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We extracted electronic health record data for individuals aged >45 years with COPD from a data repository. The prevalent cohort required a diagnosis of COPD any time during the observation period, and the inception cohort required a diagnosis of COPD made after entry into the database. A composite outcome of any new diagnosis of type 2 diabetes, cataracts, pneumonia, osteoporosis, or nontraumatic fracture; and recurrent event outcomes of repeated pneumonia or nontraumatic fracture were compared for long-term (>24 months) vs short-term (<4 months) ICS exposure.

We assessed outcomes for 318,385 and 209,062 individuals in the prevalent and inception cohorts, respectively. The composite dichotomous outcome was significantly greater for long-term vs short-term ICS use for the prevalent (hazard ratio [HR] = 2.65; 95% CI, 2.62-2.68; P <.001) and inception (HR = 2.60; 95% CI, 2.56-2.64; P <.001) cohorts. For the inception cohort, the absolute risk difference of the composite outcome was 20.26% (29.41% minus 9.15%), with a number needed to harm of 5. Hazard ratios were significantly increased in the prevalent and inception cohorts for recurrent pneumonia (HR = 2.88; 95% CI, 2.62-3.16; P <.001 and HR = 2.85; 95% CI, 2.53-3.22; P <.001, respectively) and recurrent fracture (HR = 1.77; 95% CI, 1.42-2.21; P <.001 and HR = 1.57; 95% CI, 1.20-2.06; P <.001).

Long-term ICS use for COPD is associated with significantly greater rates of the composite outcome of type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fracture; recurrent pneumonia; and recurrent fracture.

We used electronic health records from the PRIME registry to identify patients with diagnosis codes or positive test results for chlamydia and/or gonorrhea from 2018 to 2022. Outcomes were the first dates of antibiotic administered within 30 days after a positive test result for the infection. Descriptive statistics were calculated for patient sociodemographic characteristics. We used a multivariate parametric accelerated failure time analysis with shared frailty modeling to assess associations between these characteristics and time to treatment.

We identified 6,678 cases of chlamydia confirmed by a positive test and 2,206 cases of gonorrhea confirmed by a positive test; 75.3% and 69.6% of these cases, respectively, were treated. Females, individuals aged 10-29 years, suburban dwellers, and patients with chlamydia-gonorrhea coinfection had higher treatment rates than comparator groups. Chlamydia was infrequently treated with the recommended antibiotic, doxycycline (14.0% of cases), and gonorrhea was infrequently treated with the recommended antibiotic, ceftriaxone (38.7% of cases). Time to treatment of chlamydia was longer for patients aged 50-59 years (time ratio relative to those aged 20-29 years = 1.61; 95% CI, 1.12-2.30) and for non-Hispanic Black patients (time ratio relative to White patients = 1.17; 95% CI, 1.04-1.33).

Guideline adherence remains suboptimal for chlamydia and gonorrhea treatment across primary care practices. Efforts are needed to develop interventions to improve quality of care for these sexually transmitted infections.

We conducted a feasibility study to build a conversation tool, guided by principles of shared decision making, called the "About Me" Care Card. Informed by an environmental scan, we created and pilot-tested prototypes at implementation sites. All phases were overseen by a multidisciplinary steering committee.

Fourteen diverse clinicians consisting of 7 clinician types across 7 institutions piloted the card during in-person visits or by telephone. Observations showed that the card (1) allowed time to elicit what matters most to patients, (2) created space for personalized care conversations, (3) opened an examination of social care needs, and (4) moderated emotional relationships between families and individuals.

A community-based codesign process led to a feasible tool for primary care teams to facilitate whole-person conversations with aging adults. The About Me Care Card appeared to broaden conversations compared with routine care. More work is needed to determine scalability and effects on outcomes.

We conducted a scoping review in adherence to the Joanna Briggs Institute’s methodologic framework. Our search of 4 databases—PubMed, Scopus, CINAHL Plus with Full Text, and PsycINFO—used controlled vocabulary and key word terms related to SDM in the care of racially and/or ethnically diverse adults in the primary care setting. We included peer-reviewed studies conducted in the United States or Canada that evaluated the process of decision making and that had populations in which more than 50% of patients were from racial and/or ethnic minorities. Unique records were uploaded to a screening platform for independent review by 2 team members. We used grounded theory to guide our inductive approach and completed a thematic analysis.

A total of 39 studies met all inclusion criteria. We identified 5 overarching themes: (1) factors regarding the decision-making process during the clinical encounter, (2) clinician practice characteristics, (3) trust in the clinician/health care system, (4) cultural congruence between clinician and patient, and (5) extrinsic factors affecting the decision-making process. Barriers of SDM included cultural and language discordance; prejudice, bias, and stereotypes; mistrust; and clinician time constraints. Facilitators of SDM included cultural concordance between clinician and patient; clinician language competence; and clear, honest, and humanistic communication with patients having the ability to ask questions.

We identified a set of potentially modifiable factors that facilitate or impede SDM. Our findings can help inform strategies and interventions to improve SDM among racially and/or ethnically diverse patient populations.

We conducted semistructured interviews with 15 primary care physicians, 12 nurses, 15 administrative staff, and 4 pharmacists at 12 clinics; one-half characterized as high-TR clinics where patients had regular follow-ups, and the other as low-TR clinics. Interviews were audiotaped, transcribed, and coded using Atlas qualitative data analysis software (Lumivero, LLC).

Themes emerged regarding best ways to promote regular follow-up of patients with chronic conditions. These strategies included having a system to encourage follow-up (beginning with administrative staff reaching out to patients and ending with recruiting the help of patients’ family members), routine staff meetings, adaptive workflow, dealing with bureaucracy on patients’ behalf, informal channels of communication with patients, and consulting social workers. Clinics with more regular follow-up emphasized teamwork, a peaceful approach toward challenging patients, and flat as opposed to hierarchical organizational structures for personal relationships among staff.

Teamwork between staff members in primary care settings can contribute to more proactive care delivery, with greater potential to prevent long-term complications. The findings suggest that a high-functioning multidisciplinary care team that focuses on creating the right sorts of interactions and teamwork among members of the staff can contribute to engaging patients more effectively.

We conducted an open label, cluster randomized controlled trial (ClinicalTrials.gov NCT02771873) with families serving as the unit of intervention. Families were randomly assigned via computer-generated numbers to receive either the comprehensive package of interventions or enhanced usual care in a 1:1 ratio. Nonphysician health workers delivered the comprehensive package of interventions, which included annual screening for cardiovascular risk factors, structured lifestyle modification sessions, referral to a primary health care facility for individuals with established risk factors, and active follow-up to evaluate self-care adherence. Weight, body mass index (BMI), and waist circumference were measured at baseline, 1 year, and 2 years to assess the intervention’s effect on weight management. We used a generalized estimating equation model to analyze the between-group population average changes in these anthropometric parameters.

In total, 1,671 participants (1,111 women) from 750 families participated. The mean age of the study population was 40.8 (SD = 14.2) years. The attrition rate at the 2-year follow-up was 3%. The adjusted population average change attributable to the intervention at the 2-year follow-up were –2.61 kg in weight (95% CI, –3.95 to –1.26; P <.001), –1.06 kg/m² in BMI (95% CI, –1.55 to –0.58; P <.001), and –4.17 cm in waist circumference (95% CI, –5.38 to –2.96; P <.001).

The reduction in weight achieved in the family-based intervention could have a substantial public health impact in preventing future diabetes and other noncommunicable disease conditions.

We used results from the Longitudinal Occupational Health survey in Healthcare Sweden with data collected in 2021, 2022, and 2023. The sample of primary care physicians who answered at all 3 years and were aged 68 or less was 433. Performance-based reimbursement was measured using a single item. The Bern Illegitimate Tasks Scale measured illegitimate tasks, and moral distress was measured with a 10-item scale. Six items from the English National Health Staff Survey were used to measure the quality of individual and organizational care.

Of the 433 participants, 70% reported that PBR negatively impacted their work. Performance-based reimbursement was negatively associated with illegitimate tasks (b = –0.160; 95% CI, –0.240 to –0.080) and moral distress (b = –0.134; 95% CI, –0.210 to –0.058). These work factors were in turn associated with both individual and organizational quality of care. Using mediation models, we found an indirect effect (b = 0.011; 95% CI, 0.004 to 0.021) but no direct effect (b = 0.062; 95% CI, –0.019 to 0.143) between PBR on the quality of individual care.

Performance-based reimbursement systems should account for the experience of individual primary care physicians to ensure effective, safe, and quality care, as this study shows how the level of illegitimate tasks and moral distress due to a PBR system can undermine care delivery. Consequently, it is imperative for stakeholders to consider how health care systems relate to the health care staff’s experience, well-being, and the care being provided.

Our cross-sectional online survey asked patients about their primary care clinics, PCP, portal use, self-reported health, and demographics. For multivariate analysis, we used weighted logistic regression analysis with survey data to calculate maximum likelihood estimates and converted these to odds ratios. We controlled for age and self-reported health as continuous variables and for demographics as categorical variables.

We surveyed 4,795 adult patients and received responses from 2,516 (52.5%). More than one-half of patients preferred to see only their PCP for an annual checkup (52.6%), follow-up of a chronic condition (54.6%), or follow-up for a mental health condition (56.8%). Similarly, the majority of patients preferred to wait 3 to 4 weeks to see their PCP for issues possibly requiring a sensitive examination (68.2%), a new mental health concern (58.9%), or a new concern about a chronic condition (61.1%).

Our findings show that patients value having a PCP and maintaining continuity with their PCP. They also provide insight on when patients would prefer to wait to see their own PCP vs being seen more quickly by another clinician. As health care delivery and scheduling continue to evolve, these findings provide guidance for leaders in primary care.