Annals of Family Medicine最新文献

During the vulnerable, painful time around my diagnosis with a chronic illness, my physician shared with me a story from her own life. Her act of self-disclosure was profoundly impactful, reminding me that the gulf between myself and other people was not as vast as it felt. In this essay, I share my story and the conclusions I've drawn from it in the years since, using my tools as a philosopher and bioethicist. I explore what "patient-centered self-disclosure" might look like. I hope that these reflections might deepen our understanding of the intimacy and vulnerability of receiving medical care, and of the power of physician self-disclosure.

This narrative explores my experience as a family doctor deeply embedded in a rural community comprising 9 villages. The regional cemetery, a symbol of mortality, serves as a focal point for meditations on what it means to bear witness as a family doctor, depicting some of the joys and sorrows I have witnessed over the last quarter of a century serving this community. Grounded in the philosophy of "to cure-sometimes, to relieve-often, and to comfort-always," I underscore the importance of presence and compassion in family medicine, ultimately embracing mortality as a shared human journey that shapes both patients and their caregivers.

This study assessed changes in self-reported usual source of care (USC) across income groups and rural-urban settings after Affordable Care Act implementation, using 2010-2017 Medical Expenditure Panel Survey data. Multivariable regression estimated adjusted percentage changes in USC and reasons for lacking one. Usual source of care prevalence rose modestly (67% to 68%), with significant gains among low-income adults (+4.96% rural, +2.45% urban) and a small decline among urban high-income adults. Affordability-related barriers decreased, while accessibility and individual preference barriers increased. Findings suggest that insurance expansion alone may not ensure continuous care, especially given persistent non-financial access challenges.

Purpose: Outpatient antibiotic stewardship needs efficient strategies to remedy pervasive overuse. A claims-based measure of practice-specific antibiotic utilization in a Medicaid patient-centered medical home (PCMH) program was developed, implemented, and measured.

Methods: This observational study analyzed outpatient antibiotic paid claims attributed to PCMH panels during 2019, 2020, and 2021. Practices received quarterly antibiotic prescribing rate report cards, as paid claims per 1,000 patients per year which included specific performance in comparison to other PCMHs. We identified high-, middle-, and low-utilization sites at baseline and then tracked prescribing during the observation period. Arkansas Medicaid data were compared with all-payer state and national data measured by the IQVIA and published annually by the Centers for Disease Control and Prevention.

Results: In 2019, 176 of 216 PCMH sites met inclusion criteria. Cohort prescription rates were 1,089 in 2019, 785 in 2020, and 853 in 2021. Arkansas IQVIA all-payer rates for years 2019, 2020, and 2021 were 1,028, 844, and 927, while national IQVIA rates were lower at 765, 613, and 636, respectively. The Arkansas PCMH practice prescription rates in 2019 ranged from 720 to 1,491. By 2021, the range was 564 to 1,140. PCMH data showed reduced antibiotic prescribing in 2021 vs 2019 compared with national and state-specific IQVIA all-payer data analysis.

Conclusions: Analysis of antibiotic prescriptions per 1,000 patients at the practice level is feasible. Regular report cards to PCMHs were associated with reduced prescribing rates in 2021 relative to IQVIA national and state data.

My passion for geriatric medicine was inspired by the compassionate care I witnessed in my grandfather's clinic in Vijayanagar, Bangalore, India. His integral, empathetic approach to treating older adults profoundly shaped my own practice as a physician. This reflection explores pivotal moments in my journey to becoming a geriatrician, from my encounters with my grandfather's patients to applying his methods of sincere listening. Through this lens, I examine the challenges and rewards of maintaining empathy within the constraints of modern health care, while emphasizing the importance of preserving human connection.