Shannon Kelleher, Maura Powell, Alexander K Gonzalez, Shukai Cheng, Nicole Koepke, Elizabeth A Walshe, Jamillah Millner, Joshua C Fischer, Colleen M Schlotter, Flaura K Winston, Alexander G Fiks
{"title":"Testing a New Care Model: Implementing a Virtual Driving Assessment in Primary Care.","authors":"Shannon Kelleher, Maura Powell, Alexander K Gonzalez, Shukai Cheng, Nicole Koepke, Elizabeth A Walshe, Jamillah Millner, Joshua C Fischer, Colleen M Schlotter, Flaura K Winston, Alexander G Fiks","doi":"10.1370/afm.3138","DOIUrl":"10.1370/afm.3138","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing the Science of Family Medicine.","authors":"Jon Salsberg","doi":"10.1370/afm.3159","DOIUrl":"10.1370/afm.3159","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Timothy Aaron Zeller, Parker A Rhoden, Catherine Florio Pipas
Modern measures of physician value are couched in terms of productivity, volume, finance, outcomes, cure rates, and acquisition of an increasingly vast knowledge base. This inherently feeds burnout and imposter syndrome as physicians experience an inability to measure up to unrealistic standards set externally and perceived internally. Ancient and modern wisdom suggests that where populations fail to flourish, at root is a failure to grasp a vision or true purpose. Traditional philosophical conceptions of a physician's purpose center around compassion, empathy, and humanism, which are a key to thwarting burnout and recovering professional satisfaction. New compassion-based metrics are urgently needed and will positively impact physician well-being and improve population health.
{"title":"What Are Doctors For? A Call for Compassion-Based Metrics as a Measure of Physician Value.","authors":"Timothy Aaron Zeller, Parker A Rhoden, Catherine Florio Pipas","doi":"10.1370/afm.3132","DOIUrl":"10.1370/afm.3132","url":null,"abstract":"<p><p>Modern measures of physician value are couched in terms of productivity, volume, finance, outcomes, cure rates, and acquisition of an increasingly vast knowledge base. This inherently feeds burnout and imposter syndrome as physicians experience an inability to measure up to unrealistic standards set externally and perceived internally. Ancient and modern wisdom suggests that where populations fail to flourish, at root is a failure to grasp a vision or true purpose. Traditional philosophical conceptions of a physician's purpose center around compassion, empathy, and humanism, which are a key to thwarting burnout and recovering professional satisfaction. New compassion-based metrics are urgently needed and will positively impact physician well-being and improve population health.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Yun, Spencer Schell, Kevin Gulley, Michael E Johansen
{"title":"Dilation Before Automated Diabetic Retinopathy Screening Performed in the Primary Care Setting.","authors":"Jonathan Yun, Spencer Schell, Kevin Gulley, Michael E Johansen","doi":"10.1370/afm.3133","DOIUrl":"10.1370/afm.3133","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Liu, Vishal R Patel, Sahil Sandhu, Sari Reisner, Alex S Keuroghlian
Sexual and gender minority (SGM) adults experience poor health outcomes, in part due to frequent avoidance of necessary health care. Little is known, however, about factors contributing to patterns of health care utilization in this population. Using national data from the All of Us Research Program, this study evaluated the prevalence of care avoidance due to patient-clinician identity discordance (PCID) and its association with health care discrimination among SGM adults. Sexual minority (20.0% vs 9.4%; adjusted rate ratio [aRR] = 1.58; 95% CI, 1.49-1.67, P <0.001) and gender minority adults (34.4% vs 10.3%; aRR = 2.00; 95% CI, 1.79-2.21, P <0.001) were significantly more likely than their non-SGM counterparts to report care avoidance due to PCID. Exposure to health care discrimination was also more prevalent in this population and was dose-dependently associated with significantly higher rates of PCID-based care avoidance. Study findings highlight the importance of diversifying the health care workforce, expanding SGM-related clinical training, and preventing health care discrimination against SGM patients.
性与性别少数群体(SGM)成年人的健康状况较差,部分原因是他们经常逃避必要的医疗保健。然而,人们对导致这一人群利用医疗保健模式的因素知之甚少。本研究利用 "我们所有人研究计划"(All of Us Research Program)的全国性数据,评估了性少数群体成人中因患者与医生身份不一致(PCID)而避免就医的普遍程度及其与医疗歧视之间的关联。性少数群体(20.0% vs 9.4%;调整后比率比 [aRR] = 1.58;95% CI,1.49-1.67,P P
{"title":"Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults.","authors":"Michael Liu, Vishal R Patel, Sahil Sandhu, Sari Reisner, Alex S Keuroghlian","doi":"10.1370/afm.3130","DOIUrl":"10.1370/afm.3130","url":null,"abstract":"<p><p>Sexual and gender minority (SGM) adults experience poor health outcomes, in part due to frequent avoidance of necessary health care. Little is known, however, about factors contributing to patterns of health care utilization in this population. Using national data from the All of Us Research Program, this study evaluated the prevalence of care avoidance due to patient-clinician identity discordance (PCID) and its association with health care discrimination among SGM adults. Sexual minority (20.0% vs 9.4%; adjusted rate ratio [aRR] = 1.58; 95% CI, 1.49-1.67, <i>P</i> <0.001) and gender minority adults (34.4% vs 10.3%; aRR = 2.00; 95% CI, 1.79-2.21, <i>P</i> <0.001) were significantly more likely than their non-SGM counterparts to report care avoidance due to PCID. Exposure to health care discrimination was also more prevalent in this population and was dose-dependently associated with significantly higher rates of PCID-based care avoidance. Study findings highlight the importance of diversifying the health care workforce, expanding SGM-related clinical training, and preventing health care discrimination against SGM patients.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction.","authors":"","doi":"10.1370/afm.3153","DOIUrl":"10.1370/afm.3153","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cleavon Covington, Elisha Jackson, Kendall M Campbell, Judy C Washington, José E Rodríguez
{"title":"Stop Testing Black Babies!","authors":"Cleavon Covington, Elisha Jackson, Kendall M Campbell, Judy C Washington, José E Rodríguez","doi":"10.1370/afm.3143","DOIUrl":"10.1370/afm.3143","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Talitha Schut, Bernard van de Meeberg, Peter Lucassen, Rebecca S Etz, Maria van den Muijsenbergh, Reinier P Akkermans, Tim Olde Hartman
Purpose: Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care.
Methods: We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch-speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care.
Results: Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's α were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's ρ = 0.65, P <.001), indicating good convergent validity.
Conclusion: The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy.
{"title":"Dutch Translation and Psychometric Evaluation of the Person-Centered Primary Care Measure.","authors":"Talitha Schut, Bernard van de Meeberg, Peter Lucassen, Rebecca S Etz, Maria van den Muijsenbergh, Reinier P Akkermans, Tim Olde Hartman","doi":"10.1370/afm.3135","DOIUrl":"10.1370/afm.3135","url":null,"abstract":"<p><strong>Purpose: </strong>Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care.</p><p><strong>Methods: </strong>We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch-speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care.</p><p><strong>Results: </strong>Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's α were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's ρ = 0.65, <i>P</i> <.001), indicating good convergent validity.</p><p><strong>Conclusion: </strong>The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carol Shetty, Lauren Oshman, Amanda Costa, Victoria Waidley, Emily Madlambayan, Madgean Joassaint, Katharine McCabe, Courtney Townsel, Justine P Wu, Christopher J Frank, P Paul Chandanabhumma
Purpose: Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices.
Methods: We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis.
Results: We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making.
Conclusion: Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.
{"title":"Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.","authors":"Carol Shetty, Lauren Oshman, Amanda Costa, Victoria Waidley, Emily Madlambayan, Madgean Joassaint, Katharine McCabe, Courtney Townsel, Justine P Wu, Christopher J Frank, P Paul Chandanabhumma","doi":"10.1370/afm.3139","DOIUrl":"10.1370/afm.3139","url":null,"abstract":"<p><strong>Purpose: </strong>Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices.</p><p><strong>Methods: </strong>We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis.</p><p><strong>Results: </strong>We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making.</p><p><strong>Conclusion: </strong>Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Action Guides Offer Steps Toward Health Equity.","authors":"News Staff","doi":"10.1370/afm.3155","DOIUrl":"10.1370/afm.3155","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}