Journal of the American Board of Family Medicine最新文献

Objective: The Person-Centered Primary Care Measure (PCPCM) is a patient assessment of their longitudinal experience of care with a clinician and care team, evaluating core functions of primary care in the health system. However, the optimal process of implementation across health systems, including how and when to administer the survey, reporting, and process improvement activities tied to survey data, has not been established.

Methods: We distributed the 11-question PCPCM experience survey to 329,450 patients empaneled across 78 primary care practices between April 2023 and January 2024. We evaluated survey completion parameters, psychometric properties, and mean responses in relationship to patient-level demographic variables.

Results: In this large, heterogeneous system of primary care practices, the PCPCM survey was successfully distributed using the Press Ganey (South Bend, IN) platform. We found a low response rate (6.4%), but demonstrated good internal consistency, with a skew toward higher scores. PCPCM scores varied by age, sex, race, primary care clinician type, and the number of years the patient had been at their current primary care practice. Responses varied significantly by patient race, but differences were small and not uniform in direction. Black or African American patients were significantly less likely to believe that the care provided by the practice was informed by knowledge of their community, compared with all other racial groups.

Conclusions: The PCPCM was implemented successfully in a large network of primary care practices, but more work is needed to improve the response rate. Future work should focus on the use of the PCPCM for practice and clinician feedback and validation of individual PCPCM items.

Religious beliefs are cited as one cause of declining vaccination rates, and religious participation has been associated with hesitancy to receive vaccines. However, many personal vaccine objections attributed to faith-based reasons are more likely matters of personal faith interpretation rather than based on the teachings or traditions of a religious community. Studies have demonstrated ways faith-based hesitancy or skepticism toward vaccines can be addressed at both the individual level and the community level. Evidence to date suggests faith-based vaccine hesitancy and may be best approached through education that addresses and accounts for the patient's spirituality, and by collaboration with organizations that are connected to patients' religious communities.

This issue features research on virtual care, artificial intelligence (AI), vaccine hesitancy, and more. Virtual care for conditions such as hypertension is increasingly common. Two articles address concerns about virtual care. A study reports how family medicine academics use AI. One article helps us understand the religious concerns that underlie some vaccine hesitancy. Three studies focus on aspects of primary care implementation, and 3 focus on pharmaceuticals. The American Board of Family Medicine reports on the future of board certification and maintenance of certification.

Background: Primary care clinicians (PCCs) frequently report low levels of comfort in managing seizure disorders, despite their essential role in caring for patients with seizures from systematically excluded groups. This study explores seizure care practices among PCCs at a federally qualified health center and examines possible associations between provider documentation of seizure care and proxy indicators for control of seizure disorder.

Methods: This is a retrospective observational cohort study of patients presenting with a seizure disorder between 2015 and 2019. Logistic regression models examined the associations between patient demographics, clinical processes and outcomes, and electronic medical record documentation.

Results: PCCs adhered to quality metrics for documentation in 41.5% of the 446 cases. PCCs documented seizure type 94.3% of the time but only recorded seizure frequency or time since last seizure 44.3% of the time. Most patients (52.3%) were referred to a neurologist. Better clinical documentation was significantly associated with referral to a neurologist (OR 1.73; 95%CI 1.14, 2.6; P = .009), visiting a neurologist (OR 1.7; 95%CI 1.13, 2.56; P = .01), and receiving a depression, anxiety, or quality of life screening (OR 2.97; 95%CI 1.84, 4.79; P < .001).

Discussion: Our findings suggest the need for improvements in the documentation of seizure management in the primary care setting. PCCs may benefit from additional training or tools to improve their comfort with seizure treatment and understanding of the role of primary care for these disorders.

Introduction: In response to the national primary care physician shortage, states are increasingly turning to legislation that expands the scope of practice for advanced practice providers (APPs), such as nurse practitioners (NPs) and physician assistants (PAs) to practice independently without physician oversight. While the effects of these laws will be multi-faceted, little is known regarding how these laws will affect states' future abilities to attract and recruit physicians to practice within their state. This study explores medical students' (MSs) attitudes toward APP independence legislation, focusing on their perceptions of equivalency of care, the potential impact of these laws on their future practice choices, and their views on professional collaboration.

Methods: An anonymous survey was administered to MSs across all 4 years of schooling at a Midwestern medical school.

Results: This survey had a 21% (109/518) response rate. 86% of MSs expressed disagreement that APP care is comparable to physician care. In addition, 59% of respondents reported they would be less likely to practice in states allowing APP independence, a figure rising to 71% among those interested in pursuing primary care.

Discussion: The majority of MSs do not view APP-driven care as equivalent to care delivered by a physician. Further, states that enact APP independence laws may struggle to attract future physicians as the majority of MSs in this study consider the legislative landscape of the state they practice in.

Conclusion: States considering APP independence laws should consider the results of these studies when attempting to address their physician shortage.

Introduction: Following the COVID-19 pandemic, the role of virtual family medicine care is evolving. It can be tempting to consider only the technological aspects of virtual care; we argue we must attend to compassion's essential role in virtual family medicine care. This research aimed to understand the components contributing to compassionate family medicine virtual care and how these were demonstrated.

Methods: We conducted a qualitative Constructivist Grounded Theory study with 2 components; individual interviews with patients and family physicians (FP), and Collaborative Discussions, informed by the interviews, that brought patients and FPs together. Data collection and analysis were iterative using a constant comparative analysis.

Results: We recruited nineteen patient and fourteen FP participants for the first component and 6 patient and 4 FP participants for the second. We identified 4 themes: Conveying virtual compassion through actions; External factors affecting virtual compassion; Virtual visits extending compassionate care; and Role of the patient-FP relationship. These themes can be characterized as a stance that FPs assume in their practice of virtual care.

Discussion: We highlight 4 themes important to the delivery of compassionate virtual care. We provide specific actions FPs may consider in delivering virtual care. Offering virtual visits was viewed as a compassionate bridge between in-person visits.

Conclusion: Our findings support that it is possible to convey compassion in virtual visits including telephone interactions. As virtual care evolves, our findings can support patients and family physicians to safeguard compassion so that it remains a hallmark of care for all modes of delivery.

Background: Artificial Intelligence (AI) has the potential to reshape family medicine by enhancing clinical, educational, administrative, and research operations. Despite AI's transformative potential, its adoption is inconsistent, and strategic frameworks remain limited. This study explores current AI adoption, organizational policies, integration priorities, and budget allocations within family medicine departments.

Methods: A survey of 218 family medicine department chairs in the US and Canada was conducted via SurveyMonkey from August 13 to September 20, 2024, as part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) omnibus project. Survey questions assessed current and planned AI utilization, presence of formal departmental or organizational policies (defined as written guidelines, strategic plans, or frameworks), integration priorities, and budget allocations. Data were analyzed using Chi-square tests, Wilcoxon Rank Sum tests, and Kruskal-Wallis tests, with a primary focus on bivariate comparisons.

Results: The survey achieved a 50.9% response rate (111/218). Current AI use was reported by 56.9% (62/109), while 37.6% (41/109) indicated formal organizational policies. Primary goals for AI integration included improving clinical operations (52.3%), administrative streamlining (16.5%), educational applications (11.9%), and research (4.6%). Budget allocations were minimal (median, 0%; mean 2.4%), though departmental budgets likely underestimate actual institutional investment in AI. Departments reporting AI use had significantly more full-time equivalent faculty (median, 40.0 vs 25.5, P = .023). Geographic and chair demographics were not significantly associated with differences in AI adoption.

Conclusions: AI integration in family medicine departments is viewed as essential, though current adoption is limited by uncertain strategic planning and minimal departmental budget allocations, potentially reflecting reliance on centralized institutional information technology (IT) investments. While AI is widely viewed as important, structured policy frameworks and implementation strategies are still developing. Further research is essential to guide policy development and strategic investment to ensure AI's safe, efficient, and effective integration into family medicine.

Medication shortages constitute an ongoing threat to patient care across the United States and affect nearly every aspect of health care. National drug shortages have been a recurring challenge of the US health care system but were markedly aggravated during the COVID-19 pandemic. Federal executive and legislative efforts to bolster the resiliency of the pharmaceutical supply chain have thus far fallen short. This Commentary reviews the leading executive and legislative initiatives proposed during the 118^th Congress and the Biden administration to protect the national drug supply in the hope of avoiding future shortages. It will be up to the new (119th) Congress and presidential administration to take up this issue again and pursue remediation of the nation's drug shortage problem. The health of the nation demands action by policy makers to mitigate drug shortages that give rise to discontinuity of care and thereby to a compromise of the national state of health.

Introduction: Uncontrolled hypertension (blood pressure (BP) ≥130/80) is the most prevalent reversible risk factor for cardiovascular disease. Remote patient monitoring (RPM) can be an effective way to improve BP control and was further incentivized by the COVID-19 pandemic, which necessitated remote chronic disease management. We report on a natural experiment involving federal funding for virtual care expansion, which included home BP kits (BP cuffs, smartphones, cellular data) to facilitate RPM.

Methods: We performed a mixed methods analysis of 18 health centers that requested and received BP kits, assessing device distribution, patient use, and facilitators/barriers to RPM implementation. Electronic health record (EHR) data were investigated from 2020 to 2023. Qualitative data included semistructured interviews with health center staff, patients, and programmatic staff and field notes from observations of implementation meetings. Data were analyzed following a framework-informed thematic approach.

Results: 10 of 18 health centers (56%) initiated RPM with ≥ 5 patients during the study period. A total of 1,748 patients had EHR orders to initiate RPM, of which 780 (45%) responded with any BP data and 271 (16%) with meaningful BP data. There was no correlation between RPM distribution/use and health center size or number of BP kits received. The biggest barriers to RPM uptake were inadequate health center resources and the complexity of operationalizing an RPM program in general and the BP kits specifically.

Conclusions: Supplying free RPM hardware and cellular data plans in the absence of adequate support resources is insufficient to successfully augment care among hypertensive patients at community-based health centers.