| Publisher: American Board of Family Medicine
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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  Open Access journalISSN (Print) 1557-2625 - ISSN (Online) 1558-7118 Published by American Board of Family Medicine  [1 journal]
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- Practicing Family Medicine in a Pandemic World: Lessons for Telemedicine,
Health Care Delivery, and Mental Health Care
Authors: Seehusen, D. A; Bowman, M. A, Ledford, C. J. W.
Pages: 709 - 711
Abstract: In this issue of the Journal, several articles evaluate the strengths and weaknesses of telemedicine. Evidence demonstrates that telemedicine is not equally effective for all clinical situations. Another set of articles report research on the delivery of health care: electronic reminders for physicians, standing orders, guideline use, and screening for social determinants of health. Two studies report on the effects of the pandemic on the mental health of subpopulations. The impact of changing insurance status on chronic disease diagnoses, the implications of eliminating the X-waiver, and trends in early career family physician salaries are also studied.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230290R0
Issue No: Vol. 36, No. 5 (2023)
- Care Redesign to Support Telemedicine Implementation During the COVID-19
Pandemic: Federally Qualified Health Center Personnel Experiences
Authors: Frehn, J. L; Starn, B. E, Rodriguez, H. P, Payan, D. D.
Pages: 712 - 722
Abstract: Background:Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care redesign strategies to support telemedicine implementation in 2020 and 2021, and identifies improvement opportunities.Methods:We conducted semistructured, in-depth interviews with clinic personnel (n = 15) at 2 FQHCs in Northern California (December 2020-April 2021) to examine telemedicine adoption and use of audio-video and audio-only/phone telemedicine encounters.Results:FQHC clinicians and staff reported that telemedicine implementation increased access to care and reduced appointment no-show rates. However, a reported reduced ability to develop and foster interpersonal connections negatively impacted clinician-patient relationships. Care redesign strategies included systems to triage appointment types (in-person versus virtual), work-arounds to screen for and address social and nonmedical needs, and new protocols to navigate privacy needs for first time telemedicine users. In addition, increasing remote monitoring capabilities was deemed an important priority for improving telemedicine use for marginalized populations.Conclusions:Telemedicine implementation in FQHCs involved care redesign to optimize virtual interactions and care processes. Guidelines and evidence-based practices are needed to improve telemedicine use in FQHCs, including strategies to support interpersonal connections; approaches to virtually screen for and address social needs; and protocols to further mitigate privacy issues. Future research is needed to identify when telemedicine can optimally supplement in-person care to improve patient outcomes and clinic efficiency, particularly in safety net settings.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2022.220370R2
Issue No: Vol. 36, No. 5 (2023)
- Nurse Standing Orders for Buprenorphine Follow-Up Care in a Community
Health Center Network
Authors: Waters, R. C; Mugleston, M, Terry, A, Reinhart, C, Wilson, M.
Pages: 723 - 730
Abstract: Background:Less than 20% of individuals with opioid use disorder (OUD) are receiving a medication treatment for OUD in the United States. Though nurses can assume critical roles in outpatient models of OUD care, there are no published reports of buprenorphine standing orders for nurses that guide a nuanced response for patients returning as expected versus those re-engaging after a treatment lapse, without requiring real-time prescriber consultation.Methods:Standing orders for buprenorphine were created with multiple stakeholders within an urban community health center that includes traditional clinics as well as non-traditional homeless care sites. After more than two years of use, an anonymous survey assessed staff perception of usability and safety of the standing orders using the validated system usability scale (SUS) and a 5-item Likert scale. Patient retention rates at 12 and 18 months were compared for sites that were early- and late-adopters of the standing orders.Results:Of 24 clinicians and 7 nurses who responded to the survey, 46% had used the standing orders. More than 85% reported a perception that the standing orders improved team-based care and increased access to buprenorphine refills. None reported any safety concerns. The median SUS score was 75.0 (SD 15.4), rated as "excellent". There was no statistically significant difference in 12- or 18-month retention rates between early- and late-adopter sites of the standing orders.Conclusions:Nurse standing orders for buprenorphine follow-up and re-engagement care are feasible, usable and perceived as safe in varied community health center settings.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2022.220426R1
Issue No: Vol. 36, No. 5 (2023)
- Childrens Special Health Care Needs and Caregivers Well-Being During the
COVID-19 Pandemic
Authors: Pasli, M; Tumin, D.
Pages: 731 - 738
Abstract: Background:Caregivers of children with special health care needs (SHCN) report worse self-rated health when compared with caregivers of children without SHCN and have experienced significant stress during the COVID-19 pandemic. We sought to determine whether COVID-19 pandemic-era declines in well-being among caregivers of children with SHCN were steeper than among caregivers of children without SHCN.Methods:We used 2020 to 2021 (pandemic-era, n = 89,560) and 2018 to 2019 (pre-pandemic, n = 57,927) data from the National Survey of Children’s Health. Caregiver-reported physical and mental health outcomes were analyzed using multivariable ordinal logistic regression.Results:The pandemic era was associated with 26% higher odds of reporting worse mental health among caregivers of children with SHCN (95% confidence interval [CI]: +16%, +38%), and 20% higher odds of reporting worse mental health among caregivers of children without SHCN (95% CI: +15%, +26%). The magnitudes of these changes were not significantly different from one another (P = .341).Conclusions:Although caregivers of children with SHCN faced significant burdens and increased stress during the pandemic, decline in self-rated mental health among this group was similar to the trend seen among caregivers of children without SHCN.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2022.220406R2
Issue No: Vol. 36, No. 5 (2023)
- Comparing Outcomes of Musculoskeletal Radiographs from In-Person and
Telemedicine Primary Care Cohorts, April 2019-June 2021
Authors: Petrilli, J; Guth, T, Coughlin, E.
Pages: 739 - 745
Abstract: Purpose:Musculoskeletal conditions are a common reason for primary care visits, and they are being increasingly addressed at televisits. We therefore examined outcomes of musculoskeletal radiographs ordered at in-person and telemedicine primary care visits, which have implications for patient care and the economic impact of telemedicine.Methods:We performed a retrospective cohort study of musculoskeletal radiograph orders placed April 1, 2019–March 31, 2021 at a major academic health system. Radiology reports were classified as normal or abnormal based on the radiologist’s impression. Findings were compared using c2 tests.Results:The main outcome was radiographic abnormalities. A secondary outcome was the effect of social determinants of health and medical comorbidities on telemedicine utilization. A total of 1580 radiographs were reviewed. Compared with televisits occurring after onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal (OR 2.51, 95% CI 1.33–4.75; P = .004). When comparing radiographic outcomes at in-person visits before and after the pandemic’s onset, those ordered afterward had higher odds of being abnormal (OR 1.88, 95% CI 1.30–2.71; P < .001). Social determinants of health and medical comorbidities were not associated with telemedicine utilization.Conclusions:After the onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal compared with televisits. These findings indicate that prudence should be applied to ordering musculoskeletal radiographs in telemedicine encounters.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230094R1
Issue No: Vol. 36, No. 5 (2023)
- Use of Telehealth Early and Late in the COVID-19 Public Health Emergency:
Policy Implications for Improving Health Equity
Authors: Sanchez, K; Kitzman, H, Khan, M, da Graca, B, Zsohar, J, McStay, F.
Pages: 746 - 754
Abstract: Introduction:Early in the COVID-19 pandemic, primary care adopted telehealth rapidly to preserve access. Although policy flexibilities persist, but with in-person access restored, insight regarding long-term policy reform is needed for equitable access, especially for underserved, low income, and rural populations.Methods:We used electronic health record data to compare primary care telehealth use in practices serving primarily commercially insured patients versus clinics serving low-income uninsured patients, in March-June 2020 ("early COVID") and March-June 2022 ("late COVID").Results:Primary care visit mode differed significantly (P < .0001) between settings in both periods. In early COVID, video visits were most used in the commercially insured practices (54.50%), followed by office visits (32.76%); in the low-income, uninsured clinics, phone visits were most used (56.67%), followed by office visits (23.55%). In late COVID, 81.05% of visits to commercially insured practices and 92.04% to uninsured clinics were in-office; continuing telehealth use was primarily video. Smaller but significant (P ≤ .0001) differences in telehealth use by race/ethnicity were also observed, with Black and/or Hispanic patients less likely than White patients to use telehealth during both periods, after adjustment for other characteristics.Conclusions:Findings demonstrate the importance of both phone and video visits in preserving primary care access early in the pandemic. Telehealth use declined in late COVID, but still accounted for ~20% of primary care visits in the commercially insured setting and less than 10% of visits in the community care clinics. Differences in telehealth use were largely by setting, reflecting income/insurance status, indicating disparities needing to be addressed.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230080R1
Issue No: Vol. 36, No. 5 (2023)
- Intimate Partner Violence and Telemedicine Usage and Satisfaction Early in
the COVID-19 Pandemic
Authors: Fatabhoy, M. G; Zhu, G, Lajaunie, A, Schneiderhan, J. R, Pierce, J.
Pages: 755 - 765
Abstract: Background:COVID-19 has transformed the landscape of telemedicine utilization, shifting from predominantly in-person services to increased virtual encounters. Although telemedicine offers increased accessibility for medical care, many advocates voice concern about utilization and satisfaction with these services among individuals who experience intimate partner violence (IPV) given the unique practical, mental, and physical health challenges many face.Objective:The purpose of the present study was to evaluate differences in telemedicine utilization and satisfaction, as well as global health and perceived loneliness, among data-driven patterns of IPV during the early phases of the pandemic.Methods:In this longitudinal survey study, participants first completed an online survey between May 2019 and February 2020 that assessed social, psychological, and physical functioning, as well as emotional and physical IPV. A follow-up survey sent in May 2020 assessed recent telemedicine use and satisfaction, as well as response to the COVID-19 pandemic.Results:Latent class analysis favored 4 classes of IPV that differed based on severity and features of IPV experienced. Although all 4 classes reported high satisfaction with telemedicine, individuals reporting low IPV had the highest satisfaction with telemedicine and the lowest rates of telemedicine utilization. Individuals who experienced IPV, particularly multiple forms of emotional and physical IPV, reported high physical and social concerns and perceived stress.Conclusions:Clinicians using telemedicine should be aware of the multiple challenges faced by individuals experiencing IPV and take additional steps to ensure their needs are met in a safe way. These results have potentially important clinical and policy implications.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230021R1
Issue No: Vol. 36, No. 5 (2023)
- Use of Patient-Reported Symptom Data in Clinical Decision Rules for
Predicting Influenza in a Telemedicine Setting
Authors: Billings, W. Z; Cleven, A, Dworaczyk, J, Dale, A. P, Ebell, M, McKay, B, Handel, A.
Pages: 766 - 776
Abstract: Introduction:Increased use of telemedicine could potentially streamline influenza diagnosis and reduce transmission. However, telemedicine diagnoses are dependent on accurate symptom reporting by patients. If patients disagree with clinicians on symptoms, previously derived diagnostic rules may be inaccurate.Methods:We performed a secondary data analysis of a prospective, nonrandomized cohort study at a university student health center. Patients who reported an upper respiratory complaint were required to report symptoms, and their clinician was required to report the same list of symptoms. We examined the performance of 5 previously developed clinical decision rules (CDRs) for influenza on both symptom reports. These predictions were compared against PCR diagnoses. We analyzed the agreement between symptom reports, and we built new predictive models using both sets of data.Results:CDR performance was always lower for the patient-reported symptom data, compared with clinician-reported symptom data. CDRs often resulted in different predictions for the same individual, driven by disagreement in symptom reporting. We were able to fit new models to the patient-reported data, which performed slightly worse than previously derived CDRs. These models and models built on clinician-reported data both suffered from calibration issues.Discussion:Patients and clinicians frequently disagree about symptom presence, which leads to reduced accuracy when CDRs built with clinician data are applied to patient-reported symptoms. Predictive models using patient-reported symptom data performed worse than models using clinician-reported data and prior results in the literature. However, the differences are minor, and developing new models with more data may be possible.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230126R1
Issue No: Vol. 36, No. 5 (2023)
- Does Clinical Decision Support Increase Appropriate Medication Prescribing
for Cardiovascular Risk Reduction'
Authors: Boston, D; Larson, A. E, Sheppler, C. R, OConnor, P. J, Sperl-Hillen, J. M, Hauschildt, J, Gold, R.
Pages: 777 - 788
Abstract: Purpose:To assess the impact of a clinical decision support (CDS) system’s recommendations on prescribing patterns targeting cardiovascular disease (CVD) when the recommendations are prioritized in order from greatest to least benefit toward overall CVD risk reduction.Methods:Secondary analysis of trial data from September 20, 2018, to March 15, 2020, where 70 community health center clinics were cluster-randomized to the CDS intervention (42 clinics; 8 organizations) or control group (28 clinics; 7 organizations). Included patients were medication-naïve and aged 40 to 75 years with ≥1 uncontrolled cardiovascular disease risk factor, with known diabetes or cardiovascular disease, or ≥10% 10-year reversible CVD risk.Results:Among eligible encounters with 29,771 patients, the probability of prescribing a medication targeting hypertension was greater at intervention clinic encounters when CDS was used (34.9% [95% CI, 31.5 to 38.3]) versus dismissed (29.6% [95% CI, 26.7 to 32.6]; P < .001), but not when compared with control clinic encounters (34.9% [95% CI, 31.1 to 38.7]; P = .998). Prescribing for dyslipidemia was significantly higher at intervention encounters where the CDS system was used (11.3% [95% CI, 9.3 to 13.3]) compared with dismissed (7.7% [95% CI, 6.1 to 9.3]; P = .003) and to control encounters (8.7% [95% CI, 7.0 to 10.4]; P = .044); smoking cessation medication showed a similar pattern. Except for dyslipidemia, prescribing rates increased according to their prioritization.Conclusions:Use of this CDS system was associated with significantly higher prescribing targeting most cardiovascular risk factors. These results highlight how displaying prioritized actions to reduce reversible CVD risk could improve risk management.Trial Registration:ClinicalTrials.gov, NCT03001713, https://clinicaltrials.gov/.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2022.220391R2
Issue No: Vol. 36, No. 5 (2023)
- Use of Cancer Survivorship Care Guidelines by Primary Care Providers in
the United States
Authors: Townsend, J. S; Rohan, E. A, Sabatino, S. A, Puckett, M.
Pages: 789 - 802
Abstract: Background:National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs).Methods:We analyzed Porter Novelli’s 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/physician assistants were recruited.Results:To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR = 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR = 2.32 95% CI (1.70, 3.18)) or a new cancer (OR = 1.63, 95% CI (1.20, 2.22)), and treating depression (OR = 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects.Conclusion:Survivorship care guidelines and training support PCPs in providing a range of survivorship care services.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230036R1
Issue No: Vol. 36, No. 5 (2023)
- Implementation of Social Isolation Screening and an Integrated Community
Resource Referral Platform
Authors: Gunn, R; Pisciotta, M, Volk, M, Bowen, M, Gold, R, Mossman, N.
Pages: 803 - 816
Abstract: Background:Screening and referral programs for social isolation and loneliness in older patients increased during the COVID-19 pandemic in primary care settings to mitigate associated adverse health outcomes. This study explores community health centers’ experiences implementing a social isolation and loneliness screening program involving a community resource referral platform integrated into the electronic health record to support referrals.Methods:A formative mixed methods evaluation in 4 community health centers. Semistructured interviews, observation of implementation meetings, facilitated group discussions, surveys, and utilization data extracted from the electronic health record and community resource referral platform were collected and analyzed concurrently.Results:Screening for social isolation and loneliness can heighten health center staff knowledge and prioritization of socially isolated older patients. Participants indicate using an integrated community resource referral platform may only be useful in certain circumstances, particularly for those located outside urban areas. The experiences of these health centers indicate that when implementing interventions to mitigate patients’ social isolation and loneliness, it is necessary to consider other resource directories, needed adjustments to referral and documentation workflows, and potential impacts on patients and care teams.Conclusion:Screening older patients for social isolation could increase care team awareness of social risk; assistance related referral options should be considered carefully.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230047R1
Issue No: Vol. 36, No. 5 (2023)
- "Wanting the Best for Our Folks"--A Mixed Methods Analysis of Community
Health Center Social Risk Screening Initiatives
Authors: De Marchis, E. H; Aceves, B, Razon, N, Chang Weir, R, Jester, M, Gottlieb, L. M.
Pages: 817 - 831
Abstract: Background:Many community health centers (CHC) are scaling social risk screening in response to growing awareness of the influence of social adversity on health outcomes and concurrent incentives for social risk data collection. We studied the implementation of social risk screening in Texas CHCs to inform best practices and understand equity implications.Methods:Convergent mixed methods of 3 data sources. Using interviews and surveys with CHC providers and staff, we explored social risk screening practices to identify barriers and facilitators; we used electronic health record (EHR) data to assess screening reach and disparities in screening.Results:Across 4 urban/suburban Texas CHCs, we conducted 27 interviews (15 providers/12 staff) and collected 97 provider surveys; 2 CHCs provided EHR data on 18,672 patients screened during the study period. Data revealed 2 cross-cutting themes: 1) there was broad support for social risk screening/care integration that was rooted in CHCs’ mission and positionalities, and 2) barriers to social risk screening efforts were largely a result of limited time and staffing. Though EHR data showed screens per month and screens/encounters increased peri-pandemic (4.1% of encounters in 8/2019 to 46.1% in 2/2021), there were significant differences in screening rates by patient race/ethnicity and preferred language (P < .001). In surveys, 90.0% of surveyed providers reported incorporating social risk screening into patient conversations; 28.6% were unaware their clinic had an embedded screening tool.Conclusions:Study CHCs were in the early stages of standardizing social risk screening. Differences in screening reach by patient demographics raise concerns that social screening initiatives, which often serve as a path to resource/service connection, might exacerbate disparities. Overcoming barriers to reach, sustainability, and equity requires supports targeted to program design/development, workforce capacity, and quality improvement.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230099R1
Issue No: Vol. 36, No. 5 (2023)
- Contributing Factors to Delays in COVID-19-Related Hospitalization Among
Latinx and Spanish-Speaking Patients/Factores Que Contribuyen a Retrasos
en Hospitalizaciones Relacionadas con COVID-19 Entre Pacientes Latinos e
Hispano-Hablantes
Authors: Ladner, S. A; Fisher, C. F, Auguste-Nelson, C, Sandoval, R. S, McDaniel, K, Sandeep, N, Saravanan, Y.
Pages: 832 - 838
Abstract: Background:Latinx populations have been more heavily impacted by the COVID-19 pandemic than the general population of the US, including higher rates of hospitalization due to COVID-19 in eastern Massachusetts. We conducted a qualitative study to better understand the experiences of Latinx and Spanish-speaking patients who had clinically significant COVID-19 in the early months of the pandemic.Methods:Thirteen qualitative, semistructured, phone interviews were conducted between December 2020 and April 2021 with Latinx and Spanish-speaking patients who had experienced clinically significant COVID-19 in the metro-north Boston area. Interviews were recorded and transcribed in their original languages. An a priori code tree was developed which was later iteratively revised based on emerging themes. Transcripts were thematically analyzed.Results:Participants discussed their overall experiences contracting the COVID-19 infection, as well as their experiences with the disease and with being hospitalized and the months after in recovery. Family and social networks were a common support, both emotional and financial. Although they survived the disease, hospitalization had serious impacts on the mental and physical health of participants, including the remnants of trauma from hospitalization itself.Implications:Latinx and Spanish-speaking patients in eastern Massachusetts had specific experiences in the early months of the COVID-19 pandemic that were shaped by their living conditions and culture. It is important for health care professionals to understand these experiences so that they can design appropriate medical interventions as well as target outreach efforts that are culturally appropriate. Finally, serious attention should be paid to the mental health-related consequences of hospitalization and policies that can alleviate them.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2022.220395R2
Issue No: Vol. 36, No. 5 (2023)
- Impact of Health Insurance Patterns on Chronic Health Conditions Among
Older Patients
Authors: Huguet, N; Hodes, T, Liu, S, Marino, M, Schmidt, T. D, Voss, R. W, Peak, K. D, Quinones, A. R.
Pages: 839 - 850
Abstract: Background:Patients have varying levels of chronic conditions and health insurance patterns as they become Medicare age-eligible. Understanding these dynamics will inform policies and reforms that direct capacity and resources for primary care clinics to care for these aging patients. This study 1) determined changes in chronic condition rates following Medicare age eligibility among patients with different insurance patterns and 2) estimated the number of chronically ill patients who remain inadequately insured post-Medicare eligibility among patients receiving care in community health centers.Method:We used retrospective electronic health record data from 45,527 patients aged 62 to 68 from 990 community health centers in 25 states in 2014 to 2019. Insurance patterns (continuously insured, continuously uninsured, uninsured/discontinuously insured who gained insurance after age 65, lost insurance after age 65, discontinuously insured) and diagnosis of chronic conditions were defined at each visit pre- and post-Medicare eligibility. Difference-in-differences Poisson GEE models estimated changes of chronic condition rates by insurance groups pre- to post-Medicare age eligibility.Results:Post-Medicare eligibility, 72% patients were continuously insured, 14% gained insurance; and 14% were uninsured or discontinuously insured. The prevalence of multimorbidity (≥2 chronic conditions) was 77%. Those who gained insurance had a significantly larger increase in the rate of documented chronic conditions from pre- to post-Medicare (DID: 1.06, 95%CI:1.05–1.07) compared with the continuously insured group.Conclusions:Post-Medicare age eligibility, a significant proportion of patients were diagnosed with new conditions leading to high burden of disease. One in 4 older adults continue to have inadequate health care coverage in their older age.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230106R1
Issue No: Vol. 36, No. 5 (2023)
- Early-Career Compensation Trends Among Family Physicians
Authors: Sanders, K; Phillips, J, Fleischer, S, Peterson, L. E.
Pages: 851 - 863
Abstract: Purpose:Family medicine incomes are often cited as a key reason for shortages of family physicians. The purpose of this study was to identify family physician income trends and to test how income varies among early-career family physicians.Methods:We used data from the 2016 to 2020 American Board of Family Medicine National Graduate Survey (NGS) collected from early-career family physicians (n = 9566; response rate = 63.9%). The NGS asked practice income, practice activities, practice site, and setting. We performed an income trend analysis and conducted multivariate regression to test for associations of personal and workplace characteristics with income.Results:Average income across the full sample of early-career family physicians (after inflation adjustments) was $224,292. Overall, income growth outpaced inflation from 2016 to 2020. There are significant differences in income based on personal and work characteristics, and income growth varied dramatically. Notably, women respondents reported earnings of $33,522 below those of men respondents in adjusted models. In addition, the incomes of several groups lagged behind inflation, including those practicing geriatrics (–0.67%), employed by the Indian Health Service (–1.72%), and respondents who identified as Black or African American (–0.85%). Greatest increases in inflation-adjusted incomes were observed among those in palliative care (4.61%) and at nonfederal government clinics (4.46%).Conclusions:Though income is only one factor physicians consider in deciding where and how to work, it is concerning to see lower incomes among groups that traditionally experience shortages (eg, geriatrics and government-associated practice sites). Differences in expected income among family physicians choosing different work may exacerbate workforce challenges.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230039R1
Issue No: Vol. 36, No. 5 (2023)
- Fraud, Access, and the Future of Telemedicine
Authors: Elberg, J. T; Adashi, E. Y.
Pages: 864 - 866
Abstract: On July 20, 2022, the Department of Health and Human Services, Office of Inspector General (HHS-OIG), issued a Special Fraud Alert warning healthcare providers of increased fraudulent activity surrounding telemedicine companies. The Alert marks a further escalation of a multi-year effort by the Department of Justice (DOJ) and the HHS-OIG to crack down on multi-billion dollar fraud cases involving telehealth companies. It is the objective of this Commentary to place the HHS-OIG Special Fraud Alert in the context of enforcement efforts by the DOJ and HHS to stem the recent growth in telehealth fraud resulting from the COVID-19 pandemic. Taken together, it is apparent this is a critical moment in the evolution of telehealth and it is crucial to strike a proper balance between effective regulation and enforcement on the one hand, and access to care on the other.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230044R1
Issue No: Vol. 36, No. 5 (2023)
- The End of the X-waiver: Excitement, Apprehension, and Opportunity
Authors: LeFevre, N; St. Louis, J, Worringer, E, Younkin, M, Stahl, N, Sorcinelli, M.
Pages: 867 - 872
Abstract: With the passage of the MAT act (Mainstreaming Addiction Treatment) and the MATE Act (Medication Training and Expansion), the Drug Enforcement Agency "X-waiver" program governing the office-based prescription of buprenorphine for opioid use disorder has been immediately eliminated. The move was championed by vocal organizations with a rightful concern about buprenorphine access but was opposed by most physicians. Nonetheless, buprenorphine can now be prescribed like any schedule 3 medication. Studies show that despite rising opioid overdoses, buprenorphine prescription increases have been slow to rise and are particularly absent in rural communities. The elimination of the X-waiver may theoretically improve buprenorphine prescribing rates for opioid use disorder in rural areas, by nurse practitioners and physician assistants, and by resident physicians in teaching programs. It may also help decrease discrimination against individuals with opioid use disorder in postacute-care settings like nursing homes, physical rehabilitation centers, and in prisons and jails. Concerns include the elimination of the only focused opioid use disorder education many physicians receive (X-waiver courses) and a literature base showing that interest, rather than the X-waiver itself, remains the biggest barrier to recruiting more buprenorphine prescribers. Concerns also exist over the harms of precipitated withdrawal when buprenorphine is initiated inappropriately. The change of the elimination of the X-waiver brings about a new opportunity for Family Medicine and its parent organizations to champion the inclusion of opioid use disorder treatment within the chronic disease care models well-known to our integrated care settings.
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230048R1
Issue No: Vol. 36, No. 5 (2023)
- Philadelphia Mayor Frank Rizzo Was Responsible for My Becoming a Family
Doctor
Authors: Rabinowitz; H. K.
Pages: 873 - 875
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230013R1
Issue No: Vol. 36, No. 5 (2023)
- Keeping Score of the Scores: Additional Perspectives on the Decline of
Family Medicine ITE Scores
Authors: Hogans-Mathews, S; Van Durme, D, Baker, N, Brown Speights, J.
Pages: 876 - 877
PubDate: 2023-10-11T13:42:15-07:00
DOI: 10.3122/jabfm.2023.230150R0
Issue No: Vol. 36, No. 5 (2023)
