Journal of the American Board of Family Medicine最新文献

Introduction: Outreach athletic trainers (ATs) are a novel community-clinical linkage who connect high school students and family medicine practices. Our study quantitatively explored the relationship between students and ATs.

Methods: We conducted a cross-sectional study, collecting data from students and parents/guardians at a preparticipation examination event in April 2024.

Results: We recruited 79 unique participants (42 students, 37 parents/guardians). In a linear regression, parent/guardian trust in ATs, parent/guardian distrust in the health care system, student health literacy, and student age predicted student trust in ATs. Students were open to talking to ATs about concussions, headaches, and mental health concerns.

Discussion: Findings here indicate that ATs are trusted health professionals who are well positioned to support whole-person care and link students to family medicine and primary care.

Introduction: Colorectal cancer (CRC) is easily detectable with screening, but due to a variety of factors, over a third of eligible people do not get screened. One barrier to people getting adequate screening is confusion about what type of test to use. Shared decision making (SDM) is a way for the clinician to help the patient decide about whether to get screened for CRC and if so, which test to use. This scoping review examines literature about shared decision making in CRC screening to identify key factors affecting a patient's decision.

Methods: We identified studies published from January 1, 2010 through May 18, 2024 through searching 4 databases. Studies were peer reviewed publications in English that investigated the role of shared decision making in colorectal cancer screening in average risk adults, aged 45 -75, in the United States and Canada. Two independent researchers screened all titles and abstracts for eligibility and reviewed all included full text articles. The included studies were examined for themes affecting a patient's choice of screening test.

Results: Of the 5672 unique records identified, we included 28 studies in this scoping review. Four themes emerged as being important to the process of shared decision making in colon cancer screening: knowledge of specific aspects of each test, clinician recommendation, acknowledgment of strong emotions surrounding screening, and importance of external factors in decisions around screening. Patients relied on family members for information about screening and made decisions about screening using this information as well as logistics of the test chosen.

Conclusion: Future work can focus on the importance of external factors in screening decisions and recognizing and addressing the real emotions about CRC screening.

Background: Buprenorphine reduces the mortality associated with opioid use disorder (OUD) and may be prescribed in primary care. In January 2023, the requirement for a federal waiver to prescribe buprenorphine for OUD was removed. This study examines the impact of the waiver removal on buprenorphine prescribing in primary care.

Methods: This retrospective cohort study used electronic health record data from 32 primary care clinics in Washington and Idaho. The sample included all patients 18 or older who had a primary care visit between January 2022 and December 2023. We described the number of patients who received buprenorphine in the year prior and the year following the removal of the waiver. We used generalized estimating equations with exchangeable correlation structure to estimate the odds ratio of receiving buprenorphine after the removal of the federal waiver.

Results: A total of 56,003 patients met inclusion criteria and were included in the sample. The overall sample was 58.9% female, 75.8% White and mean age was 49.3 years. During the 2-year study period, 986 (1.8%) patients received buprenorphine. In our sample, we did not find a significant change in buprenorphine prescribing the year after the removal of the federal waiver after adjusting for sociodemographic characteristics (OR = 1.08, 95% CI 0.98-1.20). No significant interactions were found between the time period relative to the federal waiver removal and sociodemographic characteristics.

Conclusions: Buprenorphine prescribing did not increase the year after the removal of the federal waiver, suggesting this regulatory change was insufficient to increase buprenorphine prescribing in primary care.

Background: Despite the availability of safe and effective outpatient treatments for alcohol use disorder (AUD), primary care physicians screen and treat only a fraction of their patients with AUD. To better detect AUD, it may be effective to evaluate whether the known gastrointestinal consequences of heavy alcohol consumption are linked to subsequent AUD diagnoses. This study examined whether irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD) and gastritis/ulcer were associated with a new AUD diagnosis.

Methods: Deidentified medical record data from a large Midwestern health care system was used to identify primary care patients without an AUD diagnosis in 2020 and 2021. Separate multivariate regression models were computed to estimate the association between each GI condition measured in 2020 and 2021 and odds of AUD diagnoses in follow-up (2022 to 2023).

Results: The average age was 56.0 (SD 17.1) years old. Patients were most commonly White race (87.6%). Gastroesophageal reflux disease (GERD) (24.8%) was much more prevalent than either IBS (3.4%) or gastritis/ulcer (2.5%). After adjusting for covariates, there was no significant association between gastritis/ulcer or IBS and a new diagnosis of AUD within 2 years. However, after adjusting for all covariates GERD was significantly associated with new AUD diagnoses (OR = 1.18; 95% CI: 1.10-1.26).

Conclusions: This study suggests that primary care physicians should screen their GERD patients for AUD, as these patients are at higher risk of being diagnosed with AUD within 2 years. Further research is needed to determine patient acceptability to discussing AUD following a GERD diagnosis as compared with standard screening.

Purpose: Exhibit hall booths at medical conferences are a key avenue for promoting prescription drugs to health care providers (HCPs). Because HCPs spend considerable time interacting with industry representatives at conferences, we explored how representatives' credentials might influence HCP perceptions and prescribing intentions of promoted drugs. We also examined how disclosures of clinical trial data limitations about these drugs during conference interactions might influence HCP perceptions and intentions.

Methods: We conducted a 2 × 2 factorial experimental study with HCPs (n = 430) during or immediately after their attendance at 1 of 12 US medical conferences. Participants viewed video stimuli depicting an exhibit hall interaction between an industry representative and an HCP discussing a fictitious drug for preventing nausea and vomiting. Participants were randomly assigned to 1 of 4 experimental conditions that varied (1) the representative's educational credentials (MBA vs MD) and (2) a disclosure noting clinical trial data limitations (present vs absent). Participants then completed an online questionnaire with questions about the fictitious drug, such as perceived efficacy and perceived risk.

Results: Industry representative credentials had no influence on HCP perceptions and intentions to prescribe the drug, though representatives with medical degrees were rated as having slightly more medical knowledge. Conversely, the disclosure significantly reduced drug efficacy perceptions and led to less positive drug attitudes, although it did not influence prescribing intentions.

Conclusions: The findings suggest that HCP perceptions and intentions are not swayed by the industry representative credentials but that data limitation disclosures can temper HCP perceptions of drugs promoted at medical conferences.

Point-of-care ultrasound (POCUS) is a portable, bedside instrument enabling doctors to rapidly evaluate patients in real-time. Its application is expanding across multiple medical specialties due to its capacity to deliver prompt diagnostic information. Family medicine residents have exhibited significant interest in integrating POCUS into their training. POCUS's potential to improve patient care and outcomes is what is driving this interest, which raises the issue of whether or not primary care training should incorporate this technology. The purpose of this article is to emphasize the importance of incorporating POCUS training into family medicine residency programs globally.

Point-of-care ultrasound (POCUS) has seen growing integration into family medicine over the past decade, to the point that POCUS competency is now moving toward inclusion in board eligibility. In parallel, excitement and interest around POCUS are growing at the medical student and residency levels. With its wide array of practical applications in the outpatient setting, POCUS invites us to imagine what family medicine could look like if ultrasound truly became "the new stethoscope" and a routine part of care. This commentary highlights how POCUS can be used accurately and efficiently for abdominal aortic aneurysm (AAA) screening, avoid unnecessary emergency department visits by ruling out deep vein thrombosis (DVT), and change management of soft tissue infections by detecting abscesses. Together, these examples illustrate how POCUS can enhance care in the family medicine clinic.

In family medicine (FM), point-of-care ultrasound (POCUS) usage is rising. Clinically, acute outpatient concerns often lends itself to more opportunities to use POCUS. Common scans utilized in the acute, outpatient setting include soft tissue masses, foreign body assessments, preprocedural guidance for incision and drainage and soft tissue mass excisions, deep vein thrombosis (DVT) ultrasound (US), joint effusions, right upper quadrant (RUQ) US assessments to check for gallstones, lung US for respiratory infections (especially in children), shoulder rotator cuff assessments, bladder US, and US assisted/guided procedures such as Baker's cyst aspirations, Carpal tunnel injections, and DeQuervain tenosynovitis injections. The goal of this commentary is to share clinical scenarios that can be helpful to use POCUS in the outpatient setting. With the advent of handheld US, recent Accreditation Council for Graduate Medical Education FM updates to recommend residents to learn POCUS³, and nationwide efforts spreading POCUS into residencies and primary care departments; I am optimistic that this will inspire and empower primary care physicians to learn and use POCUS effectively to benefit patients where and when they need care the most.

Point-of-care ultrasound (POCUS) is increasingly recognized as an important and useful improvement for bedside clinical care. Its wide adoption is slowed by the time it takes to perform, and the time it takes to learn. This commentary discusses this dilemma, and needed directions in education, technical advancements, and financial workflows for family medicine clinicians to better incorporate POCUS into clinical practice.