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Annals of Family Medicine
Journal Prestige (SJR): 2.748
Citation Impact (citeScore): 3
Number of Followers: 17  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1544-1709 - ISSN (Online) 1544-1717
Published by Annals of Family Medicine Homepage  [1 journal]
  • Improving Team Dynamics Can Improve Patient Care [Annals Journal Club]

    • Authors: Clemens, C. M; Johansen, M. E.
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2735
      Issue No: Vol. 19, No. 5 (2021)
  • Addressing the Use of Teams in Primary Care [Editorials]

    • Authors: Rodriguez, J. E; Zink, T.
      Pages: 386 - 387
      Keywords: Vulnerable populations, Mixed methods, Health services, Professional practice, Coordination / integration of care
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2741
      Issue No: Vol. 19, No. 5 (2021)
  • Implementation of a Hearing Loss Screening Intervention in Primary Care
           [Original Research]

    • Authors: DeJonckheere, M; McKee, M. M, Guetterman, T. C, Schleicher, L. S, Mulhem, E, Panzer, K, Bradley, K, Plegue, M. A, Rapai, M. E, Green, L. A, Zazove, P.
      Pages: 388 - 395
      Abstract: PURPOSEHearing loss (HL) is underdiagnosed and often unaddressed. A recent study of screening for HL using an electronic prompt showed efficacy in increasing appropriate referrals for subsequent testing. We build on the results of this study using a qualitative lens to explore implementation processes through the perspectives of family medicine clinicians.METHODSWe collected clinic observations and semistructured interviews of family medicine clinicians and residents who interacted with the HL prompt. All data were analyzed using thematic, framework, and mixed methods integration strategies.RESULTSWe interviewed 27 clinicians and conducted 10 observations. Thematic analysis resulted in 6 themes: (1) the prompt was overwhelmingly viewed as easy, simple to use, accurate; (2) clinicians considered prompt as an effective way to increase awareness and conversations with patients about HL; (3) clinician and staff buy-in played a vital role in implementation; (4) clinicians prioritized prompt during annual visits; (5) medical assistant involvement in prompt workflow varied by health system, clinic, and clinician; (6) prompt resulted in more conversations about HL, but uncertain impact on patient outcomes. Themes are presented alongside constructs of normalization process theory and intervention outcomes.CONCLUSIONIntegration of a HL screening prompt into clinical practice varied by clinician buy-in and beliefs about the impact on patient outcomes, involvement of medical assistants, and prioritization during clinical visits. Further research is needed to understand how to leverage clinician and staff buy-in and whether implementation of a new clinical prompt has sustained impact on HL screening and patient outcomes.
      Keywords: Older adults, Quantitative methods, Professional practice, Health informatics
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2695
      Issue No: Vol. 19, No. 5 (2021)
  • Socioeconomic Disparity Trends in Cancer Screening Among Women After
           Introduction of National Quality Indicators [Original Research]

    • Authors: Weisband, Y. L; Torres, L, Paltiel, O, Sagy, Y. W, Calderon-Margalit, R, Manor, O.
      Pages: 396 - 404
      Abstract: PURPOSEPrimary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care–based national quality indicator program.METHODSThis repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data.RESULTSIn 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening.CONCLUSIONSWe found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel’s quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.
      Keywords: Acute illness, Women's health, Community / population health, Quantitative methods, Disparities in health and health care, Social / cultural context
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2715
      Issue No: Vol. 19, No. 5 (2021)
  • COVID-19 Personal Protective Equipment in the Home: Navigating the
           Complexity of Donning and Doffing [Original Research]

    • Authors: Kerley, B; Tan, L, Marshall, D, ONeill, C, Bialachowski, A, Pereira, J.
      Pages: 405 - 410
      Abstract: PURPOSEThe safety of care professionals and patients is paramount while caring for people with infectious diseases, including those with confirmed or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). Existing policies and protocols for donning and doffing personal protective equipment (PPE) are primarily for institutional settings such as hospitals, not for home visits for patient care. We describe a protocol for donning and doffing PPE in home settings.METHODSWe used an iterative, rapid-prototyping approach to develop the protocol. A small workgroup created preliminary drafts, drawing on hospital-based protocols and modifying them, while undertaking simulations. Wider input was solicited via 2 webinars; 1 regional (Hamilton, Ontario) with palliative clinicians, and 1 national (Canada) with varying professions. We also consulted a group of infectious disease experts. A "how-to" video accompanies the protocol.RESULTSTwelve versions of the protocol were produced, with major changes occurring within the first 6 versions. A national webinar mid-development provided further validation and minor modifications. Subsequent versions involved minor changes. The protocol has 4 phases: (1) Preparing, (2) Entering the Home, (3) Leaving the Home, and (4) After the Visit and Reprocessing. In addition to PPE-related equipment, the protocol requires additional materials including 2 pails for transporting supplies, plastic bags, hand sanitizer, disinfectant wipes, and printed easy-to-use checklists.CONCLUSIONSThis protocol addresses gaps in COVID-19–related guidelines, specifically the process of donning and doffing PPE during home visits while supplementing jurisdictional PPE guidelines and protocols.Appeared as Annals "Online First" article.
      Keywords: Prevention, Participatory / action research, Health services, COVID-19
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2667
      Issue No: Vol. 19, No. 5 (2021)
  • Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced
           Team Care With Expanded Medical Assistant Support [Original Research]

    • Authors: Shaw, J. G; Winget, M, Brown-Johnson, C, Seay-Morrison, T, Garvert, D. W, Levine, M, Safaeinili, N, Mahoney, M. R.
      Pages: 411 - 418
      Abstract: PURPOSEAssess effectiveness of Primary Care 2.0: a team-based model that incorporates increased medical assistant (MA) to primary care physician (PCP) ratio, integration of advanced practice clinicians, expanded MA roles, and extended the interprofessional team.METHODSProspective, quasi-experimental evaluation of staff/clinician team development and wellness survey data, comparing Primary Care 2.0 to conventional clinics within our academic health care system. We surveyed before the model launch and every 6-9 months up to 24 months post implementation. Secondary outcomes (cost, quality metrics, patient satisfaction) were assessed via routinely collected operational data.RESULTSTeam development significantly increased in the Primary Care 2.0 clinic, sustained across all 3 post implementation time points (+12.2, +8.5, + 10.1 respectively, vs baseline, on the 100-point Team Development Measure) relative to the comparison clinics. Among wellness domains, only "control of work" approached significant gains (+0.5 on a 5-point Likert scale, P = .05), but was not sustained. Burnout did not have statistically significant relative changes; the Primary Care 2.0 site showed a temporal trend of improvement at 9 and 15 months. Reversal of this trend at 2 years corresponded to contextual changes, specifically, reduced MA to PCP staffing ratio. Adjusted models confirmed an inverse relationship between team development and burnout (P
      Keywords: Mixed methods, Health services, Coordination / integration of care, Organizational / practice change, Quality improvement
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2714
      Issue No: Vol. 19, No. 5 (2021)
  • Technology-Enabled and Artificial Intelligence Support for Pre-Visit
           Planning in Ambulatory Care: Findings From an Environmental Scan [Original

    • Authors: Holdsworth, L. M; Park, C, Asch, S. M, Lin, S.
      Pages: 419 - 426
      Abstract: PURPOSEPre-visit planning (PVP) is believed to improve effectiveness, efficiency, and experience of care, yet numerous implementation barriers exist. There are opportunities for technology-enabled and artificial intelligence (AI) support to augment existing human-driven PVP processes—from appointment reminders and pre-visit questionnaires to pre-visit order sets and care gap closures. This study aimed to explore the current state of PVP, barriers to implementation, evidence of impact, and potential use of non-AI and AI tools to support PVP.METHODSWe used an environmental scan approach involving: (1) literature review; (2) key informant interviews with PVP experts in ambulatory care; and (3) a search of the public domain for technology-enabled and AI solutions that support PVP. We then synthesized the findings using a qualitative matrix analysis.RESULTSWe found 26 unique PVP implementations in the literature and conducted 16 key informant interviews. Demonstration of impact is typically limited to process outcomes, with improved patient outcomes remaining elusive. Our key informants reported that many PVP barriers are human effort–related and see potential for non-AI and AI technologies to support certain aspects of PVP. We identified 8 examples of commercially available technology-enabled tools that support PVP, some with AI capabilities; however, few of these have been independently evaluated.CONCLUSIONSAs health systems transition toward value-based payment models in a world where the coronavirus disease 2019 pandemic has shifted patient care into the virtual space, PVP activities—driven by humans and supported by technology—may become more important and powerful and should be rigorously evaluated.
      Keywords: Qualitative methods, Health services, Professional practice, Health informatics
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2716
      Issue No: Vol. 19, No. 5 (2021)
  • Financial Incentives for Medical Assistants: A Mixed-Methods Exploration
           of Bonus Structures, Motivation, and Population Health Quality Measures
           [Original Research]

    • Authors: Vilendrer, S; Brown-Johnson, C, Kling, S. M. R, Veruttipong, D, Amano, A, Bohman, B, Daines, W. P, Overton, D, Srivastava, R, Asch, S. M.
      Pages: 427 - 436
      Abstract: PURPOSEMedical assistants (MAs) have seen their roles expand as a result of team-based primary care models. Unlike their physician counterparts, MAs rarely receive financial incentives as a part of their compensation. This exploratory study aims to understand MA acceptability of financial incentives and perceived MA control over common population health measures.METHODSWe conducted semistructured focus groups between August and December of 2019 across 10 clinics affiliated with 3 institutions in California and Utah. MAs’ perceptions of experienced and hypothetical financial incentives, their potential influence on workflow processes, and perceived levels of control over population health measures were discussed, recorded, and qualitatively analyzed for emerging themes. Perceived levels of control were further quantified using a Likert survey; measures were grouped into factors representing vaccinations, and workflow completed in the same day or multiple days (multiday). Mean scores for each factor were compared using repeated 1-way ANOVA with Tukey-Kramer adjustment.RESULTSMAs reported little direct experience with financial incentives. They indicated that a hypothetical bonus representing 2% to 3% of their average annual base pay would be acceptable and influential in improving consistent performance during patient rooming workflow. MAs reported having greater perceived control over vaccinations (P
      Keywords: Community / population health, Mixed methods, Health services, Organizational / practice change, Quality improvement
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2719
      Issue No: Vol. 19, No. 5 (2021)
  • Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections:
           Systematic Review and Meta-Analysis [Systematic Review]

    • Authors: Boon, H. A; Van den Bruel, A, Struyf, T, Gillemot, A, Bullens, D, Verbakel, J. Y.
      Pages: 437 - 446
      Abstract: PURPOSEAccurate diagnosis of urinary tract infection in children is essential because children left untreated can experience permanent renal injury. We aimed to assess the diagnostic value of clinical features of pediatric urinary tract infection.METHODSWe performed a systematic review and meta-analysis of diagnostic test accuracy studies in ambulatory care. We searched the PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Health Technology Assessment, and Database of s of Reviews of Effects databases from inception to January 27, 2020 for studies reporting 2 x 2 diagnostic accuracy data for clinical features compared with urine culture in children aged
      Keywords: Acute illness, Children's health, Health services
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2684
      Issue No: Vol. 19, No. 5 (2021)
  • Voice Assistants and Cancer Screening: A Comparison of Alexa, Siri, Google
           Assistant, and Cortana [Research Brief]

    • Authors: Hong, G; Folcarelli, A, Less, J, Wang, C, Erbasi, N, Lin, S.
      Pages: 447 - 449
      Abstract: Despite increasing interest in how voice assistants like Siri or Alexa might improve health care delivery and information dissemination, there is limited research assessing the quality of health information provided by these technologies. Voice assistants present both opportunities and risks when facilitating searches for or answering health-related questions, especially now as fewer patients are seeing their physicians for preventive care due to the ongoing pandemic. In our study, we compared the 4 most widely used voice assistants (Amazon Alexa, Apple Siri, Google Assistant, and Microsoft Cortana) and their ability to understand and respond accurately to questions about cancer screening. We show that there are clear differences among the 4 voice assistants and that there is room for improvement across all assistants, particularly in their ability to provide accurate information verbally. In order to ensure that voice assistants provide accurate information about cancer screening and support, rather than undermine efforts to improve preventive care delivery and population health, we suggest that technology providers prioritize partnership with health professionals and organizations.
      Keywords: Prevention, Access, Health informatics
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2713
      Issue No: Vol. 19, No. 5 (2021)
  • Shared Language for Shared Work in Population Health [Special Report]

    • Authors: Peek, C. J; Westfall, J. M, Stange, K. C, Liaw, W, Ewigman, B, DeVoe, J. E, Green, L. A, Polverento, M. E, Bora, N, deGruy, F. V, Harper, P. G, Baker, N. J.
      Pages: 450 - 457
      Abstract: People working on behalf of population health, community health, or public health often experience confusion or ambiguity in the meaning of these and other common terms—the similarities and differences and how they bear on the tasks and division of labor for care delivery and public health. Shared language must be clear enough to help, not hinder people working together as they ultimately come to mutual understanding of roles, responsibilities, and actions in their joint work. Based on an iterative lexicon development process, the authors developed and propose a definitional framework as an aid to navigating among related population and community health terms. These terms are defined, similarities and differences clarified, and then organized into 3 categories that reflect goals, realities, and ways to get the job done. Goals include (a) health as well-being for persons, (b) population health as that goal expressed in measurable terms for groups, and (c) community health as population health for particular communities of interest, geography, or other defining characteristic—groups with shared identity and particular systemic influences on health. Realities are social determinants as influences, health disparities as effects, and health equity as both a goal and a design principle. Ways to get the job done include health care delivery systems for enrollees and public health in population-based civic activities—with a broad zone of collaboration where streams of effort converge in partnership with served communities. This map of terms can enable people to move forward together in a broad zone of collaboration for health with less confusion, ambiguity, and conflict.
      Keywords: Community / population health
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2708
      Issue No: Vol. 19, No. 5 (2021)
  • Defining the "New Normal" in Primary Care [Reflections]

    • Authors: Hansmann, K. J; Chang, T.
      Pages: 457 - 459
      Abstract: Health care organizations in the United States have transformed at an unprecedented rate since March 2020 due to COVID-19, most notably with a shift to telemedicine. Despite rapidly adapting health care delivery in light of new safety considerations and a shifting insurance landscape, primary care offices across the country are facing drastic decreases in revenue and potential bankruptcy. To survive, primary care’s adaptations will need to go beyond virtual versions of traditional office visits. Primary care is faced with a chance to redefine what it means to care for and support patients wherever they are. This opportunity to shape the "new normal" is a critical step for primary care to meet its full potential to lead a paradigm shift to patient-centered health care reform in America during this time when we need it most.
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2711
      Issue No: Vol. 19, No. 5 (2021)
  • Mourning My Patient, Mr Schwartz [Reflections]

    • Authors: Kannai, R; Alon, A. R.
      Pages: 460 - 462
      Abstract: The story depicts my close relationship with Mr Schwartz, an elderly Holocaust survivor, spanning over 20 years. During those years, he became a significant patient to me; during my many home visits, we often shared significant conversations about life. When Mr Schwartz was diagnosed at age 90 with advanced cancer, we made an alliance whereby I would represent him in his decision not to receive medical interventions. For the next 4 years until his death, Mr Schwartz pleaded with me to kill him, which I could not do either legally or morally.Over the years; I was moved by his honesty, frustrated at my inability to offer him relief or a sense of meaning, and pensive, as I would inevitably reflect on existential issues pertaining to myself and my dear ones. Mourning his loss was complex, for I was very close to him, yet not a part of his family. With whom can we physicians share our sadness at the loss of a person with whom we never actually spent a holiday or family dinner'
      Keywords: Acute illness, Older adults, Personalized care, Mindfulness and reflection
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2710
      Issue No: Vol. 19, No. 5 (2021)
  • "I Need to Keep Me and My Mother Safe": The Asylum Crisis at the US-Mexico
           Border [Reflections]

    • Authors: Hill E.
      Pages: 463 - 465
      Abstract: In Tijuana, Mexico, 16-year-old Joaquin, a refugee from El Salvador where LGBTQ people are persecuted, was hoping for asylum in the United States based on sexual orientation. But as a volunteer physician in Tijuana, I had learned hard lessons about the asylum process—or lack thereof—at the US-Mexico border. In 2020, there was a list of over 15,000 asylum seekers at the border in Tijuana seeking a chance at a new life in the United States, but few requests were granted. The lack of transparency about the realities of this system left thousands of families stranded in Mexico without basic rights such as health care. Health care professionals should be aware of the ongoing asylum crisis and be an active faction in the fight for its reform.
      Keywords: Vulnerable populations, Access, Disparities in health and health care, Social / cultural context
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2698
      Issue No: Vol. 19, No. 5 (2021)
  • Moving From In-Person to Telehealth Group Visits for a Mindful-Eating
           Healthy Nutrition Program [Innovations in Primary Care]

    • Authors: Carroll, J. K; Finn, L, Scharer, K, Kiel, L, Kiel, A, Callen, E, Callister, E, Campbell, I, Anderson, E, Grossman, L, Landin, C, Nederveld, A.
      Pages: 466 - 466
      Keywords: Health promotion, Access, Health informatics
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2685
      Issue No: Vol. 19, No. 5 (2021)
           DIPLOMATE LEARNING [Family Medicine Updates]

    • Authors: Price, D. W; Bazemore, A, Baxley, E. G, Stelter, K, ONeill, T. R, Fain, R, Magill, M. K, Newton, W. P.
      Pages: 468 - 470
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2749
      Issue No: Vol. 19, No. 5 (2021)
           CURRICULUM [Family Medicine Updates]

    • Authors: Brazelton T.
      Pages: 469 - 470
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2748
      Issue No: Vol. 19, No. 5 (2021)
           Medicine Updates]

    • Authors: Nease, D; Greiver, M.
      Pages: 470 - 471
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2744
      Issue No: Vol. 19, No. 5 (2021)
           Medicine Updates]

    • Authors: Seidenberg, P; Shokar, N, Vera, J, Weidner, A, Sutter, J.
      Pages: 471 - 472
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2746
      Issue No: Vol. 19, No. 5 (2021)
           FROM COMMUNITY-BASED PROGRAM COVID-19 RESPONSE [Family Medicine Updates]

    • Authors: Barr, W. B; Somers, J, Dono, R, St. Louis, J.
      Pages: 472 - 473
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2745
      Issue No: Vol. 19, No. 5 (2021)

    • Pages: 474 - 475
      PubDate: 2021-09-13T14:00:12-07:00
      DOI: 10.1370/afm.2747
      Issue No: Vol. 19, No. 5 (2021)
  • EMPLOYMENT OPPORTUNITIES [Employment Opportunities]

    • Pages: 476 - 480
      PubDate: 2021-09-13T14:00:12-07:00
      Issue No: Vol. 19, No. 5 (2021)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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