health and food Digestive Enzymes Oral By www.medicinenet.com Published On :: Wed, 24 Aug 2022 00:00:00 PDT Title: Digestive Enzymes OralCategory: MedicationsCreated: 3/2/2005 12:00:00 AMLast Editorial Review: 8/24/2022 12:00:00 AM Full Article
health and food rimantadine By www.medicinenet.com Published On :: Thu, 16 Jun 2022 00:00:00 PDT Title: rimantadineCategory: MedicationsCreated: 1/25/1999 12:00:00 AMLast Editorial Review: 6/16/2022 12:00:00 AM Full Article
health and food erythromycin By www.medicinenet.com Published On :: Fri, 17 Jun 2022 00:00:00 PDT Title: erythromycinCategory: MedicationsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 6/17/2022 12:00:00 AM Full Article
health and food How to Get Rid of Mucus in My Chest Fast By www.medicinenet.com Published On :: Wed, 22 Jun 2022 00:00:00 PDT Title: How to Get Rid of Mucus in My Chest FastCategory: Diseases and ConditionsCreated: 6/22/2022 12:00:00 AMLast Editorial Review: 6/22/2022 12:00:00 AM Full Article
health and food CDC Panel Urges Seniors to Get New, More Potent Flu Shot This Fall By www.medicinenet.com Published On :: Thu, 23 Jun 2022 00:00:00 PDT Title: CDC Panel Urges Seniors to Get New, More Potent Flu Shot This FallCategory: Health NewsCreated: 6/23/2022 12:00:00 AMLast Editorial Review: 6/23/2022 12:00:00 AM Full Article
health and food hexylresorcinol By www.medicinenet.com Published On :: Tue, 28 Jun 2022 00:00:00 PDT Title: hexylresorcinolCategory: MedicationsCreated: 6/28/2022 12:00:00 AMLast Editorial Review: 6/28/2022 12:00:00 AM Full Article
health and food Cold, Flu, Allergy Treatments By www.medicinenet.com Published On :: Fri, 15 Jul 2022 00:00:00 PDT Title: Cold, Flu, Allergy TreatmentsCategory: Diseases and ConditionsCreated: 9/24/1999 12:00:00 AMLast Editorial Review: 7/15/2022 12:00:00 AM Full Article
health and food Sore Throat By www.medicinenet.com Published On :: Thu, 21 Jul 2022 00:00:00 PDT Title: Sore ThroatCategory: Diseases and ConditionsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 7/21/2022 12:00:00 AM Full Article
health and food Is Laryngitis Contagious? By www.medicinenet.com Published On :: Fri, 22 Jul 2022 00:00:00 PDT Title: Is Laryngitis Contagious?Category: Diseases and ConditionsCreated: 9/10/2015 12:00:00 AMLast Editorial Review: 7/22/2022 12:00:00 AM Full Article
health and food Mastoiditis By www.medicinenet.com Published On :: Sat, 30 Jul 2022 00:00:00 PDT Title: MastoiditisCategory: Diseases and ConditionsCreated: 1/4/2018 12:00:00 AMLast Editorial Review: 7/30/2022 12:00:00 AM Full Article
health and food Pot Users Are Less Prone to Sinus Problems By www.medicinenet.com Published On :: Tue, 2 Aug 2022 00:00:00 PDT Title: Pot Users Are Less Prone to Sinus ProblemsCategory: Health NewsCreated: 8/1/2022 12:00:00 AMLast Editorial Review: 8/2/2022 12:00:00 AM Full Article
health and food Australia's Current Flu Season Is Tough: Will America's Be the Same? By www.medicinenet.com Published On :: Fri, 5 Aug 2022 00:00:00 PDT Title: Australia's Current Flu Season Is Tough: Will America's Be the Same?Category: Health NewsCreated: 8/4/2022 12:00:00 AMLast Editorial Review: 8/5/2022 12:00:00 AM Full Article
health and food How Do I Get Rid of Winter Depression? By www.medicinenet.com Published On :: Wed, 27 Apr 2022 00:00:00 PDT Title: How Do I Get Rid of Winter Depression?Category: Diseases and ConditionsCreated: 4/27/2022 12:00:00 AMLast Editorial Review: 4/27/2022 12:00:00 AM Full Article
health and food Smoking Rates Drop for Americans Battling Depression, Substance Abuse By www.medicinenet.com Published On :: Wed, 27 Apr 2022 00:00:00 PDT Title: Smoking Rates Drop for Americans Battling Depression, Substance AbuseCategory: Health NewsCreated: 4/27/2022 12:00:00 AMLast Editorial Review: 4/27/2022 12:00:00 AM Full Article
health and food Postpartum Depression Can Hit Both Mom & Dad, Sometimes at Same Time By www.medicinenet.com Published On :: Tue, 28 Jun 2022 00:00:00 PDT Title: Postpartum Depression Can Hit Both Mom & Dad, Sometimes at Same TimeCategory: Health NewsCreated: 6/27/2022 12:00:00 AMLast Editorial Review: 6/28/2022 12:00:00 AM Full Article
health and food How Do I Increase Serotonin? By www.medicinenet.com Published On :: Tue, 5 Jul 2022 00:00:00 PDT Title: How Do I Increase Serotonin?Category: Diseases and ConditionsCreated: 5/24/2021 12:00:00 AMLast Editorial Review: 7/5/2022 12:00:00 AM Full Article
health and food What Are 4 Symptoms of Seasonal Affective Disorder? By www.medicinenet.com Published On :: Wed, 6 Jul 2022 00:00:00 PDT Title: What Are 4 Symptoms of Seasonal Affective Disorder?Category: Diseases and ConditionsCreated: 12/10/2021 12:00:00 AMLast Editorial Review: 7/6/2022 12:00:00 AM Full Article
health and food How Childhood Abuse Can Haunt the Senior Years By www.medicinenet.com Published On :: Fri, 8 Jul 2022 00:00:00 PDT Title: How Childhood Abuse Can Haunt the Senior YearsCategory: Health NewsCreated: 7/8/2022 12:00:00 AMLast Editorial Review: 7/8/2022 12:00:00 AM Full Article
health and food Gardening Can Blossom Into Better Mental Health By www.medicinenet.com Published On :: Mon, 11 Jul 2022 00:00:00 PDT Title: Gardening Can Blossom Into Better Mental HealthCategory: Health NewsCreated: 7/11/2022 12:00:00 AMLast Editorial Review: 7/11/2022 12:00:00 AM Full Article
health and food Most Post-Stroke Depression Still Goes Untreated By www.medicinenet.com Published On :: Mon, 25 Jul 2022 00:00:00 PDT Title: Most Post-Stroke Depression Still Goes UntreatedCategory: Health NewsCreated: 7/25/2022 12:00:00 AMLast Editorial Review: 7/25/2022 12:00:00 AM Full Article
health and food Study Casts Doubt on 'Chemical Imbalance' Theory of Depression By www.medicinenet.com Published On :: Tue, 9 Aug 2022 00:00:00 PDT Title: Study Casts Doubt on 'Chemical Imbalance' Theory of DepressionCategory: Health NewsCreated: 8/9/2022 12:00:00 AMLast Editorial Review: 8/9/2022 12:00:00 AM Full Article
health and food damiana By www.medicinenet.com Published On :: Mon, 15 Aug 2022 00:00:00 PDT Title: damianaCategory: MedicationsCreated: 8/15/2022 12:00:00 AMLast Editorial Review: 8/15/2022 12:00:00 AM Full Article
health and food Re: Friendship as Medicine By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Full Article
health and food Wonca Europe 2023 Definition of General Practice/Family Medicine: New Needs New Content By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Full Article
health and food The Priority Updates from the Research Literature (PURLs) Methodology By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Full Article
health and food Only One Quarter of Family Physicians Are Very Satisfied with Their Electronic Health Records Platform By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Two decades into the era of Electronic Health Records (EHRs), the promise of streamlining clinical care, reducing burden, and improving patient outcomes has yet to be realized. A cross-sectional family physician census conducted by the American Board of Family Medicine in 2022 and 2023 included self-reported physician EHR satisfaction. Of the nearly 10,000 responding family physicians, only one-in-four (26.2%) report being very satisfied and one-in-three (33.8%) were not satisfied. These low levels of satisfaction point to the need for greater transparency in the marketplace and pressure to increase user-centric EHR design. Full Article
health and food Impact of COVID-19 on Chronic Ambulatory-Care-Sensitive Condition Emergency Department Use Among Older Adults By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: The COVID-19 pandemic social distancing requirements encouraged patients to avoid public spaces including in-office health care visits. Ambulatory-care-sensitive conditions (ACSCs) represent conditions that can be managed with quality primary care and when access is limited, these conditions can lead to avoidable emergency department (ED) visits. Methods: Using national data on ED visits from 2019 to 2021 in the National Hospital Ambulatory Care Survey, we examined the impact of COVID-19 pandemic on ACSC ED visits among older adults (aged ≥65). Results: The proportion of ED visits among older adults that were for ACSCs increased between 2019 (17.4%) and 2021 (18.5%). The trend in both rural (26.4%–28.6%) and urban areas (15.4%–16.8%) shows a significant jump from 2019 to 2021 (P < .001). Conclusions: This rise in ACSC ED use is consistent with a delay in normal primary care during the pandemic. Full Article
health and food Impact of Point of Care Hemoglobin A1c Testing on Time to Therapeutic Intervention By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Without compromising accuracy, point of care testing (POCT) provides immediate results at the time of in person patient consultation. The purpose of this study was to evaluate time until therapeutic intervention with POCT HbA1c versus venipuncture, where venipuncture was considered standard of care. The primary outcome was time (hours) to implementation of a therapeutic intervention based on POCT HbA1c result, as compared with most recent venipuncture HbA1c before the study and its associated therapeutic intervention. A total of 94 POCT HbA1c tests were included in the primary analysis. For the POCT HbA1c, the mean time to therapeutic intervention was 1.6 ± 3.14 hours. For the previous venipuncture HbA1c, the mean time to therapeutic intervention was 1376.66 ± 3356.6 hours (P < .001). Overall, this trial showed that POCT HbA1c results in a significantly faster time to therapeutic intervention than venipuncture in a primary care clinic that serves a rural population. Full Article
health and food Cannabis and Pain Management By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Family physicians are fielding questions about cannabis --particularly for the use of cannabis for treatment of pain. Like about every substance ingested to treat medical conditions, cannabis has risks and benefits. But regarding evidence-based practice and practice-based recommendations for patients about cannabis use, the cart is in front of the horse. Cannabis use is still illegal at a federal level and a Schedule 1 drug, but most states have challenged federal law by decriminalizing or legalizing cannabis for a variety of uses. Research is difficult due to this federal status as a Schedule 1 drug since federal funding is not readily available to support research. As a result, physicians have little to no guidance about the clinical usefulness of the product. This article explores what we know and what we are learning about cannabis, and the authors provide clinical guidance for patient care based on this evidence. Full Article
health and food A Comprehensive Guide to Long-Acting Injectable Antipsychotics for Primary Care Clinicians By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 We propose a paper that provides education on commonly used long-acting injectable antipsychotics (LAIs) to improve primary care based mental health interventions in patients with severe mental illnesses (SMIs) such as schizophrenia, schizoaffective disorder, and bipolar disorders. With the expanding interface of primary care and psychiatry across all healthcare settings, it has become increasingly important for primary care clinicians to have a broader understanding of common psychiatric treatments, including LAIs. Long-acting injectable antipsychotics have been shown to be helpful in significantly improving treatment adherence, preventing disease progression, improving treatment response, decreasing readmission rates, and reducing social impairment. We discuss evidence-based indications and guidelines for use of long-acting injectable antipsychotics. We provide an overview of the treatment of SMI with LAIs, mainly focusing on the most commonly used long-acting injectable antipsychotics, advantages and disadvantages of each, along with outlining important clinical pearls for ease of practical application. Equipped with increased familiarity and understanding of these essential therapies, primary care clinicians can better facilitate early engagement with psychiatric care, promote more widespread use, and thus significantly improve the wellbeing and quality of life of patients with severe mental illness. Full Article
health and food Potential Drawbacks of Noninvasive Diagnostic Methods for Nonalcoholic Fatty Liver Disease By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 The rising obesity epidemic is a phenomenon that has gained increasing attention from health providers and health policy makers. This led to recognition of nonalcoholic fatty liver disease (MASLD). The standard for its assessment has been histologic, which is neither practical nor acceptable by patients. Subsequently, a number of noninvasive assessment methods have been developed. However, despite ease of implementation, their confounding variables do hinder their accuracy. Nonetheless, the development of the liver stiffness measurement (LSM) and incorporation of other biological parameters has minimized but not eliminated the need for liver biopsy. Imaging methods are useful in evaluation, estimation, and following the progression of steatosis and fibrosis with particular attention to controlled attenuation parameter (CAP) and MRI–Proton Density Fat Fraction (MRI-PDFF). The choices for the family physician are broad and rely on tests’ availability, cost, and patient acceptance. Great efforts have been undertaken to produce more robust and novel noninvasive markers that indicate fibrinogenesis directly in an implementable and cost-effective way. Full Article
health and food Be SMART About Asthma Management: Single Maintenance and Reliever Therapy By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Single maintenance and reliever therapy (SMART) is an asthma treatment approach that utilizes combined inhaled corticosteroids and long-acting β-agonists for maintenance and quick relief therapy. Despite the evidence for its benefits in asthma treatment and its adoption into American and international asthma guidelines and recommendations, SMART remains a practice of some debate. This article reviews the available evidence for SMART and offers guidance for its integration into comprehensive asthma management. Overall, short-acting β-agonist-only asthma therapy regimens should be avoided, regardless of condition severity (SOR A Recommendation). Family medicine clinicians should start SMART for patients requiring either GINA Step 3 or 4 therapy, especially if they have signs of poor adherence (SOR B Recommendation). Finally, use budesonide-formoterol over other inhaled corticosteroid/long-acting β-agonist combinations when implementing SMART (SOR B Recommendation). Full Article
health and food Headache Treatment Options By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Family medicine physicians often see headache as the chief complaint when meeting patients within their practice. The goal is to try different treatment modalities without having to send the patient to a specialist. Headaches affect different individuals during their lifetime. Before any treatment begins, it is best that one rules out possible causes of the headache, for example, drug interactions or structural cerebrum conditions. Nonpharmacological treatment is recommended first before attempting a stepwise approach to cost-effective pharmacological treatment options. Pharmacological treatment options should include preventive and on-demand options. A family physician has all the resources to assist patients with different types of headaches. Full Article
health and food Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge. Objective: To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians. Design: Exploratory, convergent mixed methods. Participants: Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West. Approach: Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics. Results: Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions. Conclusions: While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients’ lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings. Full Article
health and food Sexual Misconduct by Board Certified Family Physicians By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Purpose: Sexual misconduct by physicians is a consequential violation of patient trust. The purpose of this study was to determine the frequency and patterns of sexual misconduct by physicians certified by the American Board of Family Medicine (ABFM). Methods: We described a cohort of current or formerly ABFM certified physicians ("Diplomates") disciplined for sexual misconduct in 2016 to 2022. Results: Ninety-four physicians, representing only 0.1% of ABFM Diplomates, were identified as having received disciplinary action(s) for reported sexual misconduct. These constituted 8.9% of the 1122 cases that resulted in a physician losing board certification or eligibility for any cause in 2016 to 2022. Ninety-three of the 94 physicians identified as male, with an average age of 56 (range 22 to 88 years). Eighty-nine percent of victims were female, and 90% were patients of the physician. Unwanted sexual behavior/assault occurred in more than half of the cases, whereas one third described an ongoing sexual relationship between patient and physician. Nearly 1 in 5 cases also included controlled substance prescribing. Seven cases involved minors. Noncontact ("grooming") behaviors were described in 34 cases, 28 of which included subsequent physical sexual behavior. A clinical setting was the site of misconduct in 84% of cases. Conclusions: Reports of sexual misconduct among board-certified family physicians are infrequent. However, any sexual misconduct by physicians is harmful to patients and the profession. The specialty should work to enhance education and change professional culture to mitigate this important problem. Full Article
health and food How Early Career Family Medicine Women Physicians Negotiate Their First Job After Residency By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Nested within a growing body of evidence of a gender pay gap in medicine are more alarming recent findings from family medicine: a gender pay gap of 16% can be detected at a very early career stage. This article explores qualitative evidence of women’s experiences negotiating for their first job out of residency to ascertain women’s engagement with and approach to the negotiation process. Methods: We recruited family physicians who graduated residency in 2019 and responded to the American Board of Family Medicine 2022 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women’s experiences through the transitory stages from residency to workforce. A qualitative researcher used Zoom to interview 19 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed using NVivo software following an Inductive Content Analysis approach. Results: Three main themes emerged from the data. First, salary was found to be nonnegotiable, exemplified by participants’ inability to change initial salary offers. Second, the role of peer support throughout residency and early career was crucial to uncovering and rectifying salary inequity. Third, a pay expectation gap was identified among women from minority and low-income households. Conclusion: To rectify the gender pay gap in medicine, a systems-level approach is required. This can be achieved through various levels of interventions: societally expanding the use of and removing the stigma around parental leave, recognizing the importance of contributions not currently valued by productivity-based payment models, examining assumptions about leadership; and institutionally moving away from fee-for-service systems, encouraging flexible schedules, increasing salary transparency, and improving advancement transparency. Full Article
health and food Primary Care Clinicians' Interest In, and Barriers To, Medication Abortion By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Purpose: Providing medication abortion in the primary care setting is a promising way to increase access to abortion, a threatened service in many States. This study aimed to characterize primary care clinicians’ interest in prescribing medication abortion, what barriers they face in adding this service, and what support they need. Methods: Data were collected from 162 practicing primary care clinicians in Minnesota using an online survey with closed- and open-ended response options. Data were analyzed using descriptive statistics, group comparison analyses, and content analysis for the open-ended questions. Results: Participants represented a diverse range of ages, years in practice, credentials, genders, and urban/rural practice settings, and held mixed knowledge and attitudes around medication abortion. All demographic groups surveyed expressed interest in prescribing medication abortion, with the strongest interest represented among younger respondents, women, and those practicing in urban settings. Clinicians who provide prenatal care or who already work with these medications in other contexts were more likely to want to add medication abortion to their practices. The most common barrier to providing medication abortion was a lack of knowledge about organizational policies and about the medications themselves. To empower clinicians to provide medication abortion, respondents voiced needing their health systems to build clear processes and wanting supportive networks of other clinicians for collaboration. Conclusions: Given the interest of primary care clinicians in providing medication abortion, health systems have a valuable opportunity to increase access. Full Article
health and food Clinician-Reported Barriers and Needs for Implementation of Continuous Glucose Monitoring By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Continuous glucose monitoring (CGM) for patients with type 1 and type 2 diabetes is associated with improved clinical, behavioral, and psychosocial patient health outcomes and is part of the American Diabetes Association’s Standards of Medical Care. CGM prescription often takes place in endocrinology practices, yet 50% of adults with type 1 diabetes and 90% of all people with type 2 diabetes receive their diabetes care in primary care settings. This study examined primary care clinicians’ perceptions of barriers and resources needed to support CGM use in primary care. Methods: This qualitative study used semistructured interviews with primary care clinicians to understand barriers to CGM and resources needed to prescribe. Participants were recruited through practice-based research networks. Rapid qualitative analysis was used to summarize themes from interview findings. Results: We conducted interviews with 55 primary care clinicians across 21 states. Participants described CGM benefits for patients with varying levels of diabetes self-management and engagement. Major barriers to prescribing included lack of insurance coverage for CGM costs to patients, and time constraints. Participants identified resources needed to foster CGM prescribing, for example, clinician education, support staff, and EHR compatibility. Conclusion: Primary care clinicians face several challenges to prescribing CGM, but they are interested in learning more to help them offer it to their patients. This study reinforces the ongoing need for improved clinician education on CGM technology and continued expansion of insurance coverage for people with both type 1 and type 2 diabetes. Full Article
health and food Colorectal Cancer Screening: A Multicomponent Intervention to Increase Uptake in Patients Aged 45-49 By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Purpose: Colorectal cancer (CRC) screening is recommended starting at age 45, but there has been little research on strategies to promote screening among patients younger than 50. This study assessed the effect of a multicomponent intervention on screening completion in this age group. Methods: The intervention consisted of outreach to patients aged 45 to 49 (n = 3,873) via mailed fecal immunochemical test (FIT) (sent to 46%), text (84%), e-mail (53%), and the extension to this age group of an existing standing order protocol allowing primary care nurses and medical assistants to order FIT at primary care clinics in an urban safety-net system. We used segmented linear regression to assess changes in CRC screening completion trends. Patients aged 51 to 55 were included as a comparison group (n = 3,943). Data were extracted from the EHR. Results: The percentage of patients aged 45 to 49 who were up-to-date with CRC screening (colonoscopy in 10 years or FIT in last year) increased an average of 0.4% (95% CI 0.3, 0.6)) every 30 days before intervention rollout and 2.8% (95% CI 2.5, 3.1) after (slope difference 2.3% [95% CI 2.0, 2.7]). This difference persisted after accounting for small changes in the outcome observed in the comparison group (slope difference 1.7% [95% CI 1.2, 2.2]). Conclusions: These results suggest that the intervention increased CRC screening completion among patients 45 to 49. Health care systems seeking to improve CRC screening participation among patients aged 45 to 49 should consider implementing similar interventions. Full Article
health and food Implementation of an Opt-Out Outpatient HIV Screening Program By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Screening rates for Human Immunodeficiency Virus (HIV) remain low despite guidelines by both the CDC and USPSTF recommending that all adolescents and adults be screened at least once. The aim of this quality improvement study was to increase HIV screening among eligible patients. Methods: This quality improvement study assessed the impact of interventions to increase HIV screening in an outpatient population at a large urban safety-net hospital. Outcomes were compared from the preintervention (December 2020 to November 2021) to postintervention years (December 2021 to November 2022). Stepwise electronic alerts to prompt HIV screening paired with provider financial incentives were implemented. The proportion of eligible individuals screened for HIV were compared after intervention implementation. Results: Average monthly HIV screening increased from 506 ± 97 to 2484 ± 663 between the pre- and postintervention periods, correlating to a 5.1-fold increase in screening (7.8% to 39.8%, P < .01). Increases were seen across all ages, and those aged 55 to 64 and 65+ had the highest relative increase in screening at 7.5 and 9.3-fold, respectively (P < .01). Screening rates increased for Hispanics (7.9% preintervention vs 43.6% postintervention, P < .01). In the pre- and postintervention periods, 41 patients with new HIV diagnoses were identified (13 preintervention and 28 postintervention) and 85.4% were linked to care within 30 days. Conclusions: Stepwise interventions targeted at primary care clinicians are an effective way to increase HIV screening rates, particularly in older demographics. Earlier HIV diagnosis coupled with linkage to care is an important strategy in ending the HIV epidemic. Full Article
health and food A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization. Objective: The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics. Methods: A qualitative design using a semistructured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke’s framework was used to identify themes and subthemes. Results: Sixteen (n = 16) participants were included in this study. Most respondents were women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact. Conclusion: HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive. Full Article
health and food Associations Between Patient/Caregiver Trust in Clinicians and Experiences of Healthcare-Based Discrimination By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Higher trust in healthcare providers has been linked to better health outcomes and satisfaction. Lower trust has been associated with healthcare-based discrimination. Objective: Examine associations between experiences of healthcare discrimination and patients’ and caregivers of pediatric patients’ trust in providers, and identify factors associated with high trust, including prior experience of healthcare-based social screening. Methods: Secondary analysis of cross-sectional study using logistic regression modeling. Sample consisted of adult patients and caregivers of pediatric patients from 11 US primary care/emergency department sites. Results: Of 1,012 participants, low/medium trust was reported by 26% identifying as non-Hispanic Black, 23% Hispanic, 18% non-Hispanic multiple/other race, and 13% non-Hispanic White (P = .001). Experience of any healthcare-based discrimination was reported by 32% identifying as non-Hispanic Black, 23% Hispanic, 39% non-Hispanic multiple/other race, and 26% non-Hispanic White (P = .012). Participants reporting low/medium trust had a mean discrimination score of 1.65/7 versus 0.57/7 for participants reporting high trust (P < .001). In our adjusted model, higher discrimination scores were associated with lower trust in providers (aOR 0.74, 95%CI = 0.64, 0.85). A significant interaction indicated that prior healthcare-based social screening was associated with reduced impact of discrimination on trust: as discrimination score increased, odds of high trust were greater among participants who had been screened (aOR = 1.28, 95%CI = 1.03, 1.58). Conclusions: Patients and caregivers reporting more healthcare-based discrimination were less likely to report high provider trust. Interventions to strengthen trust need structural antiracist components. Increased rapport with patients may be a potential by-product of social screening. Further research is needed on screening and trust. Full Article
health and food Using Primary Health Care Electronic Medical Records to Predict Hospitalizations, Emergency Department Visits, and Mortality: A Systematic Review By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Introduction: High-quality primary care can reduce avoidable emergency department visits and emergency hospitalizations. The availability of electronic medical record (EMR) data and capacities for data storage and processing have created opportunities for predictive analytics. This systematic review examines studies which predict emergency department visits, hospitalizations, and mortality using EMR data from primary care. Methods: Six databases (Ovid MEDLINE, PubMed, Embase, EBM Reviews (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment, NHS Economic Evaluation Database), Scopus, CINAHL) were searched to identify primary peer-reviewed studies in English from inception to February 5, 2020. The search was initially conducted on January 18, 2019, and updated on February 5, 2020. Results: A total of 9456 citations were double-reviewed, and 31 studies met the inclusion criteria. The predictive ability measured by C-statistics (ROC) of the best performing models from each study ranged from 0.57 to 0.95. Less than half of the included studies used artificial intelligence methods and only 7 (23%) were externally validated. Age, medical diagnoses, sex, medication use, and prior health service use were the most common predictor variables. Few studies discussed or examined the clinical utility of models. Conclusions: This review helps address critical gaps in the literature regarding the potential of primary care EMR data. Despite further work required to address bias and improve the quality and reporting of prediction models, the use of primary care EMR data for predictive analytics holds promise. Full Article
health and food Performance Evaluation of the Generative Pre-trained Transformer (GPT-4) on the Family Medicine In-Training Examination By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Objective: In this study, we sought to comprehensively evaluate GPT-4 (Generative Pre-trained Transformer)’s performance on the 2022 American Board of Family Medicine’s (ABFM) In-Training Examination (ITE), compared with its predecessor, GPT-3.5, and the national family residents’ performance on the same examination. Methods: We utilized both quantitative and qualitative analyses. First, a quantitative analysis was employed to evaluate the model's performance metrics using zero-shot prompt (where only examination questions were provided without any additional information). After this, qualitative analysis was executed to understand the nature of the model's responses, the depth of its medical knowledge, and its ability to comprehend contextual or new information through chain-of-thoughts prompts (interactive conversation) with the model. Results: This study demonstrated that GPT-4 made significant improvement in accuracy compared with GPT-3.5 over a 4-month interval between their respective release dates. The correct percentage with zero-shot prompt increased from 56% to 84%, which translates to a scaled score growth from 280 to 690, a 410-point increase. Most notably, further chain-of-thought investigation revealed GPT-4’s ability to integrate new information and make self-correction when needed. Conclusions: In this study, GPT-4 has demonstrated notably high accuracy, as well as rapid reading and learning capabilities. These results are consistent with previous research indicating GPT-4's significant potential to assist in clinical decision making. Furthermore, the study highlights the essential role of physicians' critical thinking and lifelong learning skills, particularly evident through the analysis of GPT-4's incorrect responses. This emphasizes the indispensable human element in effectively implementing and using AI technologies in medical settings. Full Article
health and food Physician Satisfaction Should Be the Measure of Electronic Health Record Quality for the Nation By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Full Article
health and food Family Medicine Must Prepare for Artificial Intelligence By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Artificial Intelligence (AI) is poised to revolutionize family medicine, offering a transformative approach to achieving the Quintuple Aim. This article examines the imperative for family medicine to adapt to the rapidly evolving field of AI, with an emphasis on its integration in clinical practice. AI's recent advancements have the potential to significantly transform health care. We argue for the proactive engagement of family medicine in directing AI technologies toward enhancing the "Quintuple Aim." The article highlights potential benefits of AI, such as improved patient outcomes through enhanced diagnostic tools, clinician well-being through reduced administrative burdens, and the promotion of health equity by analyzing diverse data sets. However, we also acknowledge the risks associated with AI, including the potential for automation to diverge from patient-centered care and exacerbate health care disparities. Our recommendations stress the need for family medicine education to incorporate AI literacy, the development of a collaborative for AI integration, and the establishment of guidelines and standards through interdisciplinary cooperation. We conclude that although AI poses challenges, its responsible and ethical implementation can revolutionize family medicine, optimizing patient care and enhancing the role of clinicians in a technology-driven future. Full Article
health and food Artificial Intelligence and Family Medicine By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Artificial intelligence (AI) is certainly going to have a large, potentially huge, impact on the practice of family medicine. The specialty is fortunate to have leading experts in the field to guide us along the way. One such team of forward thinkers provides insights into where AI can take the specialty. Another article reports on how well AI performed on the American Board of Family Medicine In-Training Examination. In addition to AI, we have 3 articles that investigate the intersection of social needs and the practice of medicine. Four clinical review articles cover nonalcoholic fatty liver disease, headache treatments, single maintenance and reliever therapy for asthma, and the use of cannabis in the setting of chronic pain. The clinical research articles cover point-of-care hemoglobin A1c testing, continuous glucose monitoring, and screening for HIV. Another group of articles examines the profession of family medicine, covering topics ranging from how women family physicians negotiate their first jobs to the words we use to define primary care. Full Article
health and food Reply to Letter to Editor Concerning “Nocturnal Pressure Controlled Ventilation Improves Sleep Efficiency in Patients Receiving Mechanical Ventilation” By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
health and food Nocturnal Pressure Support Ventilation: Truth or Dare? By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
health and food The Evolution of Intermittent Mandatory Ventilation: Update and Implications for Home Care By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
