Annals of Family Medicine最新文献

Purpose: We aimed to analyze regional variations in the assignment of International Classification of Diseases, 10th Revision (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition.

Methods: We analyzed national weekly diagnosis data for acute respiratory infections (ICD-10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses.

Results: We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis).

Conclusions: To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning.

The impact of the Supreme Court of the United States ruling against race-conscious admissions extends beyond college admissions to professional schools. Based partially on the idea that enough time had elapsed for achievement of the stated goals of affirmative action, the court ruled race-conscious admissions are unconstitutional under the 14th Amendment's Equal Protection Clause. The ruling left a crack in the door to higher education, however, allowing students to write an essay showing how race or ethnicity affected their lives. But without guidelines or a standardized approach, admissions committee members' background, personal experiences, and biases could influence evaluations.Historically, Black Indigenous People of Color (BIPOC) have experienced residential segregation. Thus, they are products of poorly funded and understaffed K-12 schools. Grade point average and standardized tests scores are heavily weighted during the admissions process in higher education; however, these metrics largely reflect the attributes of K-12 schools and access to advanced placement and science, technology, engineering, math, and medicine (STEMM) courses. These courses are often lacking in schools with predominantly BIPOC students. We must continue to develop and support K-16 STEMM programs.Higher education institutions must respond to the Supreme Court ruling. Recruitment and retention strategies should encourage, guide, and support students who pursue health care careers. Enhanced admissions processes must include a standardized, unbiased approach in assessing personal essays and the lived experience. Admissions committees should complete implicit bias and cultural humility training. Support and allocation of funds must be provided to maintain training. Safeguards must ensure applicant and institutional legal compliance.

Purpose: Mental health screening is recommended by the US Preventive Services Task Force for all patients in areas where treatment options are available. Still, it is estimated that only 4% of primary care patients are screened for depression. The goal of this study was to evaluate the efficacy of machine learning technology (Kintsugi Voice, v1, Kintsugi Mindful Wellness, Inc) to detect and analyze voice biomarkers consistent with moderate to severe depression, potentially allowing for greater compliance with this critical primary care public health need.

Methods: We performed a cross-sectional study from February 1, 2021 to July 31, 2022 to examine ≥25 seconds of free-form speech content from English-speaking samples captured from 14,898 unique adults in the United States and Canada. Participants were recruited via social media, provided informed consent, and their voice biomarker results were compared with a self-reported Patient Health Questionnaire-9 (PHQ-9) at a cut-off score of 10 (moderate to severe depression).

Results: From as few as 25 seconds of free-form speech, machine learning technology was able to detect vocal characteristics consistent with an increased PHQ-9 ≥10, with a sensitivity of 71.3 (95% CI, 69.0-73.5) and a specificity of 73.5 (95% CI, 71.5-75.5).

Conclusions: Machine learning has potential utility in helping clinicians screen patients for moderate to severe depression. Further research is needed to measure the effectiveness of machine learning vocal detection and analysis technology in clinical deployment.

Purpose: Offering medication for opioid use disorder (MOUD) in primary care can increase access to effective opioid use disorder treatment and help address the US opioid crisis. We describe a primary care office-based opioid treatment program and addiction consultation service model designed to support small, rural clinics to increase their capacity for MOUD.

Methods: This is an evaluation of an intervention to increase clinic capacity to offer MOUD. The intervention consists of a standardized curriculum, addiction medicine consultants, practice facilitation, and financial incentives. Fifteen Colorado primary care practices participated from January 2022 through January 2023. Primary outcomes included overall change in the number of active buprenorphine prescriptions and implementation of MOUD milestones before and after the intervention.

Results: The mean number of active buprenorphine prescriptions in the 3 months preceding the intervention (baseline) increased from 2.1 (SD = 7.7) to 11.3 (SD = 11.2) at 13 months. Adjusted means from the Poisson model demonstrated significant improvement over time (P <.001). Mean implementation of MOUD milestones ranged from 23% to 40% at baseline and grew to 84% to 93% by the end of the program (P <.001).

Conclusions: This model supported primary care practices that were initially doing little to no MOUD prescribing, to prescribe at significantly higher levels by the end of the program. This scalable model for addiction consultation in primary care settings illustrates how education and support to clinical teams can help practices makes changes, especially those with limited MOUD experience.

Purpose: Family medicine research is essential to improving population health. It has the unique ability to answer questions about health care outcomes and use those insights to impact communities. Increasing research capacity continues to be a challenge; however, recent literature has touted the success of incentivization in several academic medicine specialties. We used the 2022 CERA annual Family Medicine Department Chair survey to characterize the amount and type of scholarly activities by institutional financial incentive status (yes or no) and type (flat vs variable amount), to investigate the relationship between financial incentives and scholarly output.

Methods: Questions included targeted demographic variables, institutional incentives, and family medicine department scholarly output. Summary statistics and logistical regression analyses were conducted.

Results: The overall survey response rate was 47.1% (106/225). Respondents reported financial incentives were allowed at 41 (38.7%) of 106 institutions. Of these, 19 (17.9%) reported clinical faculty received cash-based incentives, while 34 (32.1%) received noncash-based incentives for engaging in scholarly activity. The main barriers to offering financial incentives were institutional budget constraints and department culture or tradition. Financial incentives were not statistically associated with scholarly output; however, faculty size was statistically significant for giving more than 6 presentations (adjusted odds ratio = 0.20; 95% CI, 0.054-0.739).

Conclusions: Institutions aiming to increase their family medicine department scholarly productivity might benefit from focusing resources on increasing their faculty size such as adding consultants, statistical analysts, grant writers, or other research staff.

Purpose: People who are transgender or gender diverse (PTGD) often experience difficulties navigating the health care system due to a variety of factors such as lack of knowledgeable and/or culturally competent clinicians, discrimination, and structural and/or socioeconomic barriers. We sought to determine whether a peer health navigator service in the Canadian province of Saskatchewan helped connect transgender and gender-diverse clients and health care practitioners (HCPs) to resources, and how this service changed their health care experiences.

Methods: Semistructured interviews were conducted with 9 clients and 9 HCPs. Interview transcripts were then analyzed by researchers using an interpretative phenomenological approach, with qualitative data analysis software.

Results: The most prevalent theme that emerged from interview data, from both clients and HCPs, was support for the navigators' work and a desire that the service should continue. It was reinforced by 3 subthemes: the importance that the navigators were PTGD, the ability of the navigators to connect people to services and reliable sources of information, and their skill in directly supporting clients. A fourth subtheme, primarily found among clients, was the navigators' ability to provide connections to affirming mental health care.

Conclusions: Clients and HCPs alike emphasized that the navigator's lived experience was invaluable and allowed them to empathize with PTGD and provide support. Furthermore, the navigators acted as a direct connection to health care services, which helped improve access for clients. Our findings underscore the need for navigator positions to become permanent within the provincial health system to improve the health care experiences of PTGD in Saskatchewan.