Journal of the American Board of Family Medicine最新文献

This issue includes information gathered from multiple health systems, covers many chronic health conditions and risk factors, and gives estimates of patient panel size. Women's health articles cover period poverty, contraception and prenatal care. Other articles tackle the complex goal of improving care for at-risk patients and those with multiple chronic and behavioral health conditions, plus the potentially sensitive question of screening for potential firearm violence exposure.

Introduction: The Veterans Health Administration (VHA) historically has spent a larger percentage of total medical expenditures on primary care than other US payers, but more recent estimates are unknown. Further, no studies have identified whether geographic differences in primary care spending exist within the VHA's 18 regional Veteran Integrated Service Networks (VISNs). Our objective was to characterize the percent and per-Veteran absolute spending on primary care nationally and by VISN in the VHA in 2022.

Methods: We calculated primary care and total VHA spending in fiscal year 2022 nationally and by VISN. We then calculated the per-Veteran absolute spending and percent of total national expenditures attributed to primary care.

Results: In 2022, VHA spent $848 per-Veteran on primary care (9.2% of total medical expenditures). Across the 18 VISNs, per-Veteran spending ranged from $641 to $1079, with the 25^th and 75^th percentiles ranging from $802 to $881. Primary care percent spending ranged from 7.1% to 11.2%, with the 25^th and 75^th percentile ranging from 8.5% to 9.7%. Only 6 of 18 VISNs were in the same quartile for primary care spending in each metric.

Discussion: Primary care spending in the VHA in 2022 as a percentage of total medical expenditures was stable compared with prior estimates. In addition, our results show discordance in each VISN's spending quartile based on the metric utilized. This finding suggests that each metric may capture a different element of primary care spending.

Family physicians in the National Health Service Corps (NHSC) are more likely than non-NHSC physicians to practice in high-need areas, but retention declines over time. Despite higher retention than non-NHSC physicians, NHSC participants experienced greater declines from 3 to 6 years post-residency (MUA: 85.0% to 60.7%; HPSA: 76.0% 6 to 66.2%; rural: 29.8% to 21.3%), underscoring the need for policies that sustain long-term commitment.

Purpose: Ongoing changes in the operations and constraints of the health care system are likely affecting how patients make decisions about care seeking. Therefore, we analyzed data from a national survey asking people where they would seek care if they had no limits.

Methods: We conducted surveys of patient experiences and perceptions regarding primary care delivery and access during the pandemic, one of which conducted during November 15 to 23, 2021 included a question asking: "If you had no limits (such as insurance coverage, or what you could afford), what would be your first choice for handling most of your health concerns?" A multidisciplinary team analyzed responses using a 3-step process: identified categories using a grounded approach, tallied category frequencies using a template-based coding approach, and involved an auditor to search for confirming/disconfirming data.

Main findings: Among 1,211 respondents with usable answers, the most frequent first preference for handling most health concerns was primary care (49.1%). Other common responses were hospital or health system (11.9%), a convenient/easily accessible source (11.6%), the current source of care (8.3%), a source that would provide quality care (8.2%), or a specialist (8.0%). Less common preferences include urgent care, clinicians with whom the respondent had a relationship, a specific procedure or treatment, self-care, alternative medicine, mental/behavioral health care, holistic/wellness/preventive medicine, or pharmacy.

Conclusion: A majority of respondents among a large national sample of patients preferred primary care for handling most health concerns. Given the known benefits of primary care, systems should support, rather than constrain, that preference.

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.