Family Medicine Care Research Articles

Evaluating the Effectiveness of Innovative Models of Care in Family Medicine: A Comparative Analysis of Health Outcomes and Patient Satisfaction

Medical care in the context of family medicine has evolved with the implementation of innovative models that seek to improve health outcomes and patient satisfaction. This study evaluated the effectiveness of these models through a comparative analysis of health outcomes and patient satisfaction levels in different contexts. A comparative observational study was conducted with 200 participants divided between those who received traditional care and those under innovative models. The results indicated significant improvements in patient satisfaction and in several health indicators in the innovative models. This study suggests that the implementation of new models of care can be an effective strategy to improve care in family medicine.

Setting the Target: Comparing Family Medicine Among US Allopathic Target Schools.

Despite the persistent primary care physician shortage over 2 decades of allopathic medical school expansion, some medical schools are absent a department of family medicine; these schools are designated as "target" schools. These absences are important because evidence has demonstrated the association between structured exposure to family medicine during medical school and the proportion of students who ultimately select a career in family medicine. In this study, we aimed to address part of this gap by defining and characterizing the current landscape of US allopathic target schools. We identified allopathic target schools by reviewing all Liaison Committee of Medical Education (LCME) accredited institutions for the presence of a family medicine department. To compare these schools in terms of family medicine representation and outcomes, we curated descriptive data from publicly available websites, previously published family medicine match results, and school rankings for primary care. We identified 12 target schools (8.7% of all US allopathic accredited medical schools) with considerable heterogeneity in opportunities for family medicine engagement, leadership, and training. Target schools with greater family medicine representation had increased outcomes for family medicine workforce and primary care opportunities. With growing primary care workforce gaps, target schools have a responsibility to enhance family medicine presence and representation at their institutions. We provide recommendations at the institutional, specialty, and national level to increase family medicine representation at target schools, with the goal that all schools eventually establish a department of family medicine.

Research to Improve Clinical Care in Family Medicine: Big Data, Telehealth, Artificial Intelligence, and More.

This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?

Residents, welcome to a career in family medicine.

Residents, welcome to a career in family medicine.

We Cannot Put This Genie Back in the Bottle: Qualitative Interview Study Among Family Medicine Providers About Their Experiences With Virtual Visits During the COVID-19 Pandemic.

When a genie is freed from its bottle, things cannot be restored to the way they were before. At the beginning of the global COVID-19 pandemic, health care systems adjusted how they delivered care overnight. Primary care practices switched from seeing patients in person to virtual care applications, including video and phone visits, e-visits, e-consults, and messaging with clinicians. Prior to the pandemic, these applications were not as widely used, but discussions around their advantages and disadvantages in some settings were being explored. Emergency regulatory changes spurred by the pandemic freed this virtual care "genie" from its bottle. Wide-scale adoption of virtual care in family medicine has much potential, as primary care services are often a patient's first point of contact with the health care system. This study aims to analyze family medicine providers' experiences using virtual visits during the pandemic, perceived outcomes of the shift to virtual visits, and discusses its implications for the future of family medicine. This qualitative study took place at 3 academic primary care clinics between June and December 2020. Data were collected through one-on-one Zoom (version 5.2.1) interviews with family medicine clinical faculty who experienced the rapid transition of in-person visits to mostly "virtual" visits. The interviews were recorded, deidentified, and transcribed. We adopted a constructivist approach to qualitative content analysis to evaluate the results. In total, 25 participants were eligible, and 20 individuals participated in this study (80% participation rate). The mean age was 43.4 years, and 85% (17/20) of the participants were female. We identified 3 main themes: the care process, patient engagement, and team-based care. This study highlights the transition from in-person to virtual visits during the pandemic from the perspective of family medicine providers. Generally, family medicine providers' perceptions of the shift to virtual visits were positive, especially regarding team-based care. Challenges involved virtual inhibition, particularly for providers. Providers described ways they integrated virtual care with aspects of in-person care, creating a hybrid environment. The genie is out of the bottle-things will not be the same-but family medicine now has the opportunity to evolve.

Are Student Attitudes Toward Family Medicine Research Associated With Family Medicine Career Choice at the Individual Level?

Are Student Attitudes Toward Family Medicine Research Associated With Family Medicine Career Choice at the Individual Level?

Associations of the Informal Curriculum and Student Perceptions of Research With Family Medicine Career Choice.

The United States is facing a primary care physician shortage that is predicted to continue through the next decade. Determining why graduating medical students pursue a career in family medicine may inform efforts to help address this shortage. Medical student responses to the Family Medicine Attitudes Questionnaire (FMAQ), a 14-item validated questionnaire developed to assess student attitudes toward family medicine, were collected at 16 US medical schools and compared to each institution's proportion of graduates entering family medicine. We also analyzed subscales of the FMAQ, including attitudes toward family medicine lifestyle, research, importance, and shortages, with respect to student choice of family medicine. We used Pearson coefficients to calculate correlations. Student attitudes toward family medicine careers were strongly correlated with an institution's proportion of graduates entering family medicine. Positive perceptions of family medicine research by students was the factor most strongly correlated with matching into a family medicine residency. Strengthening students' exposures and perceptions of family medicine and family medicine research may create viable opportunities for intervention by departments of family medicine and medical schools seeking to increase the number of graduates entering family medicine.

New models of care in family medicine

The future of primary care structures will be interprofessional or it will not be! Beyond this somewhat provocative statement, this is, in fact, a transformation that is already on the way in Western countries. This article describes developments in different countries, such as the United States, where Patient-Centered Medical Homes, based on multi-professional teams, have been developing since the 2000s, and Canada, where the evolution of financial models is accompanying that of organizational models. In Europe, two examples of integration of the health and social domains highlight the relevance of such an approach in primary care.

Perceived Impact of Virtual Visits on Access to Care in Family Medicine During the COVID-19 Pandemic: A Qualitative Study of Benefits and Challenges.

The COVID-19 pandemic in 2020 led to the rapid adoption of telemedicine, including virtual visits, to minimize face-to-face contact between clinicians and patients. Family medicine clinics across the nation had to transform how they provided primary care while maintaining the core values of family medicine. The objective of this study was to analyze how family medicine faculty perceived the impact of virtual visits on patient access to care. This qualitative study took place in an academic primary care setting. We interviewed clinical faculty who utilized virtual visits about their experiences from June to December 2020. We used qualitative content analysis to evaluate the results of the interviews. The study included a total of 20 participants. The mean age was 43.4 years, and 85% of participants were female. Researchers developed 3 themes, "Logistics of virtual visits," "reigniting the concept of home visits," and "barriers and benefits that affect specific patient populations" that describe how virtual visits have impacted patients' access to care. The results highlight how virtual visits improve access to care by increasing flexibility for patients and providers and provide a new perspective into a patient's home life. Challenges of virtual visits include language barriers, technological issues, and issues unique to vulnerable patient populations. Virtual visits can enhance family medicine's ability to provide accessible care, but there are concerns it may worsen health disparities. Further research and quality improvement projects are needed to examine ways to implement innovative care delivery solutions to avoid further exacerbating these disparities.

Influences on Family Medicine Career Choice: Implications for Healthcare Development

Influences on Family Medicine Career Choice: Implications for Healthcare Development

Multi-stakeholder validation of entrustable professional activities for a family medicine care of the elderly residency program: A focus group study

ABSTRACT Entrustable Professional Activities (EPAs) have become widely used within Competency-Based Medical Education (CBME) for the training and evaluation of residents. Little is known about the effectiveness of incorporating multiple stakeholder groups in the validation of EPAs. Here, we seek to validate an EPA framework developed for the University of Manitoba Care of the Elderly Enhanced Skills program using online focus groups consisting of five stakeholder groups. Participants were recruited to take part in one of five online focus groups, one for each stakeholder group (physician faculty, residents, non-physician healthcare professionals, administrators/managers, and patients). Each group met one time for 90 minutes over ZOOM®. The themes arising from stakeholder feedback suggest that successful EPAs must neither be too specific nor too expansive in scope, clearly delineate appropriate means of evaluation, and indicate specific clinical settings in which each EPA should be evaluated. Cross-cutting themes included requiring trainees to collaborate with other professionals when it would optimize patient care, and preparing trainees to advocate for their patients’ health (Advocacy). The present study demonstrates that multi-stakeholder analysis yields diverse feedback that can help make EPAs more clear, easier to use in evaluation, and more socially accountable.

The impact of role modelling on the future general practitioner workforce: a systematic review

ABSTRACT Role modelling has been identified as an important phenomenon in medical education. Key reports have highlighted the ability of role modelling to support medical students towards careers in family medicine although the literature of specific relevance to role modelling in speciality has not been systematically explored. This systematic review aimed to fill this evidence gap by assimilating the worldwide literature on the impact of role modelling on the future general practitioner (GP) workforce. A systematic search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane, ERIC and CINAHL, and all authors were involved in the article screening process. A review protocol determined those articles selected for inclusion, which were then quality assessed, coded and thematically analysed. Forty-six articles were included which generated four broad themes: the identity of role models in general practice, role modelling and becoming a doctor, the impact of role modelling on attitudes towards the speciality, and the subsequent influence on behaviours/career choice. Our systematic review confirmed that role modelling in both primary and secondary care has a crucial impact on the future GP workforce, with the potential to shape perceptions, to attract and deter individuals from the career, and to support their development as professionals. Role modelling must be consciously employed and supported as an educational strategy to facilitate the training of future GPs.

The Impact of Family Medicine Interest Groups and Student-Run Free Clinics on Primary Care Career Choice: A Narrative Synthesis

Student-directed activities such as family medicine interest groups (FMIG) and student-run free clinics (SRFC) have been examined to discover their impact on entry into family medicine and primary care. The objective of this review was to synthesize study results to better incorporate and optimize these activities to support family medicine and primary care choice. We conducted a comprehensive literature search using PubMed, Scopus, and CINAHL to identify all English-language research articles on FMIG and SRFC. We examined how participation relates to entry into family medicine and primary care specialties. Exclusion criteria were nonresearch articles, review articles, and research conducted outside the United States, Canada, Australia, and New Zealand. We used a 16-point quality rubric to evaluate 18 (11 FMIG, seven SRFC) articles that met our criteria. Of the nine articles that examined whether FMIG participation impacted entry into family medicine, five papers noted a positive relationship, one paper noted unclear correlation, and three papers noted that FMIG did not impact entry into family medicine. Of the seven articles about SRFC, only one showed a positive relationship between SRFC activity and entry into primary care. Larger-scale and higher quality studies are necessary to determine the impact of FMIG and SRFC on entry into family medicine and primary care. However, available evidence supports that FMIG participation is positively associated with family medicine career choice. In contrast, SRFC participation is not clearly associated with primary care career choice.

The Opinions of Family Medicine Residents about Education and Working Conditions in Turkey

Objective: In residency education, the educational environment interacts with each component of the training. This study is intended to assess the perceptions of family medicine residents about the educational and working environments from their point of view and to reveal their problems and expectations. 
 Methods: In this descriptive and cross-sectional study, nationwide 434 family medicine residents’ opinions about their educational environment were collected using a survey prepared by the researchers.
 Results: The mean age of the residents was 29.26±4.31 years. Women constituted 70.5% (n=306) of participants and 53.7% (n=233) chose family medicine career due to its working conditions. The rate of those who stated that there were no educational family health centers was 57.1% (n=248). More than half (67.5%; n=293) were satisfied with the department that they are getting education. Institutional assessment score (IAS) of those who chose family medicine for working conditions and obligations was lower than the participants who chose it because of their love and interest (p

QUALITY CONTROL OF THE WORK OF A FAMILY PHYSICIAN IN UKRAINE AS A KEY TO SUCCESSFUL PRACTICE

Summary. In the context of the reform of the medical industry in Ukraine, the issue of ensuring effective quality control of the provision of medical care and its proper organization in healthcare institutions, and primarily primary care providers (PCP), has become topical. Today in Ukraine, the control of the work of general practitioners-family doctors (audit) is a continuous process, the purpose of which is to improve the quality of medical care. The audit is characterized by a systematic approach, which makes it possible to identify problems, assess the achieved level of quality, plan, and implement changes aimed at improving the quality of medical care.
 The audit of the work of doctors is divided into professional and administrative, as well as internal and external. The audit of the work of general practitioners - family doctors, as a rule, is a combination of all these types.
 Internal quality control is carried out by the general/medical director of the PCP provider and the medical boards of the institution, and is divided into audit of the structure, process and result. In addition, there are forms of internal audit of the work of family doctors: self-control and self-assessment of quality, mutual assessment between colleagues, and assessment of the head of the PCP provider.
 The external audit of the PCP supplier is represented by non-departmental, public and departmental control. The subjects of control are the authorized bodies outside the medical institution. External quality control of the provision of medical care is carried out by state authorities, clinical expert commissions of the Ministry of Health of Ukraine, public organizations. The financial audit is carried out by the National Health Service of Ukraine and the Department of Audit and Analytics of the Ministry of Health of Ukraine. Administrative audit is carried out by the Department of Audit and Analytics of the Ministry of Health of Ukraine.
 Conclusions. In general, control over the activities of general practitioners - family doctors is an ongoing process and involves a systematic approach. Internal audits are conducted by members of the same profession, providing a unique opportunity to identify non-compliance with standards and change tactics before it leads to adverse consequences. External audit is carried out by state institutions. The balanced application of these two forms of audit allows to achieve a high quality of work of doctors. General practitioners - family doctors should strive for quality and regular internal audit as the main corrective factor in the implementation of quality care in family medicine.

Telemedicine versus in-Person Primary Care: Impact on Visit Completion Rate in a Rural Appalachian Population.

The use of telemedicine increased during the global Coronavirus disease 2019 (COVID-19) pandemic. Rural populations often struggle with adequate access to care while simultaneously experiencing multiple health disparities. Yet, telemedicine use during the COVID-19 pandemic has been understudied on its effect on visit completion in rural populations. The primary purpose of this study is to understand how telemedicine delivery of family medicine care affects patient access and visit completion rates in a rural primary care setting. We performed a retrospective cohort study on primary care patient visits at an academic family medicine clinic that serves a largely rural population. We gathered patient demographic and visit type and completion data on all patients seen in the West Virginia University Department of Family Medicine between January 2019 and November 2020. The final sample included 110,999 patient visits, including 13,013 telemedicine visit types. Our results show that telemedicine can increase completion rates by about 20% among a sample of all ages and a sample of adults only. Working-aged persons are more likely to complete telemedicine visits. Older persons with higher risk scores are more likely to complete their visits if they use telemedicine. Telemedicine can be a tool to improve patient access to primary care in rural populations. Our findings suggest that telemedicine may facilitate access to care for difficult-to-reach patients, such as those in rural areas, as well as those who have rigid work schedules, live longer distances from the clinic, have complex health problems, and are from areas of higher poverty and/or lower education.

Understanding medical students' interests in family medicine in Vietnam: A qualitative study.

Family medicine has recently been introduced into undergraduate training programs after more than 10years of only being available for postgraduate doctors in Vietnam. The aim of this study was to explore the perceptions of sixth-year medical students towards family medicine and the factors that influence their career choice for - or against - family medicine. The authors used a qualitative approach with a criterion sampling technique, including 36 participants in eight interviews and four focus group discussions, with thematical analysis. Most students could explain well what they had learned about family medicine but showed little interest in it. Only a few of the interviewees indicated they would choose a career in family medicine. The following factors influenced their career choice: valuing continuing care, the doctor-patient relationship and work-life balance; family medicine clinical rotation and teachers' roles; and related health policies offering a clear practice pathway and patient allocation to capable family doctors. The students' perceptions of family medicine were positive, but their interests in and intention to pursue a career in family medicine were still low after a clinical rotation. The authors concluded that the family medicine rotation should be maintained, family medicine should become more prominent in more components of the medical curriculum, and health policies to support and encourage becoming a family doctor are necessary.

Factors affecting the choice of career in family medicine among medical students in Saudi Arabia: a cross-sectional study

Background: Increasing the number of family physicians is one main aspect of the National Transformation Program in Saudi Arabia. Thus, this study aimed to assess factors influencing medical students' choice of family medicine (FM) as a future career in Makkah, Saudi Arabia. Methods: This cross-sectional study was conducted from November 2021 to March 2022 at seven medical schools. The participants were in their clinical years (fourth, fifth, sixth, and interns). A self-administered online questionnaire in English-language was distributed to participants, who were subsequently divided into two groups according to their choice in either FM or other specialties. The questionnaire was utilized to compare the participants' sociodemographic characteristics, factors influencing their choice of career, and knowledge of the National Transformation Program. Results: A total of 422 participants completed the study questionnaire, of which 192 (45.5%) students preferred FM. It was reported by 182 (43.1%) students that a member of their family is a medical professional. Most participants were males (n = 268; 63.5%). Influencing factors included working with patients to address their psychological, social, and lifestyle problems (79.1%), wanting a relatively easy residency (83.4%), working with non-emergent and relatively well patients (78.6%), and preferring a wide and diverse range of cases (85.9%). Conclusion: Factors influencing the choice of FM as a future career were the expansion of the FM training program, shortage of family physicians, short residency, working with non-emergent, relatively well patients, having long-term relationships and a personal bond with patients, and future educational and research opportunities.

Medical Students' Awareness and Interest towards Family Medicine at a Private Medical College in Karachi

Background: Family physicians constitute the fundamental core of the health system in many parts of the world. However, medical students' diminishing interest in Family Medicine remains a challenge worldwide. Objective: To assess medical students' awareness of the Family Medicine specialty and their interest towards selecting Family Medicine as a career. Methods: This cross-sectional study was conducted among medical students of a private medical university in Karachi from January 2021 to June 2021. A total of 333 students from all 5 years of Medicine were given a structured self-administered questionnaire assessing their awareness of Family Medicine, and their interest in it as a future career choice. Results: 91% of students had heard of Family Medicine, 80.8% knew it as a recognized specialty, 91.6% knew family physicians treat individuals of all ages and gender, 88.9% knew family physicians provide comprehensive coordinated care, 82.9% agreed Family Medicine should be taught in the undergraduate curriculum, 95.5% think family physicians can change the healthcare system of Pakistan, and 54.1% have interest in Family Medicine as a future career choice. Among the top three specialty choices, General Surgery ranked first, Emergency Medicine ranked second and Family Medicine ranked third. Conclusion: To attract students to choose a career in Family Medicine, it needs to be an essential part of undergraduate medical education. Career counselling, mentorship and role modelling can help foster interest among students in this field.

Comparative treatment scheme between nitrofurantoin and ampicillin in pregnant patients 12 to 16 weeks, gestation with asymptomatic bacteriuria

Urinary tract infection is a frequent cause of demand for care in family medicine, it can have a significant participation in maternal and neonatal morbidity. Objective. To compare the treatment scheme 7 with the antibiotic ampicillin in cases of asymptomatic bacteriuria in pregnant women with 12 to 16 weeks of gestation against nitrofurantoin. Material and methods. Observational, cross-sectional, retrospective and analytical study conducted in pregnant patients between weeks 12 and 16 of gestation with asymptomatic bacteriuria. Result. In patients with asymptomatic bacteriuria, a greater persistence of the infection was found when being treated with nitrofurantoin. Pregnant patients with 13 weeks had the highest incidence of asymptomatic bacteriuria with a frequency of 31.82 %. Conclusions. Nitrofurantoin may be considered a better treatment option than ampicillin, given its lower incidence rate of asymptomatic bacteriuria in pregnant patients at 12 to 16 weeks' gestation.