Journal of the American Board of Family Medicine最新文献

In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, "Grow the family medicine research workforce by expanding pathways and strengthening mentorship," the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, "Increase funding for family medicine research and advocate for enhanced health policy and support," the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, "Build a national infrastructure for organizing and optimizing family medicine research opportunities," the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.

The National Institutes of Health (NIH) are supporting the All of Us research program, a large multicenter initiative to accelerate precision medicine. The All of Us database contains information on greater than 400,000 individuals spanning thousands of medical conditions, drug exposure types, and laboratory test types. These data can be correlated with genomic information and with survey data on social and environmental factors which influence health. A core principle of the All of Us program is that participants should reflect the diversity present in the United States population.The All of Us database has advanced many areas of medicine but is currently underutilized by primary care and public health researchers. In this Special Communication article, I seek to reduce the "barrier to entry" for primary care researchers to develop new projects within the All of Us Researcher Workbench. This Special Communication discusses (1) obtaining access to the database, (2) using the database securely and responsibly, (3) the key design concepts of the Researcher Workbench, and (4) details of data set extraction and analysis in the cloud computing environment. Fully documented, tutorial R statistical programming language and Python programs are provided alongside this article, which researchers may freely adapt under the open-source MIT license. The primary care research community should use the All of Us database to accelerate innovation in primary care research, make epidemiologic discoveries, promote community health, and further the infrastructure-building strategic priority of the family medicine 2024 to 2030 National Research Strategy.

Osteopathic physicians (DOs) comprise a growing portion of family physicians. In 2023, more DO seniors matched into family medicine than MD seniors, and nearly a quarter of US DO seniors matched into family medicine. Family medicine benefits from the osteopathic philosophy of whole-person care, though this provides challenges regarding research in family medicine. Notably, among students entering family medicine, MD students report an average of 2.4 research activities compared with 1.7 for DO students, marking the lowest values across specialties. There are multifarious reasons for the limited research exposure of osteopathic medical students, and 2 may be amenable to change. First, osteopathic trainees have relatively limited research exposure. Second, osteopathic manipulation training emphasizes techniques that are not compatible with current theories of anatomy and pathology. The reduced research emphasis among osteopathic trainees can be addressed by strategies that focus on enhanced research exposure and a cultural shift toward fearless reevaluation of these inconsistent beliefs. Improvements in research training and culture among osteopathic trainees (including medical students and residents) will directly benefit osteopathic medicine, family medicine, and patients.

Evaluating research activity in research departments and education programs is conventionally accomplished through measurement of research funding or bibliometrics. This limited perspective of research activity restricts a more comprehensive evaluation of a program's actual research capacity, ultimately hindering efforts to enhance and expand it. The objective of this study was to conduct a scoping review of the existing literature pertaining to the measurement of research productivity in research institutions. Using these findings, the study aimed to create a standardized research measurement tool, the Productivity And Capacity Evaluation in Research (PACER) Tool. The evidence review identified 726 relevant articles in a literature search of PubMed, Web of Science, Embase, ERIC, CINAHL, and Google Scholar with the keywords "research capacity" and "research productivity." Thirty-nine English-language studies applicable to research measurement were assessed in full and 20 were included in the data extraction. Capacity/productivity metrics were identified, and the relevance of each metric was data-charted according to 3 criteria: the metric was objective, organizational in scale, and applicable to varied research domains. This produced 42 research capacity/productivity metrics that fell into 7 relevant categories: bibliometrics, impact, ongoing research, collaboration activities, funding, personnel, and education/academics. With the expertise of a Delphi panel of researchers, research leaders, and organizational leadership, 31 of these 42 metrics were included in the final PACER Tool. This multifaceted tool enables research departments to benchmark research capacity and research productivity against other programs, monitor capacity development over time, and provide valuable strategic insights for decisions such as resource allocation.

Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.

Methods: A literature review was conducted on PubMed by searching the terms "IUD insertion", "pain management", "anxiety", "gynecologic procedures". The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians' Strength of Recommendation Taxonomy (SORT) scale.

Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, "verbal analgesia", lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.

Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.

Based on our analysis of data from 10,802 family physicians, we found significant variation in collaboration with local social service agencies by rurality. This variation highlights the need for tailored strategies that address disparities in health care resource utilization and collaboration, particularly improving service access and delivery.

Introduction: The Latino population is the largest ethnic group in the United States and has a higher prevalence of diabetes mellitus than non-Latino Whites. The objective of this article is to assess if glycohemoglobin (HbA1c) monitoring rates vary across Latino patients by subgroup and nativity compared with their non-Latino White counterparts.

Methods: Our sample included 43,593 adults (18 to 79 years) with Type-2 diabetes extracted from electronic health record (EHR) data from Community Health Centers (CHCs) across 16 US states, linked with neighborhood-level Latino subgroup data within the study period 2012 to 2020. The outcome was number of HbA1c monitoring tests per year. The main independent variable was self-reported ethnicity/nativity (eg, Mexican-born, US-born Latino, etc.) or for those with no EHR-recorded country of birth.

Results: Compared with non-Latino White people with diabetes, US-born Latinos with diabetes had an 11% higher rate of receiving HbA1c monitoring; no foreign-born Latinos had monitoring rates that differed significantly from non-Latino Whites. Latinos with no country of birth recorded and living in high percent Mexican neighborhood had 22% higher rates of receiving HbA1c monitoring. Those living in high percent Dominican, Guatemalan and Honduran neighborhoods also had greater rates of HbA1c monitoring compared with non-Latino White patients.

Conclusions: It could be beneficial for clinics to inquire about nativity and subgroup information of their Latino patients, so as to customize the treatment plan and better understand utilization patterns common in their communities.