Annals of Family Medicine最新文献

Purpose: Mutual trust is a critical component of the physician-patient relationship, and although much research has examined patient trust in the physician, little attention has been given to the physician's trust in the patient in the general practice setting. This study explored general practitioners' (GPs') understanding of trust in their patients.

Methods: We conducted a qualitative study using semistructured telephone interviews with a convenience sample of Australian GPs mostly from metropolitan New South Wales, focused on how the GPs understood trust in their patients, how such trust developed, and its implications for medical care. Interviews were audio recorded, transcribed verbatim, verified, and de-identified before thematic analysis.

Results: Qualitative analysis was based on interviews with 25 GPs. We identified 3 main themes pertaining to GPs' trust in their patients: (1) trusting patients is an assumed starting point, (2) trust in patients then deepens and develops over time as part of a mutual trusting therapeutic relationship, and (3) trust in their patients is challenged when patients are perceived to be manipulating the relationship for secondary gain.

Conclusions: Our study shows that GPs understand a therapeutic relationship with a patient begins by trusting what their patients say, then develops as their patients become more actively involved in their own management. GPs need support in building mutually trusting relationships, especially in patients with complex care needs.

In this perspective piece, I explore an incredibly challenging year of my life: the year I lost joy in medicine. It was unexpected, yet not unsurprising, for me to feel this way given the seismic changes that occurred in my department: multiple leadership transitions, a pandemic, and significant faculty attrition. I wanted my clinical work to be enough to sustain me when I had lost academic mentorship and sponsorship, but the dysfunctional environment leached the joy out of my work and caused me to contemplate leaving my institution and leaving medicine altogether. Ultimately, several changes occurred that caused me to remain at my institution and helped me to regain my joy in the practice of medicine. My experience informed my understanding that small but significant shifts in compensation, schedules, and administrative work can help retain physicians. As we contemplate a shortage of physicians, institutions need to focus on acknowledging physicians for our work and rebuilding joy into our careers.

Home Health Focus is a new publicly available data set representing home health utilization by Medicare beneficiaries, aggregated annually at the home health agency, county, and state levels from 2016 to 2019. This data can be used by anyone interested in trends of Medicare home health users, both locally and nationally. We describe the creation of the cohorts of home health users, including over 6 million home health stays from 5 million Medicare beneficiaries. We also provide examples of potential research questions using these data sets.

We aimed to assess family doctors' readiness toward artificial intelligence (AI) in health care. We conducted a descriptive study using snowball sampling, targeting young family doctors. We administered a web-based questionnaire incorporating the validated medical AI readiness scale (MAIRS) via digital networks. A total of 134 participants from 20 European countries were included. MAIRS scores reflected variable readiness levels, with a median total of 69 of 110. Participants' readiness for AI increased significantly with their knowledge of its current applications and knowledge of AI usage in health care (P < .001, P = .013, respectively). The limited AI readiness highlights the need for tailored training and collaboration to support effective integration into primary care. Limitations of this study include sampling bias, small sample size, and lack of formal power analysis.

Latinos face significant health disparities, particularly concerning chronic conditions such as cardiovascular disease, diabetes, asthma, and cancer. Primary care plays a critical role in managing and preventing chronic diseases, yet Latinos face multiple barriers to accessing quality care, including uninsurance, employment environments without health care benefits, systemic discrimination, and increased social risks. To address the intersection of these complex topics, the Primary Care Latino Equity Research (PRIMER) Center convened the second annual Latino Primary Care Summit, focused on this theme, "Chronic Conditions in Latinos: Trends, Innovations and Care for the Future" in April 2024. The Summit consisted of 7 expert presentations with breakout discussion groups and discussant commentary to the entire Summit group. Nine key themes were identified from presentation content, and from notes taken at each small group discussion. Themes included: (1) social factors such as economics, political power, and advocacy, (2) Latino narratives, (3) characteristics and unique experiences of Latinos, (4) Latino subgroups, (5) family/aging/generational differences, (6) health care workforce limitations and transformation, (7) primary care approaches, systems, and quality for Latinos, (8) technology, artificial intelligence (AI), and telemedicine, and (9) trauma across the life course. From these discussions, we offer the following recommendations to the US health services and primary care research community, in order to generate knowledge that will positively impact the outcomes of chronic conditions in Latinos in the United States. By addressing these multifaceted issues with comprehensive and culturally aware strategies, primary care can significantly improve chronic care delivery for Latino patients.

Purpose: Reducing potentially preventable hospitalization (PPH), also known as ambulatory care-senstive conditions, is a global concern. This study linked data from Sax Institute's 45 and Up Study on individuals aged 45 years and older from New South Wales, Australia, with Australian Medicare claims data to establish a causal relationship between continuity of care and acute PPH using a double machine learning model.

Methods: We utilized 11 years of linked data (2007-2017) to analyze the impact of continuity of care on acute PPH, controlling for key patient characteristics (ie, age, multimorbidity status, cultural diversity, sex, education level, psychological status, physical limitation, smoking status, socioeconomic deciles). Estimation was done using a double machine learning technique with 4 algorithms (ie, least absolute shrinkage and selection operator, random forest, extreme gradient boosting, artificial neural network) to ensure robustness.

Results: Among 54,376 participants, 27,634 individuals (50.8%) experienced at least 1 acute PPH episode during the 11-year study period. Our findings indicate that even a slight improvement in continuity of care can reduce the incidence of acute PPH compared with non-acute PPH. For example, the reduction in the probability of acute PPH compared with non-acute PPH ranges from 9.8% (95% CI, 1.1%-17.8%) to 23.5% (95% CI, 14.1%-32.4%) across 4 models when continuity of care increases from the 45th percentile (0.274) to the 50th percentile (0.301).

Conclusion: Continuity of care at the primary level plays a key role in reducing acute PPH. Policies focused on person-centered or integrated care should include initiatives to promote continuity of care and support general practitioners in improving continuity of care.The authors of this article have provided Hindi and Vietnamese translations of the abstract.

Purpose: Language-concordant and professional interpreter-mediated care improve health outcomes, but clinics often lack resources to meet these needs. We developed and tested a replicable process to train heritage Spanish-speaking employees as qualified dual-role interpreters.

Methods: Our interdisciplinary team conducted a single-group, pretest-post-test study in a community health center. Participants (137 individuals) completed a demographic survey, a self-assessment of Spanish proficiency, a formal oral proficiency test of general Spanish, a 40-hour online medical interpreter course, and pre- and post-training interpretation assessments. We used a multivariate regression analysis, Spearman's rank-order correlation, and paired t-tests to analyze the results.

Results: Of 137 enrolled, 87 completed training and post-assessment. Heritage speakers had limited ability to predict their general Spanish proficiency (β = .14, P = .003; ρ = .258, P = .003). No self-reported variables predicted baseline medical interpretation skills. After training, mean interpretation scores improved significantly (pretest 7.34 vs posttest 8.46; t(87) = 7.51, P <.001). Higher general oral proficiency predicted higher interpreting post-test scores (β = .31, P <.001; ρ = .486, P <.001), and those with lower proficiency were more likely to drop out. Overall, 72% (63/87) of participants who completed training achieved qualified interpreter status.

Conclusions: An affordable, online training program can effectively prepare heritage Spanish-speaking clinic employees to be qualified interpreters. Clinics can use this approach to meet federal language access standards and address health disparities.Abstract also available in French, Spanish, and German.

Purpose: There is limited literature and guidance on the care of adopted patients in the medical setting beyond childhood. We examined the health care challenges faced by adults who were adopted as children and the perceived impact on the patient-clinician relationship.

Methods: We administered a mixed-methods online survey to US adult adoptees examining perception of how adoptee status impacts their health care interactions. Quantitative data were analyzed descriptively and with a multivariate logistic regression model to assess associations between adoption-related health care experiences and care-seeking behaviors. Qualitative data were analyzed and organized thematically into 5 major themes.

Results: Analyses were based on 204 adults adopted in childhood. The majority reported that their medical professionals had gaps in their knowledge about adoption, especially regarding how limited family medical history can contribute to negative health outcomes. Most participants perceived multiple distinct types of adoption-related discrimination by clinicians. Those who experienced these negative interactions sometimes or more often had greater than 7 times the adjusted odds of delaying care or changing clinicians when compared with adoptees who experienced this discrimination rarely or not at all.

Conclusions: In this exploratory study, we found that adoptees perceive medical professionals' lack of knowledge of the health implications of adoption as detrimental to their care and as undermining the patient-clinician relationship. Our findings suggest that adoption is both an experience and a potential identity with health implications that clinicians should be prepared to recognize and address.