JournalTOCs

Annals of Family Medicine
Journal Prestige (SJR): 2.748

Citation Impact (citeScore): 3
Number of Followers: 14

This is an Open Access Journal

Open Access journal
ISSN (Print) 1544-1709 - ISSN (Online) 1544-1717
Published by Annals of Family Medicine

[1 journal]

A Primary Care-Driven eConsult Service [article-commentary]
- Authors: Murray, K. R; Johansen, M. E.
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2209
  Issue No: Vol. 16, No. 2 (2018)
In This Issue: Refining Care and its Frameworks [Editorials]
- Authors: Stange K. C.
  Pages: 98 - 99
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2218
  Issue No: Vol. 16, No. 2 (2018)
Thank you, Reviewers and E-letter Contributors! [Editorials]
- Pages: 99 - 99
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2225
  Issue No: Vol. 16, No. 2 (2018)
Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized
Controlled Trial [Original Research]
- Authors: Yawn, B. P; Wollan, P. C, Rank, M. A, Bertram, S. L, Juhn, Y, Pace, W.
  Pages: 100 - 110
  Abstract: PURPOSEThe purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices.METHODSWe used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines.RESULTSWe enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with "in control" asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year (P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).CONCLUSIONSIntroduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices’ adherence to asthma management guidelines.
  Keywords: Chronic illness, Children's health, Quantitative methods, Health services, Coordination / integration of care, Clinical practice guidelines, Quality improvement
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2179
  Issue No: Vol. 16, No. 2 (2018)
Treating Subthreshold Depression in Primary Care: A Randomized Controlled
Trial of Behavioral Activation With Mindfulness [Original Research]
- Authors: Wong, S. Y. S; Sun, Y. Y, Chan, A. T. Y, Leung, M. K. W, Chao, D. V. K, Li, C. C. K, Chan, K. K. H, Tang, W. K, Mazzucchelli, T, Au, A. M. L, Yip, B. H. K.
  Pages: 111 - 119
  Abstract: PURPOSEWe undertook a randomized controlled trial to assess the efficacy of group-based behavioral activation with mindfulness (BAM) for treating subthreshold depression in primary care in Hong Kong.METHODSWe recruited adult patients aged 18 years or older with subthreshold depression from public primary care clinics and randomly assigned them to a BAM intervention group or a usual care group. The BAM group was provided with eight 2-hour weekly BAM sessions by trained allied health care workers. Patients in the usual care group received usual medical care with no additional psychological interventions. The primary outcome was depressive symptoms measured by the Beck Depression Inventory-II at 12 months. Secondary outcomes included incidence of major depressive disorder at 12 months. We assessed quality of life, activity and circumstances change, functional impairment, and anxiety at baseline, end of intervention, 5 months, and 12 months.RESULTSWe randomly allocated 115 patients to the BAM intervention and 116 patients to usual care. At 12 months, compared with usual care peers, BAM patients had a slightly more favorable change in levels of depressive symptoms on the Beck Depression Inventory-II (between-group mean difference in score = –3.85; 95% CI, –6.36 to –1.34; Cohen d = –0.46, 95% CI, –0.76 to –0.16). Incidence of major depressive disorder was lower with BAM (10.8% vs 26.8%, P = .01), whereas groups did not differ significantly on other secondary outcomes at 12 months.CONCLUSIONSGroup BAM appears to be efficacious for decreasing depressive symptoms and reducing the incidence of major depression among patients with subthreshold depression in primary care, although generalizability of our findings may be limited.
  Keywords: Mental health, Quantitative methods
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2206
  Issue No: Vol. 16, No. 2 (2018)
Sustainability of a Primary Care-Driven eConsult Service [Original
Research]
- Authors: Liddy, C; Moroz, I, Afkham, A, Keely, E.
  Pages: 120 - 126
  Abstract: PURPOSEExcessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability.METHODSWe conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician’s course of action, and rate of avoidance of face-to-face visits.RESULTSA total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month.CONCLUSIONSThis study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems.
  Keywords: Quantitative methods, Health services, Professional practice, Access, Coordination / integration of care, Communication / decision making, Quality improvement
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2177
  Issue No: Vol. 16, No. 2 (2018)
Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations
[Original Research]
- Authors: Mercer, S. W; Zhou, Y, Humphris, G. M, McConnachie, A, Bakhshi, A, Bikker, A, Higgins, M, Little, P, Fitzpatrick, B, Watt, G. C. M.
  Pages: 127 - 131
  Abstract: PURPOSEThe influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation.METHODSWe conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups.RESULTSIn affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727).CONCLUSIONSIn deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.
  Keywords: Chronic illness, Vulnerable populations, Quantitative methods, Health services, Professional practice, Access, Relationship, Disparities in health and health care, Multimorbidity
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2202
  Issue No: Vol. 16, No. 2 (2018)
A Core Outcome Set for Multimorbidity Research (COSmm) [Original Research]
- Authors: Smith, S. M; Wallace, E, Salisbury, C, Sasseville, M, Bayliss, E, Fortin, M.
  Pages: 132 - 138
  Abstract: PURPOSEWe aimed to develop a consensus-based set of core outcomes specifically for studies in multimorbidity.METHODSWe 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. Panelists were presented with a range of outcomes that had been identified in previous workshops and a related systematic review. They indicated their level of agreement on whether each outcome should be included in the core set using a 5-point Likert scale, and outcomes reaching a prespecified consensus level were included.RESULTSOf 30 individuals invited to be panelists, 26 from 13 countries agreed. All 26 completed both rounds of the survey. The Delphi panel reached consensus on 17 outcomes for inclusion in a core outcome set for multimorbidity (COSmm). The highest-ranked outcomes were health-related quality of life, mental health outcomes, and mortality. Other outcomes were grouped into overarching themes of patient-reported impacts and behaviors (treatment burden, self-rated health, self-management behavior, self-efficacy, adherence); physical activity and function (activities of daily living, physical function, physical activity); consultation related (communication, shared decision making, prioritization); and health systems (health care use, costs, quality of health care).CONCLUSIONSThis consensus study involved a wide range of international experts who identified a large number of outcomes for multimorbidity intervention studies. Our results suggest that quality of life, mental health outcomes, and mortality should be regarded as essential core outcomes. Researchers should, however, also consider the full range of outcomes when designing studies to capture important domains in multimorbidity depending on individual study aims and interventions.
  Keywords: Chronic illness, Mental health, Older adults, Quantitative methods, Research capacity building, Multimorbidity
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2178
  Issue No: Vol. 16, No. 2 (2018)
Recent Patterns in Shared Decision Making for Prostate-Specific Antigen
Testing in the United States [Original Research]
- Authors: Fedewa, S. A; Gansler, T, Smith, R, Sauer, A. G, Wender, R, Brawley, O. W, Jemal, A.
  Pages: 139 - 144
  Abstract: PURPOSEPrevious 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.METHODSWe conducted a retrospective cross-sectional study among men aged 50 years and older in the United States using 2010 and 2015 National Health Interview Survey (NHIS) data (n = 9,598). Changes in receipt of shared decision making were expressed as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Analyses were stratified on PSA testing (recent [in the past year] or no testing). Elements of shared decision making assessed included the patient being informed about the advantages only, advantages and disadvantages, and full shared decision making (advantages, disadvantages, and uncertainties).RESULTSAmong men with recent PSA testing, 58.5% and 62.6% reported having received ≥1 element of shared decision making in 2010 and 2015, respectively (P = .054, aPR = 1.04; 95% CI, 0.98–1.11). Between 2010 and 2015, being told only about the advantages of PSA testing significantly declined (aPR = 0.82; 95% CI, 0.71–0.96) and full shared decision making prevalence significantly increased (aPR = 1.51; 95% CI, 1.28–1.79) in recently tested men. Among men without prior PSA testing, 10% reported ≥1 element of shared decision making, which did not change with time.CONCLUSIONBetween 2010 and 2015, there was no increase in shared decision making among men with recent PSA testing though there was a shift away from only being told about the advantages of PSA testing towards full shared decision making. Many men receiving PSA testing did not receive shared decision making.
  Keywords: Prevention, Quantitative methods, Personalized care, Communication / decision making
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2200
  Issue No: Vol. 16, No. 2 (2018)
The Relationship Between Oseltamivir and Suicide in Pediatric Patients
[Research Brief]
- Authors: Harrington, R; Adimadhyam, S, Lee, T. A, Schumock, G. T, Antoon, J. W.
  Pages: 145 - 148
  Abstract: PURPOSEStudies examining the association between use of oseltamivir and neuropsychiatric events (including suicide) among children have had mixed findings and have been limited by small sample size, reliance on older data, and potential confounding. We undertook an analysis that addresses these limitations.METHODSUsing a national administrative claims database and a case-crossover design that minimized confounding, we analyzed data from 5 contemporary influenza seasons (2009–2013) for individuals aged 1 to 18 years and ascertained oseltamivir exposure from pharmacy dispensing.RESULTSWe identified 21,407 suicide-related events during this study period, 251 of which were in oseltamivir-exposed children. In case-crossover analysis, we did not find any significant association with suicide either for oseltamivir exposure (odds ratio = 0.64; 95% CI, 0.39–1.00; P = .05) or for influenza diagnosis alone (odds ratio = 0.63; 95% CI, 0.34–1.08; P = .10).CONCLUSIONOur findings suggest that oseltamivir does not increase risk of suicide in the pediatric population.
  Keywords: Acute illness, Mental health, Children's health, Quantitative methods
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2183
  Issue No: Vol. 16, No. 2 (2018)
Digital Rectal Examination for Prostate Cancer Screening in Primary Care:
A Systematic Review and Meta-Analysis [Systematic Review]
- Authors: Naji, L; Randhawa, H, Sohani, Z, Dennis, B, Lautenbach, D, Kavanagh, O, Bawor, M, Banfield, L, Profetto, J.
  Pages: 149 - 154
  Abstract: PURPOSEAlthough 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.METHODSWe searched MEDLINE, Embase, DARE (Database of s 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. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality.RESULTSOur search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36–0.67; I2 = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41–0.76; I2 = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31–0.52; I2 = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58–0.70; I2 = 95.0%). The quality of evidence as assessed with GRADE was very low.CONCLUSIONGiven the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.
  Keywords: Prevention, Quantitative methods, Clinical practice guidelines
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2205
  Issue No: Vol. 16, No. 2 (2018)
Moving From Problem-Oriented to Goal-Directed Health Records [Special
Report]
- Authors: Nagykaldi, Z. J; Tange, H, De Maeseneer, J.
  Pages: 155 - 159
  Abstract: 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. We explore the limitations of current EHRs and propose a blueprint for a new EHR design that may facilitate goal-directed health care. To reflect patient goals as a thread through the care continuum, we propose 5 major system functions for goal-directed health records based on the 8 characteristics of primary health care defined by the Institute of Medicine. We also discuss how new EHR functions could support goal-directed health care and how payment and quality measurement systems will need to be transformed. It may be possible for patient life and health goals to drive health care that is reinforced by a corresponding health record design; however, synchronized shifts must occur in the models of providing, documenting, and paying for health care.
  Keywords: Health policy, Coordination / integration of care, Personalized care, Communication / decision making, Health informatics
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2180
  Issue No: Vol. 16, No. 2 (2018)
A Narrative Approach to Healing Chronic Illness [Reflection]
- Authors: Egnew T. R.
  Pages: 160 - 165
  Abstract: 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. By addressing the inevitable existential conflicts uncovered in patients’ narratives and helping them edit their stories to promote acceptance and meaning, suffering can be transcended. This requires that clinicians be skilled in narrative medicine and open to engaging the patient’s existential concerns. By helping patients transcend their suffering, clinicians claim their heritage as healers.
  Keywords: Chronic illness, Professional practice, Communication / decision making, Mindfulness and reflection, Spirituality, Social / cultural context, Patient perspectives
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2182
  Issue No: Vol. 16, No. 2 (2018)
You Will Have a New Life [Reflection]
- Authors: Finkelstein A.
  Pages: 166 - 167
  Abstract: 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.
  Keywords: Chronic illness, Mental health, Mindfulness and reflection, Patient perspectives
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2181
  Issue No: Vol. 16, No. 2 (2018)
From Transactional Tasks to Personalized Care: A New Vision of Physicians
Roles [Reflection]
- Authors: Reuben, D. B; Sinsky, C. A.
  Pages: 168 - 169
  Abstract: 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. These steps focus on shifting physicians’ responsibilities away from transactional tasks and towards personalized aspects of care. By taking steps to close the gap between mission and daily work, physicians will again be able to find joy, purpose, and meaning in their profession and give back what patients and society need from 21st century physicians
  Keywords: Health policy, Health services, Professional practice, Coordination / integration of care, Personalized care, Relationship, Patient-centered medical home
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2203
  Issue No: Vol. 16, No. 2 (2018)
When Its Time to Retire: Notes From the Afterlife [Reflection]
- Authors: Loxterkamp D.
  Pages: 171 - 174
  Abstract: 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. This essay describes the emotional turbulence of ending one career and contemplating the next.
  Keywords: Older adults, Professional practice, Relationship, Mindfulness and reflection, Spirituality, Organizational / practice change, Social / cultural context
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2204
  Issue No: Vol. 16, No. 2 (2018)
Citizen Engagement in Primary Care [Innovations in Primary Care]
- Authors: Kiran, T; Davie, S, MacLeod, P.
  Pages: 175 - 175
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2185
  Issue No: Vol. 16, No. 2 (2018)
Ordering Labs as a Team [Innovations in Primary Care]
- Authors: Panzer J.
  Pages: 176 - 176
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2207
  Issue No: Vol. 16, No. 2 (2018)
SOCIAL DETERMINANTS OF HEALTH IN FAMILY MEDICINE RESIDENCY EDUCATION
[Family Medicine Updates]
- Authors: Clements D. S.
  Pages: 178 - 178
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2211
  Issue No: Vol. 16, No. 2 (2018)
IMPLEMENTING PRIMARY HEALTH CARE POLICY UNDER CHANGING GLOBAL POLITICAL
CONDITIONS: LESSONS LEARNED FROM 4 NATIONAL SETTINGS [Family Medicine
Updates]
- Authors: van Weel, C; Turnbull, D, Bazemore, A, Garcia-Pena, C, Roland, M, Glazier, R. H, Phillips, R. L, Goodyear-Smith, F.
  Pages: 179 - 180
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2214
  Issue No: Vol. 16, No. 2 (2018)
FAMILY PHYSICIANS CONTINUE MOVE TO NEW PAYMENT MODELS, AAFP SURVEY FINDS
[Family Medicine Updates]
- Authors: Laff M.
  Pages: 180 - 181
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2215
  Issue No: Vol. 16, No. 2 (2018)
TAMMY CHANG, MD, MPH, MS SELECTED AS 2017 NAM PUFFER/ABFM FELLOW [Family
Medicine Updates]
- Pages: 181 - 181
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2213
  Issue No: Vol. 16, No. 2 (2018)
STFM ENHANCES ITS LEADING CHANGE OFFERINGS [Family Medicine Updates]
- Pages: 182 - 182
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2219
  Issue No: Vol. 16, No. 2 (2018)
ADFM AND FMAHEALTH BOARDS ENGAGEMENT AROUND A PUBLIC MEMBER PILOT STUDY
[Family Medicine Update]
- Authors: Grumbach, K; Gilchrist, V, Davis, A, Hobbs, J, Worthington, M, Schneider, F. D, Stream, G, OConnor, M, Campbell, T.
  Pages: 182 - 183
  PubDate: 2018-03-12T14:00:17-07:00
  DOI: 10.1370/afm.2212
  Issue No: Vol. 16, No. 2 (2018)