Extension Rural Offices" based on principles of the Cooperative Extension model. Today, these 2 systems are working collaboratively to address unmet population health needs in their communities. Nationally, the Cooperative Extension Service has formed a steering committee to guide its movement into the health arena.CONCLUSIONResources of the agricultural and health sectors offer communities complementary expertise and resources to address adverse population health outcomes. The collaboration between Cooperative Extension and the health sector is 1 manifestation of this emerging collaboration model termed Health Extension. Initial skepticism and protection of funding sources and leadership roles can be overcome with shared funding from new sources, shared priority setting and decision making, and the initiation of practical, collaborative projects that build personal relationships and trust.
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2087
      Issue No: Vol. 15, No. 5 (2017)
  • Providing Office-Based Treatment of Opioid Use Disorder [Innovations in
           Primary Care]

    • Authors: Wilson, C. G; Fagan, E. B.
      Pages: 481 - 481
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2139
      Issue No: Vol. 15, No. 5 (2017)
  • Fall Prevention: Empowering People Through Online Education [Innovations
           in Primary Care]

    • Authors: Frith; J.
      Pages: 482 - 482
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2138
      Issue No: Vol. 15, No. 5 (2017)
           [Family Medicine Updates]

    • Authors: Ireland; J.
      Pages: 483 - 484
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2127
      Issue No: Vol. 15, No. 5 (2017)

    • Authors: Rutter, A; Theobald, M.
      Pages: 484 - 486
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2129
      Issue No: Vol. 15, No. 5 (2017)
  • ADFM IS TURNING 40! [Family Medicine Updates]

    • Authors: Gilchrist, V; Davis, A, Alexander, C, Weidner, A, Noland, P.
      Pages: 486 - 487
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2128
      Issue No: Vol. 15, No. 5 (2017)
           PROGRAM [Family Medicine Updates]

    • Authors: Brown, S. R; Miser, W. F.
      Pages: 487 - 488
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2130
      Issue No: Vol. 15, No. 5 (2017)
           WITH QUALITY IMPROVEMENT [Family Medicine Updates]

    • Authors: Nease, D. E; Campbell-Scherer, D, Haught, J.
      Pages: 488 - 489
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2140
      Issue No: Vol. 15, No. 5 (2017)

    • Authors: Frost, J. L; Campos-Outcalt, D, Hoelting, D, LeFevre, M, Lin, K. W, Vaughan, W, Bird, M. D.
      Pages: 490 - 491
      PubDate: 2017-09-11T13:54:08-07:00
      DOI: 10.1370/afm.2146
      Issue No: Vol. 15, No. 5 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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