Departments Of Family Medicine Research Articles

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.

Clinical Efforts Double Disparity for Nonphysician URiM Faculty: Implications for Academic Family Medicine

With a new definition of high-quality primary care and the shift in nonphysician faculty’s role as core faculty members in family medicine residency programs, new attention is needed on the delineation of clinical efforts and clinical efforts disparities across disciplines (eg, psychology, marriage and family therapy, pharmacy) within departments of family medicine. Additionally, those who identify as underrepresented in medicine (URiM), specifically those who are nonphysician faculty, are dually impacted by the clinical efforts double disparity. This paper examines the current landscape of clinical efforts in academic family medicine for physician faculty and nonphysician faculty as well as discusses how to build equity in clinical efforts for nonphysician faculty and URiM faculty within academic family medicine impacted by the double disparity.

Strengthening healthcare through family medicine training in The Gambia: The journey so far.

According to the World Health Organizations (WHO) family medicine forms the bedrock upon for accessible, affordable and equitable healthcare for any country. The need for family doctors is more acute for low income countries like The Gambia. More so that The Gambian health infrastructure is suboptimal and appropriate health personnel is low. This is worsened by brain drain leading to poor health indices. Despite these challenges and more, the department of Family Medicine was accredited for training in the Gambia with improved infrastructure (at the training centre), with 7 residents. Though there are still challenges there are also opportunities and strengths. There is therefore hope that the right personnel will be produced for an improved Gambian health system.

Evaluation of the one-minute preceptor as a teaching method for family medicine residents

Background and objective: Health professionals struggle to appropriately train resident doctors in overcrowded medical centers. The one-minute preceptor teaching approach is an effective teaching model that provides a solution to the problem. This study aims to determine the effectiveness of a one-minute preceptor in improving the clinical teaching skills of supervisors and the critical thinking skills of residents and to assess the residents' and supervisors’ attitudes toward a one-minute preceptor. Methods: From October 1, 2021, to February 28, 2022, a cross-sectional study was conducted in the Family Medicine department at Hawler Medical University, in Erbil, Iraq. Eight family medicine supervisors and 30 resident doctors at the specialized Family Medicine Health Center were involved in the study. Pre-and-post assessment questions were administered to the supervisors before and after one-minute preceptor training to assess their knowledge. Kirkpatrick's evaluation model was used to evaluate supervisors’ knowledge and application of skills after training, and to assess whether intended outcomes occurred with the residents. Results: All supervisors agreed that this approach to teaching should be incorporated into medical education (50% agreed and 50% strongly agreed) and improved their teaching skills (75% agreed, 25% strongly agreed). More than half of the residents agreed that this new teaching method should be incorporated into medical education. (50% agreed and 10% strongly agreed) Conclusion: The one-minute preceptor teaching model intends to provide doctors with an effective framework to improve their instructional effectiveness.

Departmental Metrics to Guide Equity, Diversity, and Inclusion for Academic Family Medicine Departments.

Equity, diversity, and inclusion (EDI) efforts have accelerated over the past several years, without a traditional guidebook that other missions often have. To evaluate progress over time, departments of family medicine are seeking ways to measure their current EDI state. Across the specialty, unity regarding which EDI metrics are meaningful is absent, and discordance even exists about what should be measured. This paper provides a general metrics framework, including a wide array of possibilities to consider measuring, for assessing individual departmental progress in this broad space. These measures are designed to be general enough to provide common language and can be customized to align with strategic priorities of individual family medicine departments. The Diversity, Equity, and Inclusion Committee of the Association of Departments of Family Medicine has produced a common framework to facilitate measurement of EDI outcomes in the following areas: care delivery and health, workforce recruitment and retention, learner recruitment and training, and research participation. This framework allows departments to monitor progress across these domains that impact the tripartite mission, providing opportunities to capitalize on measured gains in EDI. Departments can review this framework and consider which metrics are applicable or develop their own metrics to align with their strategic priorities. In the future, collective departments could compare notes and measure aggregate progress together. Evaluating progress is a step in the journey toward the goal of ensuring that departments are operating from inclusive and just academic systems.

A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data

BackgroundDespite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design.MethodsWe interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism.ResultsParticipant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism.ConclusionsOrganizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.

Risk factors and early preventive measures for long COVID in non-hospitalized patients: analysis of a large cohort in the United Arab Emirates

ObjectivesLong COVID is characterized by persistent symptoms lasting for 4 weeks or more following the acute infection with SARS-CoV-2. Risk factors for long COVID and the impact of pre-COVID vaccination and treatment during acute COVID-19 remain uncertain. This study aimed to investigate patient-specific factors associated with long COVID in a large cohort of non-hospitalized adult patients with mild to moderate COVID-19 in Dubai. Study designCohort study. MethodsThe study included 28,375 non-hospitalized adult patients diagnosed with mild to moderate COVID-19 between January 1, 2021, and September 31, 2022, in Dubai, who were followed up for 90 days. The presence of long COVID symptoms was documented by physicians during patient visits to the family medicine department. Furthermore, long COVID-related risk factors were collected and analyzed, including patient demographics, comorbidities, pre-COVID vaccination status, and the COVID-related treatments received during the acute phase of the illness. Cox proportional hazard models were applied for the statistical analysis. ResultsAmong the cohort, 2.8% of patients experienced long COVID symptoms during the 90-day follow-up. Patients with long COVID tended to be younger, female, and of Caucasian race. Common symptoms included fatigue, muscle pain, respiratory symptoms, abdominal and neurological symptoms, allergic reactions, skin rashes, and hair loss. Risk factors for long COVID were identified as diabetes mellitus, asthma, and Vitamin D deficiency. Females and Caucasians had a higher risk of long COVID during the pre-Omicron period compared to the Omicron period. Pre-COVID vaccination was associated with a reduced risk of long COVID in all patient subgroups. Treatment with favipiravir or sotrovimab during the acute phase of COVID-19 was linked to a decreased risk of long COVID, although favipiravir showed limited effectiveness in the high-risk group. ConclusionThis study contributes to the existing knowledge by identifying risk factors for long COVID among non-hospitalized patients and emphasizing the potential benefits of pre-COVID vaccination and timely treatment.

Analysing Crime Scene Data, Medical Records and Forensic Information to Determine the Causes of Suicides.

To analyse crime scene data, medical records, and forensic information to unveil insights into the causes and traits of suicides. Descriptive study. Place and Duration of the Study:Department of Family Medicine, Kayseri City Hospital, Kayseri, Turkiye, between January 2020 to December 2021. A suicide investigation team (doctor, social worker, psychologist) was created to study cases and conduct on-site psychological autopsies. Triggered by emergency calls, the team interviewed suicide victims' relatives using semi-structured questionnaires, gathering data on personal details, time, method, and potential motives. Medical records revealed psychiatric history and medication use, while national judicial systems were reviewed for legal records. A total of 158 fatal suicides were studied. Males accounted for 73.4%, females 26.6%. The leading cause was psychiatric illness (43%), chiefly depression (39%). Suicide peaked in the fall, especially in September, mainly at 23:00-23:59. Home was the common site (58.9%), and hanging was the primary method (44.3%). Prior hospitalisation for suicide attempts was 7.5%. Criminal records were held by 16.4% (26 individuals). The results support the idea that suicides have seasonal patterns and that there are temporal windows of increased risk for suicide. Suicide reasons, Suicide time, Psychological autopsy, Seasonal and temporal patterns.

139 Adapting Center for Improvement of Mentored Experiences in Research (CIMER) Mentor Training for Clinical Research Professionals: A Process Description

OBJECTIVES/GOALS: Learn how the National Organization of Research Development Professionals (NORDP) adapted the Center for Improvement of Mentored Experiences in Research (CIMER) NIH-funded evidenced-based mentor training curriculum for research development professionals and how the curriculum will be further adapted for clinical research professionals. METHODS/STUDY POPULATION: NORDP pioneered the adaptation of the CIMER curriculum for professional research staff. In addition to revamping the case studies and ensuring the curriculum was appropriately staff-centric, the NORDP team developed best practices for adapting the curriculum. This approach included four phases: (1) developing expertise in mentor training, (2) adapting curriculum for staff, (3) creating role-specific case studies, and (4) integrating mentor training with institutional or professional association-based mentoring programs. In collaboration with CIMER and units at the University of Minnesota (UMN), the mentor training model for research development will be further adapted for clinical research staff, i.e. coordinators, regulators, facilitators. RESULTS/ANTICIPATED RESULTS: This poster will discuss the preliminary work of adapting the curriculum for clinical research professionals by the UMN’s Departments of Family Medicine and Community Health and Clinical and Translational Science Institute’s Translational Workforce Development team. The anticipated short to mid-term outcomes of this work include: (1) improved research professionals mentoring knowledge and skills, (2) diversity addressed across research roles, (3) reduced staff turnover and associated costs, (4) increased staff job satisfaction and moral, and (5) research culture changed to value mentoring excellence across the academic enterprise. DISCUSSION/SIGNIFICANCE: Research mentoring has traditionally been focused on faculty and trainees. Given the unique skill sets and increasing complexity of research staff roles, mentoring can increase job satisfaction and reduce the overall costs related to turnover, i.e. research productivity, loss of institutional knowledge, hiring costs, etc.

Comprehensive evaluations of coronavirus disease 2019 survivors regarding immunity, laboratory and computed tomography change

Abstract Background Long coronavirus disease is an incapacitating disease that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 infections. At least 65 million persons global are estimated to have long COVID, with situations increasing daily. Patients and methods This is a prospective cohort study done on COVID-19 survivors’ proved by computed tomography (CT) or RCR testing who registered for follow-up at post-COVID Clinic at Family Medicine Department in Zagazig University Hospital through systematic random sampling technique. Survivors followed-up for 6 months by three visits. Results Total 137 adult patients with COVID-19 were included in this study. Mean age of the studied group 42.01 ± 8.28 years where most of them were females (78.1%). As regards inflammatory marker C-reactive protein, erythrocyte sedimentation rate (ESR) and D-dimer were slightly elevated and improving in the subsequent visits but complete blood picture, liver functions, kidney function, cardiac enzymes result through follow-up visits were in normal range. As regards CT change (72.3%) demonstrated abnormal CT in first visit and became (20.5%) at follow-up visit. As regards serology results, 100% demonstrated positive serology in first measurement and 12.5% turned negative in follow-up measurement after 3 months. Conclusion Small percent of COVID-19 patients present with some abnormalities, but after follow-up period we observed overall improvement in all parameters.

Inappropriate laboratory test utilization in outpatient tertiary care: Implications for value-based healthcare.

To assess the rate of inappropriate repetition of laboratory testing and estimate the cost of such testing for thyroid stimulating hormone (TSH), total cholesterol, vitamin D, and vitamin B12 tests. A retrospective cohort study was carried out in the Family Medicine and Polyclinic Department at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Clinical and laboratory data were collected between 2018-2021 for the 4 laboratory tests. The inappropriate repetition of tests was defined according to international guidelines and the costs were calculated using the hospital prices. A total of 109,929 laboratory tests carried out on 23,280 patients were included in this study. The percentage of inappropriate tests, as per the study criteria, was estimated to be 6.1% of all repeated tests. Additionally, the estimated total cost wasted amounted to 2,364,410 Saudi Riyals. Age exhibited a weak positive correlation with the total number of inappropriate tests (r=0.196, p=0.001). Furthermore, significant differences were observed in the medians of the total number of inappropriate tests among genders and nationalities (p<0.001). The study identified significantly high rates of inadequate repetitions of frequently requested laboratory tests. Urgent action is therefore crucial to overcoming such an issue.

The memory to the teacher, Doctor of Medical Sciences, Professor E.V. Frolova

The article is dedicated to the memory of Professor of the Department of Family Medicine, member of the editorial board of the journal “Russian Family Doctor”, Doctor of Medical Sciences, Professor E.V. Frolova, who became a mentor and supervisor for a nurse with higher education, citizen of Israel Claudia Konson.

Medical interns' training in family medicine at a district hospital and primary health care clinics in Middelburg, Mpumalanga.

Training of medical interns at the Middelburg district hospital has been introduced as part of the mandatory 6 months' rotation in Family Medicine department since 2021. This report provides an overview of what has been attained in 2021 and 2022. It covers various aspects of the activities medical interns have been exposed to in the Middelburg hospital and the surrounding primary health care clinics.Contribution:Sharing experiences of family medicine training for medical interns in district hospitals is essential because the 6 months' rotation is new for most family physician trainers, especially those in small hospitals and primary health care clinics. Taking into account the paucity of evidence on the topic, the report brings current information that supports that training medical interns in district hospitals and primary health care clinics prepares them to be comfortable and competent clinicians for the generalist work during the community service year ahead.

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.

Evaluation of Student Applications Made for Psychological Reasons to a University Hospital Health Center

Objective: With this study, it was aimed to determine the reasons and results of young adults who apply with psychological problems in a primary care institution of a university and to evaluate the relationship between sociodemographic characteristics. Method: The descriptive and retrospective study was conducted in XXXXX University Faculty of Medicine, Department of Family Medicine and Sıhhiye Health Center. All students between the ages of 18-35, who were registered in the specified date range in our study, and who came to a psychologist interview at least 3 times at regular intervals were evaluated. In our study, the data of the patients were collected by examining the data forms recorded by the psychologist. The personal data of the patient was not used in the data form. Results: In the study, 276 applications were evaluated retrospectively. It was observed that 83.3% of the applicants were women, and the mean age was 20.99±2.176. When evaluated in terms of application reasons; it was determined that 35.5% of them applied due to anxiety, stress, obsessive-compulsive disorder [OCD] problems, 35.9% of them had communication problems and psychosocial problems. For the treatment of 65.2%, it was decided to follow up with a psychologist [who did not require referral to a psychiatrist]. When the relationship between the outcome of the applications and the reasons for the application is evaluated; 54.8% of mood problems were referred to a psychiatrist and were followed up by a psychologist after the medication was started; it was determined that 51.1% of the patients who applied with communication and psychosocial problems were followed up by a psychologist without the need for referral to a psychiatrist. Conclusion: As a result, university students have high levels of anxiety, stress, OCD problems, communication problems, and psychosocial problems; it was found that women, those living in dormitories and those with a diagnosis of psychiatric illness applied more frequently. Students should be encouraged to benefit from the health centers, which are created for them, where primary care preventive health care is at the forefront.

Final conclusions of the own investigations of combined antihypertensive treatment on clinical state in patients with arterial hypertension without and with diabetes mellitus: use of own materials in education in nation. and Engl. languages at pre- and po

General practice – family medicine department. Object of investigation – patients with confirmed diagnosis of arterial hypertension without and with diabetes mellitus of second type, which were under observation at the primary medical care centers. &#x0D; The aim of the investigation was the study of efficiency of the combined (calcium channel blocker – amlodipin besilat and angiotensin II receptor antagonist – valsartan) antihypertensive treatment in patients with arterial hypertension combined with diabetes mellitus from the start of the treatment in the practice of primary care physician.&#x0D; Methods of the investigation included physical examination, general clinical, instrumental and laboratory methods, monitoring of side effects.&#x0D; As a result it was found, that combined antihypertensive treatment (amlodipin and valsartan) is effective and safe in patients with arterial hypertension and diabetes mellitus of 2 type, which helps to reach the target level of arterial pressure in 72 % of patients and can be recommended from the beginning of the treatment in the practice of family physician. Maximal effect of the treatment in patients with arterial hypertension of II-III degree and diabetes mellitus of 2 type was observed only at 12th week of treatment. At combined antihypertensive treatment (amlodipin and valsartan) they observed tendency to the reduction of left ventricle hypertrophy. Despite the rate and percentage of the reaching of target arterial pressure were lower in the group of patients, which have diabetes mellitus of 2 type, it is necessary to recommend more active modification of the way of life in the named group of patients. It was found reduction of heart and vascular risks in the group of patients with arterial hypertension II–III degree with diabetes mellitus 2 type. This makes the basis for more active modification of life style and using from the start of the treatment combined antihypertensive therapy immediately. Consider all found results using from the start of the treatment combined antihypertensive therapy immediately by the primary care physician is proved for patients with arterial hypertension combined with diabetes mellitus.&#x0D; Accumulated materials (including theoretical reviews, demonstrative poster reports etc.) are used at training of interns in speciality «general practice – family medicine», during practical classes for higher courses education in national and English languages

Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study.

In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare.

Type 2 Diabetes Mellitus and Erectile Dysfunction: A study on risk factors and their correlation to serum testosterone level.

Background &#x0D; Diabetes mellitus (DM) is one of the major cause of erectile dysfunction (ED). Testosterone regulates nearly every component of ED and this subnormal testosterone concentration con tribute to ED. &#x0D; The objective of our work was to study the age of the patient, duration of diabetes mellitus, body mass index (BMI), glycosylated haemoglobin (hbA1c) and urinary albumin creatinine ratio (uACR) in type 2 diabetic male patients as etiology for ED and their relation to the serum testosterone level. &#x0D; Methodology &#x0D; We studied 100 male type two diabetic patients selected from the outpatient department of the Family Medicine department in Olive Healthcare. We divided our patients into two groups. Group A: 50 patients with type 2 diabetes mellitus with ED and Group B: 50 patients with type 2 diabetes mellitus without ED. We assessed their history with special focus on the age of the patient, disease duration and lab investigations. The patients answered the five item version of the International Index of Erectile Function (IIEF-5) questionnaire. &#x0D; Results &#x0D; Total serum testosterone was significantly lower in type 2 diabetic male patients with ED compared to those without ED. HbA1c, diabetes duration and uACR were independently negatively correlated with testosterone level. &#x0D; Conclusion &#x0D; The duration of diabetes, glycemic control and uACR contributed to ED in type 2 diabetics and they are independently and negatively correlated with total serum testosterone level.

A Hybrid Model of In-Person and Telemedicine Diabetes Education and Care for Management of Patients with Uncontrolled Type 2 Diabetes Mellitus: Findings and Implications from a Multicenter Prospective Study.

Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic. This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period. Of the enrolled 181 patients, more than half of the participants were women (n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients (n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all p < 0.001). The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.

In memory of Professor E.V. Frolova

This obituary is dedicated to Professor E.V. Frolova of the Department of Family Medicine, a member of the editorial board of the Russian Family Doctor Journal.