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J. of the American Board of Family Medicine     Open Access   (Followers: 10, SJR: 1.174, CiteScore: 2)
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Journal of the American Board of Family Medicine
Journal Prestige (SJR): 1.174
Citation Impact (citeScore): 2
Number of Followers: 10  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1557-2625 - ISSN (Online) 1558-7118
Published by American Board of Family Medicine Homepage  [1 journal]
  • This Issue's Emphasis: Inequity and COVID-19, Intertwined

    • Authors: Bowman, M. A; Seehusen, D. A, Ledford, C. J. W.
      Pages: 215 - 218
      Abstract: This issue continues our tradition of advancing family medicine by publishing articles on issues that affect patients and the practice of family medicine, specifically with an emphasis on inequity and the COVID pandemic, which are often intertwined. We have articles on topical issues such as appropriate transgender care, newer diabetes medications, transportation as a social risk, and a thought-provoking commentary on ableism. A clinical review on olfactory loss takes on new meaning. Oregon Medicaid coverage policy supported family physicians assisting their patients by decreasing their opioid use, and a article suggests that buprenorphine should be decriminalized. Strengthening the desire to enter family medicine before starting medical school can help meet future patient needs.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.220037
      Issue No: Vol. 35, No. 2 (2022)
  • Peer Reviewers for the Journal of the American Board of Family Medicine in

    • Authors: Bowman, M. A; Seehusen, D. A, Ledford, C. J. W, Lupo, P.
      Pages: 219 - 222
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.220040
      Issue No: Vol. 35, No. 2 (2022)
  • Underrepresented Minority Family Physicians More Likely to Care for
           Vulnerable Populations

    • Authors: Jetty, A; Hyppolite, J, Eden, A. R, Taylor, M. K, Jabbarpour, Y.
      Pages: 223 - 224
      Abstract: Using data from 2016 to 2020, we found that family physicians who identify as underrepresented minorities in medicine were more likely to have a larger percentage of vulnerable patients in their panels. Increasing access to care for vulnerable patient populations will require a combination of advocating for policies to diversify the physician pipeline and those that encourage all primary care physicians to care for vulnerable patients.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210280
      Issue No: Vol. 35, No. 2 (2022)
  • Patient Research Interest Differences by Gender and Race/Ethnicity: A
           North Texas Primary Care Practice-Based Research Network (NorTex) Study

    • Authors: Shabu, T; Espinoza, A. M, Manning, S, Cardarelli, R, Fulda, K. G.
      Pages: 225 - 234
      Abstract: Background:Recruiting and increasing participation of women and racial/ethnic groups remains an ongoing struggle despite the National Institutes of Health Revitalization Act mandating the inclusion of these populations. This study examined gender and racial/ethnic differences in research interest in participating in Practice-Based Research Network studies focused on cardiovascular disease (CVD), diabetes, cancer, and mental health research.Methods:A total of 1348 participants and 18 NorTex clinics from the North Texas Primary Care Registry Project (NRP) database were included in this cross-sectional study. Participants who signed up through the registry to participate in future research projects and self-reported as non-Hispanic White, Hispanic, or non-Hispanic Black were included. Research interest in heart disease, high cholesterol, high blood pressure and heart failure were categorized as CVD; depression and anxiety were categorized as mental health; diabetes and cancer research were coded as single item dependent variables.Results:Of registry participants, 72% were female, 34.5% were Black, and 24.4% were Hispanic. Of participants, 70% (n = 942) were interested in CVD research, the leading area of interest. Mental health research (56.3%, n = 755) was the second highest area of interest, while cancer had the least interest (38.4%, n = 515). After controlling for age, smoking, and having a diagnosis of the medical condition, gender did not predict interest in CVD, diabetes, cancer, or mental health research. However, race/ethnicity significantly predicted interest in diabetes and cancer research.Conclusion:Results indicate there are racial/ethnic differences in interest in specific research topics among our registry participants. This information may be helpful to develop successful recruitment strategies.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210340
      Issue No: Vol. 35, No. 2 (2022)
  • Implementation of Transgender/Gender Nonbinary Care in a Family Medicine
           Teaching Practice

    • Authors: Ulrich, I. P; Harless, C, Seamon, G, Kim, A, Sullivan, L, Caldwell, J, Reed, L, Knoll, H.
      Pages: 235 - 243
      Abstract: Purpose:Numerous studies have shown that transgender or gender nonbinary (TGNB) individuals encounter significantly more health care barriers, including overall lack of access to gender-affirming care providers. This study describes 2 assessments of transgender care services at a large family medicine teaching practice.Methods:Staff and providers were invited to attend an optional, practice-wide, hourlong free training session on gender-affirming care offered on 3 different dates in 2019. A structured protocol was used to collect observational data from which key takeaways from the training sessions were developed. Separately, a retrospective chart review of patients with a gender dysphoria diagnosis was completed. Charts were reviewed for adherence to regional and international organization recommendations for comprehensive transgender care.Results:Three main takeaways from the training sessions included lack of knowledge or familiarity with gender terminology and expression, fear of offending patients, and employee hesitation to change behaviors when interacting with patients. On chart review, the most common interventions identified were need to schedule a follow-up visit (61.5%), need for health maintenance screenings (osteoporosis screening, 50%; Papanicolaou smear, 56.3%; mammogram, 66.7%), need for mental health screening (41.5%), need for laboratory monitoring of testosterone therapy (20%), and corrected gender markers/names listed in the appropriate place in the patient chart (16.9%).Conclusions:This study highlighted hesitation to provide and lack of familiarity with transgender care among practice staff. Although some aspects of comprehensive transgender care are well implemented, maintaining follow-up, completing health maintenance and mental health screenings, and appropriate laboratory monitoring are areas for improvement.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210182
      Issue No: Vol. 35, No. 2 (2022)
  • Validating the Group-Based Medical Mistrust Scale with English and Spanish
           Speaking Latino Parents of Adolescents

    • Authors: Martinez, B; Huh, J, Tsui, J.
      Pages: 244 - 254
      Abstract: Background:Medical mistrust can be a barrier to health care utilization. While the Group-Based Medical Mistrust Scale (GBMMS) has been validated among diverse populations, we know little about its psychometric performance among English-Speaking (ES) and Spanish-Speaking (SS) Latinos. We aim to examine the factor structure of GBMMS among Latino parents and explore whether scale latent factor structures would be different across preferred languages.Methods:Parents of adolescents participating in an urban academic enrichment program for low-income students completed an online survey as part of a cross-sectional study about Human Papillomavirus (HPV) prevention. We tested the validity of the GBMMS in ES and SS respondents and performed exploratory factor analysis to identify latent factors. We examined scale scores, item means, item endorsement, and residual variance across language groups.Results:2-factor latent structure was identified for both ES and SS groups; factors were labeled as ‘Suspicion’ and ‘System-wide discrimination.’ Scale validity was better among SS (α = 0.76). Medical mistrust scores did not vary across language groups, but variation emerged in item endorsement by language.Discussion:Our results suggest that the factor structures of the medical mistrust construct, measured by the GBMMS, are similar across ES and SS Latinos and that the GBMMS is valid for both populations. High factor pattern loading reflects a shared mistrust of how health care systems view and treat people of their racial/ethnic background, independent of their preferred languages. Measurement of medical mistrust and identifying its underlying causes are needed within diverse populations to fully address structural- and community-level influences on health inequities.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210307
      Issue No: Vol. 35, No. 2 (2022)
  • Prescription Patterns of Novel Antihyperglycemic Medications

    • Authors: Ali, A. S; Khan, M, Ortega, D, Jaffery, S, Lamerato, L. E, Budzynska, K.
      Pages: 255 - 264
      Abstract: Background:Glucagon-like peptide-1 agonists (GLP-1a) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are recommended in carefully selected patients with type 2 diabetes. This study will assess prescription of these medications and investigate predictors of prescription.Methods:This retrospective cross-sectional study included 31,354 patients. Data including sociodemographic descriptors, clinical histories, medications, and health insurance providers were extracted from a health system's administrative databases. Variables to be associated with prescription of a GLP-1a or SGLT-2i were assessed using a multivariable logistic regression model.Results:Mean age was 62.58 years and 40.8% identified as African American. Only 3.4% were prescribed a GLP-1a and 2.1% received a SGLT-2i. Logistic regression demonstrated lower odds of receiving either medication in the highest age-group (70 to 79 years) (GLP-1a: odds ratio [OR] 0.44, P < .01, SGLT-2i: OR 0.39, P < .01) and in African Americans (GLP-1a: OR 0.64, P < .01, SGLT-2i: OR 0.28, P < .01). Atherosclerotic cardiovascular disease was not associated with GLP-1a prescription (P = .54) and conferred lower odds of being prescribed SGLT-2i (OR 0.68, P < .01). History of chronic kidney disease conferred lower odds of receiving GLP-1a and was not associated with the odds of receiving SGLT-2i.Conclusions:Prescription of GLP-1a and SGLT-2i medications was low as compared with existing literature. Advanced age and African American race were negatively associated with prescription of these medications. Contrary to guideline recommendations; atherosclerotic cardiovascular disease and chronic kidney disease were not positively associated with prescription.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210360
      Issue No: Vol. 35, No. 2 (2022)
  • COVID-19's Perceived Impact on Primary Care in New England: A Qualitative

    • Authors: Sullivan, E. E; Breton, M, McKinstry, D, Phillips, R. S.
      Pages: 265 - 273
      Abstract: Background:COVID-19 impacted primary care delivery, as clinicians and practices implemented changes to respond to the pandemic while safely caring for patients. This study aimed to understand clinicians' perceptions of the positive and negative impacts of COVID-19 on primary care in New England.Methods:This qualitative interview study was conducted from October through December 2020. Participants included 22 physicians and 2 nurse practitioners practicing primary care in New England. Data were thematically coded and analyzed deductively and inductively using content analysis.Results:Through qualitative content analysis, 4 areas were identified in which clinicians perceived that COVID-19 impacted primary care: 1) bureaucracy, 2) leadership, 3) telemedicine and patient care, and 4) clinician work-life. Our findings suggest that the positive impacts of COVID-19 included changes in primary care delivery, new leadership opportunities for clinicians, flexible access to care for patients via telemedicine, and a better work-life balance for clinicians. Respondents identified negative impacts related to sustaining pandemic-inspired changes, the inability for some populations to access care via telemedicine, and the rapid implementation of telemedicine causing frustration for clinicians.Conclusions:Understanding clinician perspectives on how primary care transformed to respond to COVID-19 helps to identify beneficial pandemic-related changes that should be sustained and ideas for improvement that will support patient care and clinician engagement.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210317
      Issue No: Vol. 35, No. 2 (2022)
  • Practice Adjustments Made by Family Physicians During the COVID-19

    • Authors: Price, D. W; Eden, A. R, Baxley, E. G, Williamson, A, Newton, W. P.
      Pages: 274 - 283
      Abstract: Introduction:COVID-19 pandemic-related health care disruptions necessitated rapid adaptation among family physicians to safely meet patient needs while protecting themselves and their staff. On April 1, 2020, the American Board of Family Medicine (ABFM) introduced a COVID Performance Improvement (PI) activity for physicians to report on and receive Family Medicine certification credit for practice adjustments they made during the early stages of the pandemic. We aimed to understand the types of interventions implemented, and lessons physicians learned from the efforts.Methods:We analyzed data from COVID-PI activities submitted by self-selected family physicians between April 1 and June 30, 2020. We summarized the COVID-related topics chosen for improvement and performed a qualitative content analysis on a random sample of open-text responses about lessons learned.Results:The most common practice changes among 1259 unique COVID-PI activity submissions related to virtualization of patient visits, implementing new workflows, developing screening protocols, and obtaining and preserving personal protective equipment. We identified 12 themes regarding lessons learned, most commonly regarding patient and staff safety, modified practice processes and workflows, positive perceptions of and future plans for virtual visits, access to care, and patient satisfaction. Most submitters noted early successes with their interventions.Conclusion:A PI activity template designed for continuous board certification allowed family physicians to report on how they successfully implemented short term practice changes during the early stages of the COVID-19 pandemic. Reflections from this subset of physicians regarding lessons learned may prove useful in informing future COVID-19 related practice changes.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210391
      Issue No: Vol. 35, No. 2 (2022)
  • Hospital-Based Healthcare Worker Perceptions of Personal Risk Related to
           COVID-19: One Year Follow-Up

    • Authors: Yamane, D; Zarabian, K, Devine, K, Benjenk, I, Farrar, K, Park, O. L, Kim, J, Davison, D, Heinz, E.
      Pages: 284 - 294
      Abstract: Background:The COVID-19 pandemic has significantly impacted health care workers (HCW). Most research focused on the adverse mental health effects during the initial surge of cases; and yet little is known about approximately how workers are faring 1 year into the pandemic. The objective of this study is to examine stress, burnout, and risk perception in an academic medical system, 1 year after the start of the pandemic.Methods:HCW across care specialties participated in online surveys in Spring 2020 and Spring 2021. The surveys included questions related to workplace stress and risk perception related to COVID-19. Correlates of stress and burnout were explored using multivariable linear regression models. Professional Quality of Life Scale (PROQOL) questions were added to the second survey.Results:While HCW reported significantly fewer concerns about the risk of COVID-19 transmission to themselves and their families during the 2021 survey (compared with 2020), the percentage of workers who reported feeling excess stress at work or considered resigning stayed the same. One year into the pandemic, 57% of study participants met criteria for moderate or high levels of traumatic stress and 75% met criteria for moderate or high levels of burnout. As compared with participants who cared for no COVID-19 deaths, participants who cared for COVID-19 patients who died had significantly higher traumatic stress (1 to 10: Coef. = 2.7, P = .007;>10: Coef. = 6.7, P < .001) and burnout scores (1 to 10: Coef. = 2.7, P = .004;>10: Coef. = 2.6, P = .036).Conclusion:While Although perceptions of risk declined over the course of the year, levels of stress still remained high despite high vaccination rates. Those who witnessed more COVID-19 deaths were more likely to report increased burnout and post-traumatic stress. As our nation continues to grapple with the COVID-19 pandemic and new variants emerge it is imperative to focus on recovery strategies for high burnout groups to ensure the wellbeing of our health care workforce.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210272
      Issue No: Vol. 35, No. 2 (2022)
  • Impact of the COVID-19 Pandemic on Exercise Habits Among US Primary Care

    • Authors: Byrne, N. W; Parente, D. J, Yedlinsky, N. T.
      Pages: 295 - 309
      Abstract: Background:To explore how the COVID-19 pandemic has affected exercise habits, we hypothesized that participants' physical activity would have increased by at least 30 min/wk after the onset of the pandemic.Methods:We distributed an anonymous survey to ambulatory patients at the Family Medicine Clinic, University of Kansas Medical Center to analyze changes in exercise habits and weight.Results:Of the 500 adult patients surveyed, 382 were included. Results were stratified by demographics, including employment status before and during COVID-19. The median change in weekly exercise duration was 0.0 minutes, but the mean change was –25.7 minutes; total exercise duration decreased after the pandemic's onset (paired Wilcox signed rank test P < .001). More individuals reported participation in virtual group classes (6.3% before the pandemic vs 13.1% during the pandemic; McNemar's P < .001). Individuals with home exercise equipment before the pandemic were more likely to acquire more than were those who had none before (Chi square test P < .005). Overall, there is a significant trend in the direction of weight gain (Wilcox signed rank test P < .001).Conclusions:Most participants decreased physical activity during the unprecedented COVID-19 pandemic, expanding our understanding of how exercise habits change during stressful life events.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210313
      Issue No: Vol. 35, No. 2 (2022)
  • Blood Pressure Checks for Diagnosing Hypertension: Health Professionals'
           Knowledge, Beliefs, and Practices

    • Authors: Green, B. B; Anderson, M. L, Ehrlich, K, Hall, Y. N, Hansell, L. D, Hsu, C, Joseph, D, Margolis, K. L, McClure, J. B, Munson, S. A, Thompson, M. J.
      Pages: 310 - 319
      Abstract: Introduction:The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new hypertension diagnosis and initiating treatment, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common.Methods:e-mail-linked surveys were sent to primary care team members (n = 421) from 10 clinics. The sample included medical assistants, licensed practical nurses, registered nurses, and advanced practice registered nurses (LPN/RN/APRNs), physician assistants (PAs), and physicians. Those licensed to diagnosis hypertension (physician/PA/APRNs) received additional questions. Data were collected from November 2017 to July 2019.Results:2-thirds of invitees responded (163 MA/LPN/RNs, 86 physicians, and 33 PA/APRNs). When making a new hypertension diagnosis, most respondents believed that BP measured manually with a stethoscope (78.6%) or ABPM (84.2%) were very or highly accurate. In contrast, most did not believe that automated clinic BPs, home BP, or kiosk BP measurements were very or highly accurate. Almost all reported always or almost always relying on clinic BP measurements in making a diagnosis (95.7%), but most physician/PA/APRNs (60.5%) would prefer ABPM if it was readily available. Very few physician/PA/APRNs used the guideline-concordant diagnostic threshold (135/85 mmHg) with home monitoring (14.0%) or ABPM (8.4%), with 140/90 mmHg the most commonly reported threshold for home (59.4%) and ABPM (49.6%).Discussion:Our study found health care professional knowledge, beliefs, and practices gaps in diagnosing hypertension. These gaps could lead to clinical care that is not aligned with guidelines.Conclusion:System changes and interventions to increase use of evidence-based practices could improve hypertension diagnosis and outcomes.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210318
      Issue No: Vol. 35, No. 2 (2022)
  • Assessing the Adequacy of Obstructive Sleep Apnea Diagnosis for High-Risk
           Patients in Primary Care

    • Authors: Arsic, B; Zebic, K, Sajid, A, Bhave, N, Passalacqua, K. D, White-Perkins, D, Lamerato, L, Rees, D, Budzynska, K.
      Pages: 320 - 328
      Abstract: Introduction:The exact prevalence of obstructive sleep apnea (OSA) is unknown, and primary care providers are left with conflicting guidance on screening criteria from various institutions. The purpose of this study was to identify health care gaps in OSA diagnosis for patients at high risk of OSA.Methods:A retrospective medical record review was performed assessing adult patients (≥ 18 years) who had outpatient visits in family medicine clinics, located in the cities of Detroit, Troy, and Commerce, Michigan in 2018. The primary outcome was the number of patients assessed for OSA. Patients determined as high risk for OSA had at least 3 of the following criteria: (1) hypertension, (2) age 50 years and older, (3) male gender, and (4) body mass index> 35 kg/m2. Statistical approach included univariate and logistic regression analysis. Manual chart review of 200 randomly selected records was performed to determine the most common reasons for OSA screening.Results:Out of 30,022 patients, 4,911 (16.4%) were at high risk for OSA, of which 1,524 (31.0%) were assessed for OSA. Logistic regression analysis of high-risk patients revealed that male sex (odds ratio, 1.84; 95% CI, 1.51–2.26; P < .001) and body mass index> 35 kg/m2 (odds ratio, 4.96; 95% CI, 4.04–6.09; P < .001) were significantly associated with OSA evaluation. Race was not associated with OSA assessment.Conclusion:Because many individuals at high risk for OSA are not referred for evaluation, improved guidance on OSA screening based on objective risk factors is needed.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210296
      Issue No: Vol. 35, No. 2 (2022)
  • Oncology and Primary Care Provider Views on Cancer Survivorship Care: Mind
           the Gap

    • Authors: Doescher, M. P; Nagykaldi, Z, Zhao, Y. D, Dwyer, K.
      Pages: 329 - 340
      Abstract: Context:Coordination between oncology and primary care practices in cancer survivorship is lacking.Objective:To identify cancer care coordination perceptions, knowledge, and practices in a sample of Oklahoma oncology care providers (ONCs) and primary care providers (PCPs) regarding post-treatment care of adult cancer survivors.Design:Cross-sectional, statewide survey by mail/web link in 2014/5.Setting:PCPs identified through a primary care research network, primary care organization membership lists; ONCs identified through who were clinically active and seeing cancer patients were eligible. The final sample size included 101 ONCs and 58 PCPs who reported actively seeing cancer patients.Measures:Responses to predominately Likert scale or ranked-order questions derived from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors.Analyses:Chi square and t tests were performed to test bivariate associations between provider type and survey measures.Results:Statistically significant differences (P < .05) between ONC and PCP perceptions were observed for several questions on communication between the 2 provider types, ONC perceptions of PCP ability to address survivorship care, and responsibilities for post-treatment care.Conclusions:Highly discrepant perspectives between ONCs and PCPs regarding communications and responsibilities for survivorship care may lead to adverse health outcomes. Interventions aimed at improving care coordination for cancer survivors should define each provider group's responsibilities in survivorship care, and create structures and processes that foster clear channels of communication between ONC and PCP practices.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210286
      Issue No: Vol. 35, No. 2 (2022)
  • All in the Family: A Qualitative Study of the Early Experiences of Adults
           with Younger Onset Type 2 Diabetes

    • Authors: Gopalan, A; Blatchins, M. A, Xu, K. K, Altschuler, A, Marshall, C. J, Hessler, D. M, Fernandez, A, Grant, R. W.
      Pages: 341 - 351
      Abstract: Objective:Adults with type 2 diabetes diagnosed at a younger age are at increased risk for poor outcomes. We examined life stage-related facilitators and barriers to early self-management among younger adults with newly diagnosed type 2 diabetes.Research Design and Methods:We conducted 6 focus groups that each met twice between November 2017 and May 2018. Participants (n = 41) were aged 21 to 44 years and diagnosed with type 2 diabetes during the prior 2 years. Transcripts were coded using thematic analysis and themes were mapped to the Capability-Opportunity-Motivation-Behavior framework.Results:Participants were 38.4 (±5.8) years old; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified 9 themes that fell into 2 categories: (1) the impact of having an adult family member with diabetes, and (2) the role of nonadult children. Family members with diabetes served as both positive and negative role models, and, for some, personal familiarity with the disease made adjusting to the diagnosis easier. Children facilitated their parents' self-management by supporting self-management activities and motivating their parents to remain healthy. However, the stress and time demands resulting from parental responsibilities and the tendency to prioritize children's needs were perceived as barriers to self-management.Conclusions:Our results highlight how the life position of younger-onset individuals with type 2 diabetes influences their early experiences. Proactively addressing perceived barriers to and facilitators of self-management in the context of family history and parenthood may aid in efforts to support these high-risk, younger patients.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210223
      Issue No: Vol. 35, No. 2 (2022)
  • Reduction of Long-Term Opioid Prescribing for Back Pain in Community
           Health Centers After a Medicaid Policy Change

    • Authors: Muench, J; Hoopes, M, Mayhew, M, Pisciotta, M, Shortreed, S. M, Livingston, C. J, Von Korff, M, DeBar, ,Lynn L.
      Pages: 352 - 369
      Abstract: Introduction:Beginning around 2011, innumerable policies have aimed to improve pain treatment while minimizing harms from excessive use of opioids. It is not known whether changing insurance coverage for specific conditions is an effective strategy. We describe and assess the effect of an innovative Oregon Medicaid back/neck pain coverage policy on opioid prescribing patterns.Methods:This retrospective cohort study uses electronic health record data from a network of community health centers (CHCs) in Oregon to analyze prescription opioid dose changes among patients on long-term opioid treatment (LOT) affected by the policy.Results:Of the 1,789 patients on LOT at baseline, 41.6% had an average daily dose of
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210306
      Issue No: Vol. 35, No. 2 (2022)
  • Predictors of Primary Care Practice Among Medical Students at the Michigan
           State University College of Human Medicine

    • Authors: Edwards-Johnson, J; Lee, Y, Wendling, A, Patel, B, Phillips, J.
      Pages: 370 - 379
      Abstract: Introduction:This study examines the evolution of student and physician interest in primary care from medical school matriculation to practice, focusing on student factors that potentiate primary care (PC) practice.Methods:We compiled a dataset of 2,047 Michigan State University College of Human Medicine graduates from 1991 to 2010. PC interest was assessed using the Association of American Medical Colleges (AAMC) matriculating student (MSQ) and graduation (GQ) questionnaires. PC practice was determined using AMA physician Masterfile data. C2 analyses and logistic regression were used to examine factors that predict PC practice.Results:PC interest at matriculation and at graduation were the factors most likely to predict PC practice. After controlling for URM status, gender, and rural origin, the odds of practicing PC among those with a sustained interest in PC (on both the MSQ and GQ) were 100 times higher than those with no interest in PC, on either survey (P < .01). Among those students who developed an interest in PC by graduation, the odds of practicing PC were 60 times higher than noninterested students (P < .01). Finally, among students who were interested in PC at matriculation, but not graduation, the odds of eventually practicing PC were 3.8 times higher than noninterested students (P < .01).Conclusions:Our study suggests that cultivating PC interest at any point during medical school may predict PC practice. Early and sustained interest in primary care was the most substantial predictor of PC practice in our study, highlighting the need for primary care education even before medical school matriculation.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210257
      Issue No: Vol. 35, No. 2 (2022)
  • A Malpractice Claims Study of a Family Medicine Department: A 20-Year

    • Authors: Schacht, K; Furst, W, Jimbo, M, Chavey, W. E.
      Pages: 380 - 386
      Abstract: Background:This study describes medical malpractice claims from a large academic family medicine department over 20 years. The intent of this investigation is to analyze trends within the department, seeking to better understand how to improve the quality of patient care.Study Design:The Office of Patient Relations and Clinical Risk (PRCR) at University of Michigan Health maintains a centralized database of family medicine malpractice claims dating back to 1987. Records from 2000 to 2020 were requested from this database and received in a deidentified manner to protect patient confidentiality, and as such this study was exempt from IRB review. A total of 55 claims occurred during this time period. These claims were then analyzed in both qualitative and quantitative terms.Results:Of the 55 claims, 87.3% involved adult patients; 76.5% of the claims occurred in the outpatient setting; 98.1% of the claims involved attending physicians and 26.9% involved resident physicians; 54.5% of the claims were closed without payment and 43.6% of the claims were settled. The average settled claim amount was $742,110.50 which dropped to $160,838.59 after excluding obstetric claims. In addition, 61.8% of the claims were related to diagnosis related allegations and 16.4% of the claims involved treatment related allegations. Primarily involving allegations of missed or delayed diagnoses of cancer, 29.1% of the claims were cancer related. While 79.2% of settled claims did not meet standard of care, 83.3% of the claims closed without payment did meet standard of care.Conclusions:Most claims involved adult patients, occurred in the outpatient setting, and involved diagnosis related allegations. Although representing a minority of the claims, obstetric claims made up most of the total settlement amount. Missed or delayed diagnoses of cancer were a common cause for claims, reinforcing the important role that primary care physicians have in supervising and administering preventative health care to patients. This study also emphasizes the value of peer review committees to help inform medical-legal consultants as evidenced by the high correlation between standard of care determination and final claims outcomes.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210260
      Issue No: Vol. 35, No. 2 (2022)
  • A Linguist's Perspective on the American Board of Family Medicine's
           Differential Item Functioning Panel

    • Authors: Cramer J.
      Pages: 387 - 389
      Abstract: As part of their continuing efforts to create higher parity levels in the Family Medicine Certification Examination, the American Board of Family Medicine has established procedures to explore bias in certification examinations by establishing a differential item functioning (DIF) analysis process and panel review. The review panel consists of a diverse group of family physicians and a linguist who is charged with determining whether items from the examination contain bias unrelated to the practice of medicine. It is the objective of this commentary to explain the panel process itself and to promote the inclusion of a linguist in similar panels. I argue that the inclusion of a linguist on a DIF panel can aid in determining where language itself is the source of bias.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210350
      Issue No: Vol. 35, No. 2 (2022)
  • Ableism at the Bedside: People with Intellectual Disabilities and COVID-19

    • Authors: Chicoine, C; Hickey, E. E, Kirschner, K. L, Chicoine, B. A.
      Pages: 390 - 393
      Abstract: People with intellectual and developmental disabilities have a higher risk of mortality from COVID-19 than the general population. Providers may assume that this is due to the burden of comorbidities for this population; however, the disparity in mortality persists even when controlling for comorbidities. We review the current policies and practices that may be contributing to this higher level of mortality. We contend that pervasive ableism among medical providers leads to a variation in the medical care options that are provided to people with intellectual disabilities and their families. Due to this bias, poor outcomes for people with intellectual disabilities may become a self-fulfilling prophecy. We make recommendations to address the modifiable factors that are contributing to the higher level of mortality for people with intellectual disabilities who are infected with COVID-19, provide strategies to combat ableism within the medical field, and discuss the unique role of the primary care physician as an advocate.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210371
      Issue No: Vol. 35, No. 2 (2022)
  • Against Our Instincts: Decriminalization of Buprenorphine

    • Authors: Messinger, J. C; Chukka, A, Boyd, J. W.
      Pages: 394 - 397
      Abstract: The rate of overdose deaths has increased dramatically over the past 2 decades. Recently, efforts have been made to expand access to medications for opioid use disorder, such as buprenorphine, by removing X-waiver training requirements. However, relieving such barriers has also raised concern about increasing diversion rates for buprenorphine use, defined as the use of buprenorphine for some purpose or by someone other than it was originally intended. Historically, diversion has been addressed through the criminalization of buprenorphine possession without a prescription. We argue that while buprenorphine diversion is not to be condoned, the benefits of such actions greatly outweigh the harms. Thus, criminalization of diverted buprenorphine represents a dangerous and wasteful response that threatens the progress made through expanded access to this lifesaving medication.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210308
      Issue No: Vol. 35, No. 2 (2022)
  • Support Physicians Who Identify as Underrepresented Minorities--But All
           Physicians Should Care for Vulnerable Populations

    • Authors: Hayashi A. S.
      Pages: 398 - 399
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.220036
      Issue No: Vol. 35, No. 2 (2022)
  • Content Analysis of Transportation Screening Questions in Social Risk
           Assessment Tools: Are We Capturing Transportation Insecurity'

    • Authors: Razon, N; Gottlieb, L.
      Pages: 400 - 405
      Abstract: Purpose:To analyze transportation screening and assessment questions used in social risk screening tools to understand how these tools assess patients' mobility and transportation needs.Methods:We conducted content analysis of transportation screening and assessment tools used in adult health care delivery settings.Results:We identified 23 unique social risk screening tools; 14 included at least 1 transportation question. Transportation screeners differed in terms of content domain, structure, and response options. Existing transportation screening and assessment tools do not uniformly or comprehensively assess transportation needs. Questions typically fail to surface relevant information on financial constraints, disability, local transportation options, and social isolation that should influence related interventions.Conclusions:Development of a brief screening question that broadly captures transportation insecurity followed by a more comprehensive assessment triggered by positive response could enable policy makers and health systems to better identify individuals facing transportation insecurity and to develop transportation solutions that address patients' transportation needs.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210256
      Issue No: Vol. 35, No. 2 (2022)
  • Olfactory Loss and Beyond: A Practical Review of Chemosensory Dysfunction

    • Authors: Claus, L. E; Leland, E. M, Tai, K. Y, Schlosser, R. J, Kamath, V, Lane, A. P, Rowan, N. R.
      Pages: 406 - 419
      Abstract: Background:Our ability to smell and taste is dictated by 3 chemosensory systems with distinct physiologic mechanisms – olfaction, gustation, and chemesthesis. Although often overlooked, dysfunction of these special senses may have broad implications on multiple facets of patients' lives –including safety, nutritional status, quality of life, mental health, and even cognitive function. As "loss of smell or taste" emerged as a common symptom of coronavirus disease 2019 (COVID-19), the importance of intact chemosensory function has been thrust into the spotlight. Despite the growing recognition of chemosensory dysfunction, this already highly prevalent condition will increasingly impact a larger and more diverse population, highlighting the need for improved awareness and care of these patients.Methods:Comtemporary review of chemosensory function and assessments.Conclusions:Although patient-reported chemosensory function measures highlight the ease of screening of chemosensory dysfunction, self-reported measures underestimate both the prevalence and degree of chemosensory dysfunction and do not adequately distinguish between olfaction, gustation, and chemesthesis. Meanwhile, psychophysical assessment tools provide opportunities for more accurate, thorough assessment of the chemosenses when appropriate. Primary care providers are uniquely situated to identify patients burdened by chemosensory dysfunction and raise patient and provider awareness about the importance of chemosensory dysfunction. Identification of chemosensory dysfunction, particularly olfactory dysfunction, may raise suspicion for many underlying medical conditions, including early detection of neurodegenerative conditions. Furthermore, identification and awareness of patients with chemosensory dysfunction may help primary care providers to identify those who may benefit from additional therapeutic and safety interventions, or consultations with specialists for more detailed evaluations and management.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210373
      Issue No: Vol. 35, No. 2 (2022)
  • Motivational Interviewing Strategies for Addressing COVID-19 Vaccine

    • Authors: Boness, C. L; Nelson, M, Douaihy, A. B.
      Pages: 420 - 426
      Abstract: Severe acute respiratory syndrome coronavirus 2, or coronavirus disease 2019 (COVID-19), vaccine hesitancy, defined as a behavioral phenomenon whereby individuals neither fully accept nor fully reject the COVID-19 vaccine, presents a major health threat in the midst of the current pandemic. Traditional approaches for addressing vaccine hesitancy in health care lack empirical support and, in some instances, have actually increased vaccine hesitancy. Thus, there is an urgent need for approaches that effectively address COVID-19 vaccine hesitancy, especially in health care settings. The current article highlights the need for and importance of motivational interviewing (MI), which emphasizes collaborative communication between physicians and patients, in addressing vaccine hesitancy. We describe a 3-step process for addressing COVID-19 vaccine hesitancy that includes using a guiding style, using the MI toolbox, and responding mindfully and skillfully to the individual's degree of hesitancy. The discussion concludes with a consideration of possible challenges in implementing these steps when addressing and resolving COVID-19 vaccine hesitancy.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210327
      Issue No: Vol. 35, No. 2 (2022)
  • Clinical Quality Measures: A Challenge for-and to-Family Physicians

    • Authors: Drabkin, A; Adler, R. N, Altman, W, Ehrlich, A. M, Agnoli, A, Alper, B. S.
      Pages: 427 - 434
      Abstract: Introduction:Improving design, selection and implementation of appropriate clinical quality measures can reduce harms and costs of health care and improve the quality and experience of care delivery. These measures have not been evaluated for appropriateness for use in performance measurement in a systematic, reproducible, and widely accepted manner.Methods:We defined 10 criteria for evaluation of measure appropriateness in 4 domains: Patient-centeredness of outcomes, specification of population measured and measure detail, reliable evidence that benefits likely outweigh harms, and independence from significant confounders. We applied these criteria to 24 measures under consideration for statewide use in Massachusetts in public and private incentive-based programs. We appraised each measure as Appropriate or Not Appropriate for such use.Results:We rated 15 measures as Appropriate (62.5%). Three measures (12.5%) were considered Appropriate only if applied at a system level but not for patient-provider assessment and 6 measures (25%) were rated Not Appropriate. Reasons for designation as "Not Appropriate" included benefits not clearly outweighing harms, lack of preservation of patient autonomy, inappropriate specification of population and measure detail, confounding by locus of control, and confounding by social determinants of health.Conclusions:Using this consensus-driven, 10-criteria methodology we were able to evaluate appropriateness of clinical quality measures. This methodology may improve measure design and inform selection of the most appropriate measures for use in quality measurement, financial incentives, and reporting.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210294
      Issue No: Vol. 35, No. 2 (2022)
  • Diagnosis and Management of Plantar Dermatoses

    • Authors: Rasner, C. J; Kullberg, S. A, Pearson, D. R, Boull, C. L.
      Pages: 435 - 442
      Abstract: Plantar dermatoses (PD) are common, occurring either spontaneously on healthy skin or developing secondarily from previously established foot disease. PD share similar symptoms and morphology, making them challenging to differentiate. A few of the most frequently encountered PD include tinea pedis, psoriasis, contact dermatitis, dyshidrotic dermatitis (or recurrent vesicular palmoplantar dermatitis), and juvenile plantar dermatosis. This review offers practical advice for diagnosing and treating the most common PD in the primary care office.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.200410
      Issue No: Vol. 35, No. 2 (2022)
  • You Can Call Me "Doctor" and "Friend"

    • Authors: Ellis J.
      Pages: 443 - 444
      Abstract: Despite interacting with a number of other people, doctors are at risk of social isolation. The author shares from his experiences how the use of professional titles may unintentionally hinder the development of meaningful relationships at and away from work. This may increase the risk for physicians to experience isolation, loneliness and burnout.
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.210328
      Issue No: Vol. 35, No. 2 (2022)
  • It Takes a Village to Redesign Residencies...

    • Authors: Newton, W. P; Magill, M.
      Pages: 445 - 448
      PubDate: 2022-04-04T06:47:38-07:00
      DOI: 10.3122/jabfm.2022.02.220067
      Issue No: Vol. 35, No. 2 (2022)
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