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Adapting an In-Clinic Resource Navigator Program to a Virtual Referral Model 将临床资源导航程序应用于虚拟转诊模型
Pub Date : 2022-03-01 DOI: 10.1370/afm.2791
Kellia J. Hansmann, Julia Alberth, Robert Freidel, Allison Jenness
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引用次数: 0
FROM AFMRD: WHO TO GO TO FOR WHAT: THE ABFM OR THE ACGME 从afmrd:谁去做什么:abfm或acme
Pub Date : 2022-03-01 DOI: 10.1370/afm.2779
Sarah Z. Cole, Karen Elisa Milian Olmos
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引用次数: 0
Failure of the Problem-Oriented Medical Paradigm and a Person-Centered Alternative 以问题为导向的医学范式的失败和以人为本的替代方案
Pub Date : 2022-03-01 DOI: 10.1370/afm.2782
J. Mold
Our problem-oriented approach to health care, though historically reasonable and undeniably impactful, is no longer well matched to the needs of an increasing number of patients and clinicians. This situation is due, in equal parts, to advances in medical science and technologies, the evolution of the health care system, and the changing health challenges faced by individuals and societies. The signs and symptoms of the failure of problem-oriented care include clinician demoralization and burnout; patient dissatisfaction and non-adherence; overdiagnosis and labeling; polypharmacy and iatrogenesis; unnecessary and unwanted end-of-life interventions; immoral and intolerable disparities in both health and health care; and inexorably rising health care costs. A new paradigm is needed, one that humanizes care while guiding the application of medical science to meet the unique needs and challenges of individual people. Shifting the focus of care from clinician-identified abnormalities to person-relevant goals would elevate the role of patients; individualize care planning; encourage prioritization, prevention, and end-of-life planning; and facilitate teamwork. Paradigm shifts are difficult, but the time has come for a reconceptualization of health and health care that can guide an overdue transformation of the health care system.
我们以问题为导向的医疗保健方法,尽管在历史上是合理的,而且无可否认具有影响力,但已经不能很好地满足越来越多的患者和临床医生的需求。造成这种情况的部分原因是医学科学和技术的进步、卫生保健系统的发展以及个人和社会面临的不断变化的卫生挑战。问题导向护理失败的症状和体征包括临床医生士气低落和倦怠;患者不满和不依从;过度诊断和标签;多药与医源性;不必要和不受欢迎的临终干预;在健康和保健方面存在不道德和无法容忍的差距;以及不断上涨的医疗成本。需要一种新的模式,使护理人性化,同时指导医学科学的应用,以满足个人的独特需求和挑战。将护理的重点从临床医生确定的异常转移到与个人相关的目标将提升患者的作用;个性化护理计划;鼓励优先排序、预防和临终规划;促进团队合作。范式转变是困难的,但现在是重新定义卫生和卫生保健概念的时候了,这可以指导卫生保健系统迟来的变革。
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引用次数: 5
FROM STFM: ADDICTION EXPERTS COLLABORATE WITH STFM TO CREATE NEW NATIONAL ADDICTION CURRICULUM 来自stfm:成瘾专家与stfm合作创建新的国家成瘾课程
Pub Date : 2022-03-01 DOI: 10.1370/afm.2803
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引用次数: 0
Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff 与邮寄粪便免疫化学测试(FIT)完成相关的临床因素:支持人员的差异作用
Pub Date : 2022-03-01 DOI: 10.1370/afm.2772
Melinda M. Davis, J. Schneider, Amanda F. Petrik, Edward J. Miech, Brittany Younger, Anne L. Escaron, Jennifer S Rivelli, Jamie H. Thompson, Denis B Nyongesa, G. Coronado
PURPOSE Mailed fecal immunochemical test (FIT) programs can facilitate colorectal cancer (CRC) screening. We sought to identify modifiable, clinic-level factors that distinguish primary care clinics with higher vs lower FIT completion rates in response to a centralized mailed FIT program. METHODS We used baseline observational data from 15 clinics within a single urban federally qualified health center participating in a pragmatic trial to optimize a mailed FIT program. Clinic-level data included interviews with leadership using a guide informed by the Consolidated Framework for Implementation Research (CFIR) and FIT completion rates. We used template analysis to identify explanatory factors and configurational comparative methods to identify specific combinations of clinic-level conditions that uniquely distinguished clinics with higher and lower FIT completion rates. RESULTS We interviewed 39 clinic leaders and identified 58 potential explanatory factors representing clinic workflows and the CFIR inner setting domain. Clinic-level FIT completion rates ranged from 30% to 56%. The configurational model for clinics with higher rates (≥37%) featured any 1 of the following 3 factors related to support staff: (1) adding back- or front-office staff in past 12 months, (2) having staff help patients resolve barriers to CRC screening, and (3) having staff hand out FITs/educate patients. The model for clinics with lower rates involved the combined absence of these same 3 factors. CONCLUSIONS Three factors related to support staff differentiated clinics with higher and lower FIT completion rates. Adding nonphysician support staff and having those staff provide enabling services might help clinics optimize mailed FIT screening programs.
目的:邮寄粪便免疫化学试验(FIT)可以促进结直肠癌(CRC)的筛查。我们试图确定可修改的临床水平因素,以区分初级保健诊所在响应集中邮寄的FIT计划时FIT完成率较高与较低。方法:我们使用来自单个城市联邦合格医疗中心的15家诊所的基线观察数据,参与了一项实用试验,以优化邮寄FIT计划。临床层面的数据包括使用由实施研究综合框架(CFIR)和FIT完成率提供的指南对领导层进行访谈。我们使用模板分析来确定解释因素,并使用配置比较方法来确定临床水平条件的特定组合,这些组合独特地区分了FIT完成率较高和较低的诊所。结果我们采访了39位临床负责人,确定了58个潜在的解释因素,代表了临床工作流程和CFIR内部设置域。临床水平FIT完成率从30%到56%不等。比率较高(≥37%)的诊所的配置模型具有以下3个与支持人员相关的因素中的任何一个:(1)在过去12个月内增加了后台或前台工作人员,(2)有工作人员帮助患者解决CRC筛查的障碍,(3)有工作人员分发fit /教育患者。低发病率诊所的模型涉及这三个因素的综合缺失。结论:三个因素与支持人员区分FIT完成率高和低的诊所有关。增加非医生支持人员,并让这些人员提供支持性服务,可能有助于诊所优化邮寄FIT筛查项目。
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引用次数: 5
FROM ADFM: KNOWLEDGE, ATTITUDES, AND SKILLS FOR FAMILY MEDICINE LEADERS: COMPETENCIES FOR SUCCESS 来自adfm:家庭医学领导者的知识、态度和技能:成功的能力
Pub Date : 2022-03-01 DOI: 10.1370/afm.2805
J. Borkan, Peter A. Catinella, M. Muramoto
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引用次数: 1
FROM NAPCRG: NAPCRG 50TH ANNIVERSARY – A YEAR-LONG CELEBRATION 源自napcrg: napcrg 50周年纪念——为期一年的庆祝活动
Pub Date : 2022-03-01 DOI: 10.1370/afm.2804
J. Brown, Jack Westfall, D. Harper, L. Green
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引用次数: 1
Connecting Group Care Patients to Mental Health and Food Resources During the COVID-19 Pandemic 在COVID-19大流行期间,将团体护理患者与精神卫生和食物资源联系起来
Pub Date : 2022-03-01 DOI: 10.1370/afm.2790
C. Wolcott, Lisa Wanger, Lara Penny
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引用次数: 0
Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-Based Integrated Delivery System 美国综合输送系统中接受补贴医疗保险患者的社会风险因素和援助意愿
Pub Date : 2022-03-01 DOI: 10.1370/afm.2774
L. Tuzzio, R. Wellman, E. D. De Marchis, L. Gottlieb, Callie Walsh-Bailey, Salene M. W. Jones, C. Nau, J. Steiner, M. Banegas, A. Sharp, Alphonse J Derus, C. Lewis
PURPOSE Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients’ social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system. METHODS A survey was administered to Kaiser Permanente members on subsidized exchange health insurance plans (2018-2019). The survey included questions about 4 domains of social risks, desire for help, and attitudes. We conducted a descriptive analysis and estimated multivariate modified Poisson regression models. RESULTS Of 438 participants, 212 (48%) reported at least 1 social risk factor. Housing instability was the most common (70%) factor reported. Members with social risks reported more discomfort being screened for social risks (14.2% vs 5.4%; P = .002) than those without risks, although 90% of participants believed that health systems should assist in addressing social risks. Among those with 1-2 social risks, however, only 27% desired assistance. Non-Hispanic Black participants who reported a social risk were more than twice as likely to desire assistance compared with non-Hispanic White participants (adjusted relative risk [RR] 2.2; 95% CI, 1.3-3.8). CONCLUSIONS Athough most survey participants believed health systems have a role in addressing social risks, a minority of those reporting a risk wanted assistance and reported more discomfort being screened for risk factors than those without risks. Health systems should work to increase the comfort of patients in reporting risks, explore how to successfully assist them when desired, and offer resources to address these risks outside the health care sector. VISUAL ABSTRACT
由于粮食不安全和住房不稳定等社会条件影响健康结果,卫生系统越来越多地筛查和解决患者的社会风险。这项研究记录了社会风险的普遍性,并审查了在美国综合交付系统中解决这些风险的援助愿望。方法对Kaiser Permanente的补贴交换健康保险计划会员(2018-2019年)进行调查。该调查包括4个领域的问题,包括社会风险、寻求帮助的愿望和态度。我们进行了描述性分析并估计了多元修正泊松回归模型。结果:在438名参与者中,212名(48%)报告了至少一种社会风险因素。住房不稳定是报告中最常见的因素(70%)。有社会风险的会员在接受社会风险筛查时更不自在(14.2%对5.4%;P = 0.002),尽管90%的参与者认为卫生系统应协助解决社会风险。而在1-2名社会风险者中,只有27%的人希望得到帮助。报告有社会风险的非西班牙裔黑人参与者比非西班牙裔白人参与者渴望帮助的可能性高出两倍多(调整相对风险[RR] 2.2;95% ci, 1.3-3.8)。结论:尽管大多数调查参与者认为卫生系统在解决社会风险方面发挥着作用,但少数报告有风险的人需要帮助,并且报告比没有风险的人进行了更多的风险因素筛查。卫生系统应努力提高患者报告风险的舒适度,探索如何在需要时成功地帮助他们,并提供资源在卫生保健部门之外解决这些风险。视觉文摘
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引用次数: 6
The Food Box Pilot 食品盒飞行员
Pub Date : 2022-03-01 DOI: 10.1370/afm.2769
B. Engebretsen, Allison Kane, H. Laroche
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引用次数: 1
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The Annals of Family Medicine
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