Family Medicine Research Research Articles

Diversity in Family Medicine Research.

In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, "Grow the family medicine research workforce by expanding pathways and strengthening mentorship," the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, "Increase funding for family medicine research and advocate for enhanced health policy and support," the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, "Build a national infrastructure for organizing and optimizing family medicine research opportunities," the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.

Osteopathic Research in Family Medicine.

Osteopathic physicians (DOs) comprise a growing portion of family physicians. In 2023, more DO seniors matched into family medicine than MD seniors, and nearly a quarter of US DO seniors matched into family medicine. Family medicine benefits from the osteopathic philosophy of whole-person care, though this provides challenges regarding research in family medicine. Notably, among students entering family medicine, MD students report an average of 2.4 research activities compared with 1.7 for DO students, marking the lowest values across specialties. There are multifarious reasons for the limited research exposure of osteopathic medical students, and 2 may be amenable to change. First, osteopathic trainees have relatively limited research exposure. Second, osteopathic manipulation training emphasizes techniques that are not compatible with current theories of anatomy and pathology. The reduced research emphasis among osteopathic trainees can be addressed by strategies that focus on enhanced research exposure and a cultural shift toward fearless reevaluation of these inconsistent beliefs. Improvements in research training and culture among osteopathic trainees (including medical students and residents) will directly benefit osteopathic medicine, family medicine, and patients.

Answering the "100 Most Important Family Medicine Research Questions" from the 1985 Hames Consortium.

The 1985 Hames Consortium convened family medicine researchers to identify outstanding questions in their practice. In this descriptive review, we collected, codified, and analyzed available literature to describe the availability of evidence to answer these questions. Of 136 total questions, researchers rated 33 questions as not at all answered (24.2%), 49 questions as somewhat answered (36.0%), 37 as mostly answered (27.2%), and 17 as fully answered - will implement in practice (12.5%). Notably, 2 of the categories with the highest number of total questions, community oriented primary care and the value of comprehensive care, had the highest percentage of unanswered questions. The Hames 100 questions and categories themselves demonstrate the values and purpose of family medicine research and can serve as a powerful tool to discuss the future of family medicine research. The varied questions illustrate the broad scope of interest of family physicians in 1985, which remains just as relevant today. Our findings indicate that relatively few questions were fully answered, with even fewer questions answered in family medicine journals.

Team Science in Family Medicine Research.

Collaboration, particularly interdisciplinary collaboration, is very common in family medicine research. Interdisciplinary collaboration and team science are encouraged and have significant advantages but they also have challenges to implementation. Addressing those challenges, even with changes to how promotion and tenure are conceptualized to reward team science is necessary for family medicine research to continue to grow and prosper.

CERA: A Vehicle for Facilitating Research in Family Medicine.

CERA: A Vehicle for Facilitating Research in Family Medicine.

Past Is Prologue: The Essential Role of Advocacy in Shaping the Future of Family Medicine Research.

Past Is Prologue: The Essential Role of Advocacy in Shaping the Future of Family Medicine Research.

Current and Future Challenges to Publishing Family Medicine Research.

Current and Future Challenges to Publishing Family Medicine Research.

Family medicine research in Kazakhstan: challenges, needs and support

Family medicine (FM), a relatively new speciality, has actively addressed the issue of research, despite the fact that, until recently, the majority of family doctors defined themselves in terms antithetical to research. Initial attempts in developing countries have typically concentrated on clinical care and teaching, with engagement in research being less common. The aim of the study is to investigate family the FM specialists’ perspectives on research engagement in Kazakhstan employing a mixed-methods research design with the collection of both quantitative and qualitative data. We surveyed 83 FM specialists to better understand the needs and barriers faced by this community in conducting research. Semi-structured interviews were conducted to obtain an in-depth picture of the issues. Understanding these issues is central to developing informed policies for promoting FM specialists’ research engagement, as well as taking steps to build their research capacity. The study resulted in important findings in understanding the specialists’ challenges in conducting research, and the needs and support provided to researchers in FM in Kazakhstan. The research barriers are a lack of time to conduct research, difficulty in publishing research, and a lack of cooperation between peers and research mentoring from experienced professionals. Specialists’ needs include specialized training programs and internships, a team of like-minded people and research partnerships, and access to patient databases and archived data. The specifically targeted policies should be undertaken to facilitate the specialists’ research careers by promoting research engagement, fostering research capacity, and recognizing FM as a specialty. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1197-1205

Ferritin Cutoffs and Diagnosis of Iron Deficiency in Primary Care

Ferritin is often measured by general practitioners, but the association of different cutoffs with the rates of iron deficiency diagnoses, particularly nonanemic iron deficiency, is unknown. To investigate the association of the ferritin cutoff choice with the incidence of nonanemic and anemic iron deficiency diagnoses in primary care. In this retrospective cohort study, patients 18 years or older with at least 1 consultation with a general practitioner participating in the Family Medicine Research Using Electronic Medical Records (FIRE) project, an electronic medical records database of Swiss primary care, from January 1, 2021, to November 30, 2023, were evaluated. Sex, age, clinical patient characteristics, and professional general practitioner characteristics. Incidence of iron deficiency diagnoses (nonanemic and anemic) at ferritin cutoffs of 15, 30, and 45 ng/mL and ferritin testing itself. Time-dependent Cox proportional hazards regression was used to examine associations of patient and general practitioner characteristics with ferritin testing as adjusted hazard ratios (AHRs). The study included 255 351 patients (median [IQR] age, 52 [36-66] years; 52.1% female). Per 1000 patient-years and at ferritin cutoffs of 15, 30, and 45 ng/mL, iron deficiency diagnoses had incidences of 10.9 (95% CI, 10.6-11.2), 29.9 (95% CI, 29.4-30.4), and 48.3 (95% CI, 47.7-48.9) cases, respectively; nonanemic iron deficiency diagnoses had incidences of 4.1 (95% CI, 3.9-4.2), 14.6 (95% CI, 14.3-15.0), and 25.8 (95% CI, 25.3-26.2) cases, respectively; and anemic iron deficiency diagnoses had incidences of 3.5 (95% CI, 3.3-3.7), 6.0 (95% CI, 5.8-6.2), and 7.5 (95% CI, 7.3-7.7) cases, respectively. Ferritin testing showed notable associations with fatigue (AHR, 2.03; 95% CI, 1.95-2.12), anemia (AHR, 1.75; 95% CI, 1.70-1.79), and iron therapy (AHR, 1.50; 95% CI, 1.46-1.54). Ferritin testing was associated with female sex in all age groups, including postmenopausal. Of the patients who received ferritin testing, 72.1% received concomitant hemoglobin testing, and 49.6% received concomitant C-reactive protein testing. In this retrospective cohort study of primary care patients, ferritin cutoffs of 30 and 45 ng/mL were associated with a substantially higher incidence of iron deficiency compared with 15 ng/mL. These results provide a basis for health system-level evaluation and benchmarking of ferritin testing in high-resource settings and call for a harmonization of diagnostic criteria for iron deficiency in primary care.

Strength in family medicine research: New CFPC efforts identify opportunities and set priorities.

Strength in family medicine research: New CFPC efforts identify opportunities and set priorities.

Establishing a standing patient advisory board in family practice research: A qualitative evaluation from patients' and researchers' perspectives.

Patient and public involvement is vital for high-quality research. Integrating patients' and providers' perspectives early in research enhances the feasibility and relevance of study results. Within our family practice-based research network ForN, we established a standing patient advisory board (PAB) to include patients with diverse conditions and experiences. In this paper, we aim to describe the establishment and functioning of a standing PAB in family medicine research from patients' and researchers' perspectives. After each PAB meeting, patients and researchers were asked to name anonymously positive and challenging moments in a feedback form with open questions. Researchers were also asked to reflect on how they implemented the discussion content in their research projects. The responses from both groups were transferred to MAXQDA 2018 and analyzed separately using thematic analysis. We analyzed 40 feedback forms from patients and 14 feedback forms from researchers. The dominant theme in the patients' feedback was 'exchange': They positively emphasized the 'exciting and open discussions' and the exchange of perspectives with one another and researchers. The clarity of the researchers' presentations and the research topics were appreciated. Researchers also positively highlighted the open atmosphere of the discussions. Presenting their research to the PAB helped most researchers reflect on their research topics from patients' perspectives and implement changes. However, researchers also mentioned several barriers to the implementation of PAB members' feedback. The establishment of a standing PAB in family practice research is feasible and productive both from patients' and researchers' perspectives. This study reports the evaluation of the establishment of a standing PAB in family practice research. Board members are involved in the design of studies, the co-production of interventions and information material, and the interpretation of data.

Empowering tomorrow's healers: Pioneering approaches in South Asian family medicine practice and research.

Empowering tomorrow's healers: Pioneering approaches in South Asian family medicine practice and research.

Protocol for the 2023 CERA Department Chair Survey.

CERA, the Council of Academic Family Medicine Educational Research Alliance, is a program sponsored by the academic family medicine organizations with the goal of supporting and improving educational research in family medicine. CERA produces surveys of different groups in academic family medicine, including an annual survey of department chairs, and members can apply to add their question sets to these surveys. This article describes the methods and demographics of the 2023 CERA Department Chair Survey. The call for proposals for the CERA Department Chair Survey was open from April 3, 2023 through May 9, 2023. Fifteen proposals were received, and five were accepted for the final survey based on scoring by peer reviewers. The Institutional Review Board of the American Academy of Family Physicians approved the survey. The final survey, including question sets from five research teams and standard demographic questions, was sent to 227 department chairs in the United States and Canada. Overall, 114 chairs responded to the survey, for a response rate of 50.2%. Demographic variables, including race/ethnicity, gender, age, and region of the country, did not differ between respondents and nonrespondents. The CERA Department Chair Survey provides a framework for members of academic family medicine organizations to conduct survey research on topics that are important to the specialty. Advantages of the CERA process include a national sample and robust response rate. Disadvantages are primarily the limitation in number of survey questions and the fact that not all proposals are accepted.

Underfunding for Research Training and Career Development: The Impact on Family Medicine Research.

The National Institutes of Health and related federal awards for research training (RT) and research career development (RCD) are designed to prepare applicants for research careers. We compared funding rates for RT and RCD for anesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, obstetrics-gynecology, pathology, pediatrics, and psychiatry. We estimated the denominator using the number of residency graduates from different specialties from 2001 to 2010 from the Association of American Medical Colleges data. For the numerator, we used published data on federally funded awards by specialty from 2011 to 2020. We also examined the correlation between RCD funding and overall research funding. Family medicine had the lowest rate per graduating resident for RT (0.01%) and RCD (0.77%) awards among 10 specialties and was lower than the mean/median for the other nine specialties, ranging from 2.15%/1.19% and 9.83%/8.74%. We found a strong correlation between rates of RCD awards and mean federal funding per active physician, which was statistically significant (ρ=0.77, P=.0098). Comparatively low rates for family medicine awards for RT and RCD plausibly contribute to poor federal funding for family medicine research, underscoring the need to bolster the research career pathway in family medicine.

Artificial intelligence for family medicine research in Canada: current state and future directions: Report of the CFPC AI Working Group.

To understand the current landscape of artificial intelligence (AI) for family medicine (FM) research in Canada, identify how the College of Family Physicians of Canada (CFPC) could support near-term positive progress in this field, and strengthen the community working in this field. Members of a scientific planning committee provided guidance alongside members of a CFPC staff advisory committee, led by the CFPC-AMS TechForward Fellow and including CFPC, FM, and AI leaders. This initiative included 2 projects. First, an environmental scan of published and gray literature on AI for FM produced between 2018 and 2022 was completed. Second, an invitational round table held in April 2022 brought together AI and FM experts and leaders to discuss priorities and to create a strategy for the future. The environmental scan identified research related to 5 major domains of application in FM (preventive care and risk profiling, physician decision support, operational efficiencies, patient self-management, and population health). Although there had been little testing or evaluation of AI-based tools in practice settings, progress since previous reviews has been made in engaging stakeholders to identify key considerations about AI for FM and opportunities in the field. The round-table discussions further emphasized barriers to and facilitators of high-quality research; they also indicated that while there is immense potential for AI to benefit FM practice, the current research trajectory needs to change, and greater support is needed to achieve these expected benefits and to avoid harm. Ten candidate action items that the CFPC could adopt to support near-term positive progress in the field were identified, some of which an AI working group has begun pursuing. Candidate action items are roughly divided into avenues where the CFPC is well-suited to take a leadership role in tackling priority issues in AI for FM research and specific activities or initiatives the CFPC could complete. Strong FM leadership is needed to advance AI research that will contribute to positive transformation in FM.

Barriers to research in family medicine-interviews with Portuguese family physician researchers.

There is a need for a deeper understanding of the barriers to research in family medicine (FM) and to consider the perceptions and perspectives of professionals. Our study aims to provide a strategic view for research capacity building in FM. We included the perspective of family physician researchers (FPR) on the existing barriers to investigation in this context. To understand and characterize the barriers to research in FM (personal and structural), from the perspective of Portuguese family physicians who are researchers. A qualitative study, of phenomenological nature, was performed, through the conduction of semi-structured interviews with FPR, from 2019 to 2022. Data analysis and thematic coding were done on MAxQDA®, with inductive and deductive approaches, until data saturation was reached. A total of 12 family physicians/researchers were interviewed. Seven main themes were identified as barriers to research: time, professional valorization, funding, ethics committees, infrastructure, management/institutions, and participants. Each theme is divided into subthemes that make it possible to assess how a barrier can affect researchers in performing research activities. Our study highlights the identification of 7 main barriers. Structuring them into sub-themes not only improved the organization of our results but also provided robust support for the next phase, namely the application of a survey with the aim of gaining a deeper insight into the repercussions that these barriers to FPR have at a national level. This research is crucial to laying the foundations for a policy document that offers well-defined and tailored recommendations to address the barriers we have uncovered.

Shaping the Future of Family Medicine Research: The 2023 National Family Medicine Research Summit.

Shaping the Future of Family Medicine Research: The 2023 National Family Medicine Research Summit.

A Milestone for Promoting Research in Family Medicine.

A Milestone for Promoting Research in Family Medicine.

Importance of different electronic medical record components for chronic disease identification in a Swiss primary care database: a cross-sectional study.

Primary care databases collect electronic medical records with routine data from primary care patients. The identification of chronic diseases in primary care databases often integrates information from various electronic medical record components (EMR-Cs) used by primary care providers. This study aimed to estimate the prevalence of selected chronic conditions using a large Swiss primary care database and to examine the importance of different EMR-Cs for case identification. Cross-sectional study with 120,608 patients of 128 general practitioners in the Swiss FIRE ("Family Medicine Research using Electronic Medical Records") primary care database in 2019. Sufficient criteria on three individual EMR-Cs, namelymedication,clinical or laboratory parametersandreasons for encounters, were combined by logical disjunction into definitions of 49 chronic conditions; then prevalence estimates and measures of importance of the individual EMR-Cs for case identification were calculated. A total of 185,535 cases (i.e. patients with a specific chronic condition) were identified. Prevalence estimates were 27.5% (95% CI: 27.3-27.8%) for hypertension, 13.5% (13.3-13.7%) for dyslipidaemia and 6.6% (6.4-6.7%) for diabetes mellitus. Of all cases, 87.1% (87.0-87.3%) were identified viamedication, 22.1% (21.9-22.3%) viaclinical or laboratory parametersand 19.3% (19.1-19.5%) viareasons for encounters. The majority (65.4%) of cases were identifiable solely throughmedication. Of the two other EMR-Cs,clinical or laboratory parameterswas most important for identifying cases of chronic kidney disease, anorexia/bulimia nervosa and obesity whereasreasons for encounterswas crucial for identifying many low-prevalence diseases as well as cancer, heart disease and osteoarthritis. The EMR-Cmedicationwas most important for chronic disease identification overall, but identification varied strongly by disease. The analysis of the importance of different EMR-Cs for estimating prevalence revealed strengths and weaknesses of the disease definitions used within the FIRE primary care database. Although prioritising specificity over sensitivity in the EMR-C criteria may have led to underestimation of most prevalences, their sex- and age-specific patterns were consistent with published figures for Swiss general practice.

Evaluation of family physicians’ knowledge level, attitudes and behaviours on Asthma, COPD

Objective: The most common complaints about chest diseases that we encounter in family practice centers are of asthma and Chronic obstructive pulmonary disease (COPD). Thus, it was aimed to evaluate the attitudes, behaviors and knowledge level of family physicians on asthma and COPD.
 
 Methods: Our research is a descriptive cross-sectional study. Our study was conducted between September-November 2019 by including family physicians, family physician research assistants and family physician specialists. 387 physicians participated in the study. The 35-question survey in our study consists of sociodemographic data and consists of questions aiming to evaluate the knowledge level, attitudes and behaviors on asthma-COPD.
 
 Results: A total of 387 family physicians including 251 family physicians, 31 family physician specialists and 105 family physician research assistants were included in this study. When the rates of using the spirometry device in suspected asthma-COPD, were compared, the difference between family medicine research assistants and family physicians was found to be statistically significant (p