Journal of the American Board of Family Medicine最新文献

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.

No longer are prolonged sadness and despondency, with their effects on day-to-day functioning, conceived of as a response to someone's internal world or external environment. Instead, the syndrome has been elevated to a medical disorder-depression-explained as a chemical imbalance in the nervous system that requires medication to rebalance these chemicals. How did we arrive at this modern state of affairs? While the answer to this question is complex and has been hotly debated, one thing is certain: This relatively new explanation of depression as a neurochemical imbalance leads to the current privileging of pharmacotherapy over other approaches to treatment. However, the pharmacologic effect of these treatments is still speculative. Numerous studies have failed to show a benefit to active treatment greater than that seen with placebo, and most patients will not achieve remission of symptoms despite treatment. This overreliance on medication may reflect a "medicine is awesome" stance that biases clinicians toward medical interventions. A more expansive understanding of depressed mood, one that can and should be discussed with patients, is to understand it as a reaction to one's psychosocial, political, economic, and physical environment. This more expansive understanding includes the neurobiological basis of mood, but it also allows for discussions of non-pharmaceutical treatments, ones that can be aligned with each patient's agenda. Medications may be an eventual option after a thorough explanation of limited benefit and possible harms. However, this reframing of depression facilitates a valuable, satisfying means of developing trust and helping people with depressed mood.

Background: Healthcare access disparities persist, particularly among Medicaid patients in regions like the Inland Empire, California. These patients often face prolonged wait times for primary and specialty care, compounded by difficulties in scheduling with providers. Leveraging eConsult platforms offers a potential solution to improve specialist care accessibility. This study examines the impact of the Inland Empire Health Plan's (IEHP) eConsult services on enhancing interactions between primary care providers (PCPs) and specialists and improving patient care.

Methods: We analyzed 2,505 eConsults conducted between January and June 2022 within the IEHP, focusing on dermatology, pulmonology, and urology. Each eConsult was categorized based on closure outcomes, advice provided, and authorization status. We cross-referenced eConsult data with claims and authorization records to determine encounter completion, particularly whether a face-to-face specialist visit occurred.

Results: Only a fraction of eConsults (27% dermatology, 25% pulmonology, 37% urology) resulted in specialist advice. In cases where eConsults did not suffice, specialists recommended in-person follow-up; however, a significant portion of patients (57% dermatology, 71% pulmonology, 53% urology) did not receive in-person specialty care.

Conclusion: This study highlights the potential of eConsults in improving specialty care access for Medicaid patients in underserved regions. While eConsults show promise in expediting specialist access, challenges such as varying PCP utilization and the need for in-person visits persist. Addressing these issues with standardized protocols and better triaging can significantly reduce healthcare disparities and improve patient outcomes.

Diagnostic errors are a significant challenge in health care, often resulting from gaps in physicians' knowledge and misalignment between confidence and diagnostic accuracy. Traditional educational methods have not sufficiently addressed these issues. This commentary explores how large language models (LLMs), a subset of artificial intelligence, can enhance diagnostic education by improving learning transfer and physicians' diagnostic accuracy. The American Board of Family Medicine (ABFM) is integrating LLMs into its Continuous Knowledge Self-Assessment (CKSA) platform to generate high-quality cloned diagnostic questions, implement effective spaced repetition strategies, and provide personalized feedback. By leveraging LLMs for efficient question generation and individualized learning, the initiative aims to transform continuous certification and lifelong learning, ultimately enhancing diagnostic accuracy and patient care.

Purpose: Increasingly emphasized by leaders in family medicine and primary care research, team science is an approach to research that requires clear documentation for replicability. Here, we report the approach to documenting team science in 2 US family medicine research journals.

Methods: Our interdisciplinary team, composed of MDs and PhDs from family medicine and other disciplines, established a definition of the "team science" construct, which included the utilization of interdisciplinary partnerships and/or collaboration with community-based organizations. Two team members reviewed every original research article published in 2023 in the Annals of Family Medicine (AFM) and the Journal of the American Board of Family Medicine (JABFM). Data extraction identified the use of the term "team science" or the presence of elements of the construct as defined by the team, as well as the funding source(s).

Results: Of the 107 articles reviewed, none explicitly mentioned the term "team science." However, 19 (17.8%) described interdisciplinary partnerships. Seventeen (15.9%) described the disciplines of the contributors, and 5 (4.7%) described community collaborators. Most articles (80.4%) were funded studies, with 70.9% supported by national governmental or nongovernmental entities.

Conclusions: In this sample of articles, team science was either not reported at all or it was described in a limited way. The authors recommend that editors encourage discussions of interdisciplinarity and team science research practices in manuscripts, including descriptions of the strengths each disciplinary representative brings to the team.