Journal of the American Board of Family Medicine最新文献

Introduction: There are concerns of postacute sequelae of COVID-19, but the impact of long COVID on the US workforce is unclear.

Methods: We analyzed the nationally representative 2022 Medical Expenditure Panel Survey (MEPS). Adult (aged 18 or above) full time workers were classified as those who had never had COVID-19, those who had COVID-19 without long COVID, and those who had long COVID. The number of days of work missed due to illness in 2022 was assessed in unadjusted negative binomial regressions and those adjusted for paid sick leave, age, sex, race and comorbidities.

Results: Among 125,151,402 (weighted) adults, 42.9% never had COVID-19, 49.6% had COVID-19 without long COVID, and 7.5% had long COVID. Patients with long COVID missed more than 8 days of work in a year which was 171% higher than patients without COVID-19% and 62% higher than those who had COVID-19 without long COVID. After adjusting for potential confounding variables, patients who had COVID-19 without long COVID had a greater rate of missing work (IRR 1.75; 95% CI 1.51, 2.04) compared with those who did not have COVID-19. Long COVID patients had an even higher rate of missing work (IRR 2.21; 95% CI 1.79, 2.73) compared with those who did not have COVID-19.

Discussion: An additional outcome for patients with long COVID is an impact on the workforce and significantly more missed workdays.

Background: Comprehensiveness in primary care is defined as the breadth of services provided by a health care clinician team and is an important metric related to patient outcomes and care delivery. We describe a novel measure of comprehensiveness based on ICD-10 codes.

Methods: We compare the distribution of ICD-10 codes from the care of a large population at a regional academic health system to the distribution of codes from the National Ambulatory Medical Care Survey (NAMCS) using linear regression and the mathematical inner product.

Results: The linear regression between the pattern of ICD-10 codes for the selected population and the NAMCS has a slope 1.00, 95% CI 0.57:1.43, P = .0002, R² 0.62. When considering specific specialty areas of practice, primary care is distinct from specialty care based on the inner product between the distribution of care for a given specialty independent of whether a regional or national reference population is used.

Conclusion: The distribution of care based on ICD-10 codes provides a stable and possibly generalizable reference for comprehensive care. The inner product of an ICD-10 care distribution and a reference provides a quantitative estimate of comprehensiveness that distinguishes primary care from specialty care.

Objectives: This study compared the performance of and patient preference for New York City Health and Hospital's (NYC H + H) social needs screener to 2 widely used screeners, a version of the Accountable Health Communities screener and the WellRx screener, that include the same core domains of social needs.

Methods: Two NYC H + H primary care clinics provided data for analysis. A convenience sample completed 1 of the 2 other screeners during May-June 2024, in addition to the NYC H + H screener. Analyses compared rates of needs detected and number of needs identified as well as patient preference.

Results: The H + H screener performed similarly to both alternate screeners in identifying patients with social needs, (κ = 0.7, P < .001 and κ = 0.6, P < .001). The number of positive items identified by each screener was virtually identical. Patients preferred the H + H screener to the alternates, but differences were not statistically significant.

Conclusions: Despite differences in question phrasing and response options, all 3 screeners performed similarly.

Introduction: Firearm violence now accounts for more than 45,000 deaths annually in America, making it the leading cause of death in the pediatric population. Despite this, primary care clinicians (PCCs) lack screening tools to assess a patient's future risk of gun violence, hampering the ability to allocate resources that could prevent morbidity and mortality.

Methods: Longitudinal quantitative study designed to evaluate whether the Serious fighting, Friend weapon carrying, community Environment, and firearm Threats (SaFETy) score and other measures could predict gun violence exposure over 6 months in a nonurban primary care (PC) based adolescent-young adult population.

Results: Eighty-eight patients between the ages of 14 to 24 completed the baseline questionnaire and 62 completed the 6-month questionnaire. 45% of participants had a SaFETy score >0. Any score >0 indicates an increased risk of future firearm violence. A strong correlation was found between the SaFETy score and gun violence exposure, and Adverse Childhood Events (ACEs).

Conclusions: This was among the first studies attempting to assess the viability of screening for firearm violence and other associated risk factors in a nonurban PC setting. Our findings suggest that adolescent and young adult PC patients are willing to disclose in a survey topics related to violence and firearms with their PCC. If validated in the PC setting, the SaFETy score could become a crucial tool for PCCs given the ease with which it can be implemented into a routine visit and the nonthreatening, and nonconfrontational question design. Tools such as the SaFETy score can provide PCPs with vital insight into their patients' past gun violence exposures and future violence risks.

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.

Purpose: The purpose of this study is to gain understanding on factors identified by primary care practice members as impacting sustainability of diabetes Shared Medical Appointments (SMAs) after participating in a pragmatic trial that included sustainability planning. SMAs provide diabetes self-management education and support (DSMES) in primary care, though sustainability can be challenging.

Methods: The Invested in Diabetes study was a pragmatic comparative effectiveness trial of 2 approaches to providing SMAs for adults with type 2 diabetes. Qualitative interviews at the study end explored primary care practices' experiences with SMAs and perspectives on sustainability, analyzed using a grounded theory hermeneutic editing approach.

Results: Seventy-nine interviews were conducted in 20 participating practices. One primary finding and 3 themes on factors necessary for sustainment emerged: finding: SMAs were seen as valuable, but sustainment plans were inconsistent; theme 1) Sustainability hinges on practical factors, some not supported in current health care payment models; theme 2) Relevance and efficiency are important: future diabetes SMAs anticipated adaptations or revisions; and theme 3) Improvement in reportable practice quality measures would be an incentive to continue SMAs.

Discussion: Diabetes SMAs were perceived as beneficial, but difficult to sustain. We found that primary care teams want to provide SMAs and that changes in how primary care practices are reimbursed could support implementation and sustainment of DSMES approaches such as SMAs, leading to improved patient outcomes.

Conclusion: There is urgent need for explicit attention to policy change, health care payment innovation, and novel reimbursement models to enhance sustainability of diabetes SMAs.

Purpose: Understanding primary care panel sizes is crucial as US policy makers and workforce planners wrestle with both primary care shortage and rising clinician burnout. We aimed to investigate physician and practice factors associated with variation in panel size.

Methods: We analyzed data from the 2017 to 2023 American Board of Family Medicine (ABFM) Family Medicine Continuing Certification Questionnaire. The nationally-representative, mandatory (100% response rate) questionnaire included demographic, practice, and panel size data for family physicians (FPs). Bivariate analyses and generalized linear models with a log-linked γ distribution examined associations between panel size and physician, practice, and area characteristics.

Results: 21,770 FP respondents reported estimated panel size averaging 1,933 patients/FP. On adjusted analyses, FPs in independently owned practices reported the largest panel sizes, while those in academic practices and federal clinics had the smallest panel sizes. FPs working in practices of 2 to 5 physicians had larger panel sizes than those in solo or larger group practices. FPs providing obstetric and inpatient care had smaller panel sizes than their counterparts. Working with nurse practitioners or physician assistants was associated with larger panel sizes. A greater proportion of vulnerable patients in a practice was associated with smaller panel sizes. Panel size decreased over time after adjusting for other predictors.

Conclusions: Panel sizes among FPs vary significantly based on practice type and size, team composition, and scope of practice. These findings highlight the importance of considering both individual and practice-level factors in workforce planning and policy development to optimize primary care delivery and manage physician workloads effectively.

Background: Buprenorphine is a partial µ-opioid agonist approved by the Food and Drug Administration (FDA) for the treatment of chronic pain and opioid use disorder (OUD). Despite its favorable safety profile compared with other opioids and the 2022 US Department of Veterans Affairs and Department of Defense guideline recommending it as first-line opioid for patients with chronic pain requiring daily opioids, its adoption among primary care clinicians (PCCs) remains limited. This survey aims to evaluate PCCs' familiarity with and interest in prescribing and/or transitioning patients to buprenorphine for chronic pain and OUD. In addition, we assessed their interest in using an electronic Consult (eConsult) platform to support buprenorphine prescribing.

Methods: An anonymized electronic survey was distributed to our institution's PCCs working across 53 clinics in rural southern Minnesota and western Wisconsin. Our survey was deployed for 2 weeks. We received 146 responses (31.7% response rate).

Results: Only 37% of respondents currently prescribe buprenorphine, and 19% prescribed it for both OUD and chronic pain. Despite this, 72% expressed interest in prescribing buprenorphine in the future. Key barriers to prescribing included insufficient knowledge (76%) and lack of confidence (78%). Additional concerns included cost, insurance challenges, stigma, patient resistance, and inadequate training. Notably, 89% of respondents expressed interest in using an eConsult platform for buprenorphine initiation and transition.

Conclusion: These findings suggest a need for enhanced education, resource access, and institutional support to help PCCs incorporate buprenorphine into their practices, potentially improving the management of chronic pain and OUD.

Objective: Continuity of primary care reduces costs and hospitalizations over 1-year periods, but its long-term effects remain unclear, a key concern for value-based payment. We examined associations between physician-level continuity and health care expenditures/utilization across single- and multi-year measurement periods.

Design: Retrospective cohort study using 2011 to 2017 Medicare Fee-for-Service (FFS) claims. We constructed physician-level continuity measures over 1- to 5-year lookback periods. Generalized linear models estimated associations with total Medicare Part A & B expenditures, and logit models assessed hospitalization and emergency department (ED) visits, adjusting for patient and physician characteristics.

Setting & participants: Nationally representative sample of 4,940 primary care practices, including 1.1 to 2.5 million Medicare FFS beneficiaries seen by 6,758-14,949 physicians.

Results: Beneficiaries in the highest continuity quintile had 7.4%-10.4% lower total expenditures than those in the lowest quintile, with the greatest difference in the 1-year lookback. Hospitalization and ED visit odds were 5.5%-8.6% and 4.9%-6.3% lower, respectively, for high-continuity physicians. Effects attenuated slightly with longer lookbacks.

Conclusion: Physician continuity is consistently associated with lower costs, hospitalizations, and ED visits across lookback periods. Given this stability and the complexity of multi-year claims measurement, a 1-year assessment may be sufficient for physician continuity evaluation and value-based payment programs.