Journal of the American Board of Family Medicine最新文献

The Building Research Capacity (BRC) initiative was founded in 2015 as a collaboration between the Association of Departments of Family Medicine (ADFM) and the North American Primary Care Research Group (NAPCRG). It aims to enhance family medicine research engagement by helping develop researchers, research educators, and research leaders. Through consultations, a fellowship, tailored presentations at national conferences, and ongoing assessment, BRC addresses the dynamic needs of various stakeholders in family medicine research. There is a growing need for organized efforts in primary care research capacity development, and BRC is positioned to provide ongoing leadership and direction. Targeted areas of growth for BRC are expansion and diversification, collaboration, and iterative evaluation and adaptation. A commitment to innovation, inclusivity, and adaptability propels BRC toward transformative growth in family medicine research.

Primary care researchers are increasingly at the forefront of developing innovations and new research methods to address complex issues in health care, including multi-morbidity, social determinants of health, health equity, managing population health in clinical practice, patient satisfaction, and provider burnout. Research demonstrates that "primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes."¹As a primary care specialty, family medicine has evolved beyond its initial focus on clinical practice and education to realizing the imperative for the discipline to robustly engage in research and embrace the responsibility to generate the evidence that drives changes in primary care practice and policy.² The primary care clinic is increasingly seen as a complement to medical school laboratories as a powerful site for developing new evidenced-based medicine, and essential for translating new clinical knowledge into practice. Practice-Based Research Networks (PBRNs) comprising primary care clinicians working in the "real world" of clinics promise to bridge "the gaps between communities, funders and policy makers"³ and the National Institutes of Health has shown increased interest in strengthening Clinical Translational Science Awardees' collaborations with PBRNs.⁴ Despite primary care's proven ability to deliver improved outcomes at a lower cost, not enough family physicians are currently engaging in research to improve practice and inform policy. This commentary attempts to describe the wide range of family physicians' intensity of involvement in primary care research and the prospects of mentoring for these needs.

Background: There is great interest in intensive primary care interventions to address high utilization among medically and socially complex patients. How patients experience these interventions has received less attention.

Objective: To better understand patients' experience of intensive primary care, we interviewed patients receiving care from the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an ambulatory intensive care intervention at an urban federally qualified health center.

Methods: We interviewed 25 participants enrolled in the SUMMIT randomized controlled trial and conducted a Reflective Thematic Analysis using a hybrid inductive-deductive approach.

Results: Patients reported high levels of medical and social needs that outstripped prior levels of care and resources. They perceived multiple benefits of SUMMIT through the following themes: 1) Team-based care with improved access to services. Patients appreciated their medical and social needs being met, through higher-level, multidisciplinary care. 2) Caring relationships. Patients described the SUMMIT team as being like family and felt that team members had a genuine sense of duty and obligation toward them. 3) Overcoming stigma. Patients felt valued and treated with dignity. 4) Evolving self-efficacy. Over time, patients experienced increasing success, including engagement in care and improved health behaviors.

Conclusion: Patients perceived the SUMMIT team as better meeting their health-related needs, compared with traditional primary care. They spoke of the team as family and felt humanized and supported in overcoming barriers to engagement, which led to increased self-efficacy. Evaluations assessing the effectiveness of intensive primary care should measure potential patient-centered benefits beyond short-term utilization and cost reduction.

Background: Physician burnout contributes to distress, turnover, and poor patient outcomes. Evidence suggests individual professional coaching may mitigate burnout but is costly and time intensive. Group coaching evidence is lacking. Here, we assess a group coaching program in ambulatory-based faculty.

Methods: A randomized trial occurred from February 1, 2023, to May 31, 2023, in 5 ambulatory and/or primary care-based departments at an academic institution. Participants were randomly assigned to an intervention (offered a 4-month, online, group coaching) or to a control group (not offered coaching). Surveys measuring validated dimensions of distress (burnout, impostor syndrome, moral injury, loneliness) and well-being (self-compassion, flourishing) were administered before and after the intervention. A linear mixed model analysis was performed on an intent-to-treat basis.

Results: Among 160 participants, the mean (SD) age was 42.0 (8.4), 131 (81.9%) identified as female, and 135 (85.4%) as White. Group coaching improved intervention participants' burnout domain of depersonalization (δ: -1.72 points [CI: -3.26, -0.17]; P = .03), impostor syndrome (δ: -0.82 points [95% CI: -1.47, -0.18, P = .01), and flourishing (0.35 points (95% CI: 0.03, 0.66), P = .03) compared with the control. There were no significant differences in the other domains of burnout, or moral injury, loneliness, or self-compassion.

Discussion: Four months of group-coaching improved some well-being outcomes in ambulatory-based clinicians. The intervention may be particularly useful given its accessibility, and online delivery supports greater scalability and lower cost than individual coaching.

Conclusion: Group coaching is an institutionally provided, individually harnessed tool to heal physician burnout.

Trial registration: ClinicalTrials.gov Identifier: NCT05635448.

Family medicine as a specialty has steadily increased its research capacity. Specific approaches are needed to attain the following: 1) Advocate for increased funding for Departments of Family Medicine from institutional leadership. 2) Identify and promote promising practices for chairs to support and fund research participation within their departments and institutions. Having each assumed the chair position recently, the authors summarize the specific approaches taken to expand the research capacity in a midsized urban and a large research intensive urban public university family medicine department. They included: obtaining adequate support from the Dean and other institutional programs at the time of on-boarding, focusing on established research themes within the department, ensuring the recruited faculty had high likelihood of success via their track record and mentorship, and getting the buy-in from all faculty through sharing of vision and helping everyone establish their scholarly niche.

Introduction: The 1985 Hames Consortium convened family medicine researchers to identify outstanding questions in their practice.

Method: In this descriptive review, we collected, codified, and analyzed available literature to describe the availability of evidence to answer these questions.

Results: Of 136 total questions, researchers rated 33 questions as not at all answered (24.2%), 49 questions as somewhat answered (36.0%), 37 as mostly answered (27.2%), and 17 as fully answered - will implement in practice (12.5%). Notably, 2 of the categories with the highest number of total questions, community oriented primary care and the value of comprehensive care, had the highest percentage of unanswered questions.

Discussion: The Hames 100 questions and categories themselves demonstrate the values and purpose of family medicine research and can serve as a powerful tool to discuss the future of family medicine research. The varied questions illustrate the broad scope of interest of family physicians in 1985, which remains just as relevant today. Our findings indicate that relatively few questions were fully answered, with even fewer questions answered in family medicine journals.

Collaboration, particularly interdisciplinary collaboration, is very common in family medicine research. Interdisciplinary collaboration and team science are encouraged and have significant advantages but they also have challenges to implementation. Addressing those challenges, even with changes to how promotion and tenure are conceptualized to reward team science is necessary for family medicine research to continue to grow and prosper.