Family Medicine Specialty Research Articles

Clinical Staff Perceptions of Pay-for-Performance Financial Incentives for HPV Vaccine Promotion.

The purpose was to investigate clinical staff perceptions of pay-for-performance human papillomavirus (HPV) vaccination financial incentives. In 2022, the authors conducted a national survey of clinical staff (N = 2527; response rate = 57%). Respondents were (1) certified to practice in the United States; (2) practiced as a physician, physician assistant, nurse practitioner, advanced practice nurse, registered nurse, licensed practical/vocational nurse, medical assistant, or certified nursing assistant; (3) worked in pediatrics, family medicine, or general medicine specialties; and (4) had a role in HPV vaccination for children ages 9 through 12 years. The team used ordered regressions to model whether respondents agreed with (ie, "Strongly agreed" or "Agreed" on a 5-point Likert scale) each of the 9 statements. The statements were mapped to domains based on the theory of planned behavior: attitudes (5 statements), perceived behavioral control (2), and norms (2). Favorable responses to 9 statements ranged from 32% to 85%; 5/9 items had more than 50% favorable responses. The following example odds ratios (ORs) are for "agree" versus "neutral" or "disagree" to change their behavior to obtain the incentive. Clinical staff with prior experience with incentives were more likely to agree with 8/9 positive statements about incentives (eg, OR = 1.32 [95% confidence interval {CI}: 1.12-1.57]). Family medicine clinics were more likely than pediatric clinics to agree with 5/9 statements (eg, OR = 1.42 [95% CI: 1.18-1.70]). Clinical staff with more years of experience were less likely to agree with 6/9 statements (eg, OR = 0.97 [95% CI: 0.97-0.98]). Clinical staff's perceptions of pay-for-performance HPV vaccination financial incentives were generally favorable.

First-Generation Low-Income Individuals in Medicine: A Scoping Review.

This comprehensive scoping review of the medical literature on first-generation low-income (FGLI) individuals in medicine aimed to synthesize the highest levels of evidence to inform medical education stakeholders. Database searches were conducted in Academic Search Premier, Education Research Premier, ERIC, Ovid MEDLINE, Ovid Embase, Professional Development Collection, PubMed, Scopus, Google Scholar, and Web of Science Core Collection from database inception through March 15, 2023. English-language articles on first-generation or low-income individuals in medicine from U.S. medical schools were included. Articles were evaluated for level of evidence and themes chosen. Database searches resulted in 27,075 citations, 247 of which qualified for data extraction. The articles were classified by evidence level: level I (n = 2), level II (n = 17), level III (n = 90), level IV (n = 78), and level V (n = 60). Publications reported on 9 major outcomes: exam performance (n = 108), medical school performance (n = 63), residency and fellowship performance (n = 7), honor society status (n = 12), leave of absence (n = 9), withdrawal, dismissal, and attrition (n = 20), medical education graduation (n = 37), career choice (n = 109), and intent to practice in disadvantaged and rural communities (n = 60). Compared with their peers, FGLI individuals had lower medical school and standardized exam scores, enrollment in national medical honor societies and multiple degree programs, and graduate medical education performance and higher rates of leaves of absence, incompletion of medical education, pursuing primary care and family medicine specialties, and intent to practice in underserved communities. Despite an increase in the number of FGLI individuals in medicine, there remains significant opportunity to improve their inclusion and support. Multi-institutional, prospective, risk-adjusted, observational studies are required to determine how to best support FGLI individuals through all medical career stages.

Determining Risk Management Priorities and Suggesting Strategies in the Management of Family Health Centres

Aim: The purpose of this study is to identify the risks faced by decision-makers in the management of Family Health Center (FHC) and to propose strategies according to their relative importance. Materials and Methods: Eight different risks were identified as a result of the literature review. In order to evaluate the identified risks, four different physicians with at least ten years of managerial experience in FHCs and two health managers with at least ten years of experience in their field were included in the study. SWARA (Stepwise Weight Assessment Ratio Analysis) method was used to evaluate and analyze the opinions. SWARA method is a weight calculation method based on expert opinions developed for the finalization of decision problems. Results: According to the results of the analysis, experts ranked financial risks (%27), clinical and patient safety risks (%21), and operational risks (%15) as the most important risks, respectively. Hazard risks (%4) were assessed as the least risky in relative terms. For FHCs to carry out their activities effectively, financial risks should be minimized first. Conclusions: Additional measures should be taken by the public for the use and rental of FHCs. Diversification of other sources of income can be ensured by expanding the health services provided beyond the resource transfer linked to the public budget. Regional investment and incentives can be developed by municipalities. Strengthening data protection policies to assess the compliance of medical practices with legal standards and to ensure the security of personal patient data can also reduce legal risks. In FHCs, general safety issues, especially patient safety, are also priority issues that should be investigated and legislation should be developed. In addition, management courses/training can be added to the family medicine specialty curriculum to improve the managerial skills of physicians.

Levels of Reflection in Teachers and Family Medicine Residents: A Qualitative Study

Objective: to analyze the levels of reflection according to Mezirow’s model in a group of teachers and residents in the Family Medicine specialty in Mexico. Methods: a qualitative study was conducted using a Word format questionnaire to collect sociodemographic data, and critical incidents related to teacher-student communication problems. The participants’ level of reflection was analyzed based on these incidents. Results: the study classified 192 events related to critical incidents, and the participants’ reflection levels were determined. 104 events (81.88%) described by teachers, and 45 events (69.23%) by residents were categorized in the first level of analysis, corresponding to non-reflective. 21 events (16.53%) by teachers, and 18 events (27.69%) by residents were situated in the second level: reflective, while 2 events (1.57%) by teachers, and 2 events (3.07%) by residents were classified as critical reflection. Conclusion: according to Mezirow’s model, the level of reflection in most participants did not lead to changes to favor behavioral modification. These findings suggest the need for additional strategies to promote critical reflection and facilitate attitudinal change in educational contexts.

Provider Perspectives on Analgesic Use in Intrauterine Device Insertion Procedures: A Mixed Methods Analysis.

The intrauterine device (IUD) is one type of long-acting reversible contraceptive that is becoming increasingly popular among patients and healthcare providers alike, though many are deterred from using this option due to pain or fear of pain with IUD insertion. While the IUD insertion process itself is standardized, the use of pain medication is not. There is a lack of research regarding provider preference in analgesic use for IUD insertion procedures, which analgesics are being provided to patients, and under which circumstances. This study aims to explore which analgesics are being used routinely in clinical settings, which patient populations are more likely to receive or benefit from these treatments, and why. Secondarily, this study aims to evaluate the impacts ofprovider characteristics such as location of training and practice, length of practice, and type of training in analgesic administration. Various national organizations were contacted via email and asked to distribute the "IUD Pain Management" survey via discussion board or email newsletter. This survey was developed to gather demographic information on providers of IUD placement procedures and evaluate trends in analgesic methods used based on provider and patient characteristics. Additionally, the survey included an opportunity for participants to agree to participate in a brief interview to further elaborate on their responses via phone. Survey responses were collected and evaluated on the secure QuestionPro platform.Results from the interview were qualitatively assessed by coding recurrent themes between participant interviews. Survey respondents represented physicians from family medicine and OB-GYN specialties, as well as nurse practitioners, registered nurses, physician assistants, and OB-GYN resident physicians. The average length of clinical practice is 6.7 years. The majority of respondents reported offering some sort of analgesic for IUD insertion procedures, with nonsteroidal anti-inflammatory drugs being the most commonly used. Participants also reported an increased likelihood of prescribing analgesics for adolescent and nulliparous patients. Participant interviews included themes such as patient perception of pain, provider training, barriers to access, and alternative analgesic options. Our study has identified a significant amount of variation in practices regarding analgesic use for IUD insertion procedures and highlighted some underlying causes of these inconsistencies. Future studies should further investigate trends in analgesic administration in IUD insertion procedures with a larger sample size and delve into factors such as provider education and barriers to access.

Interventional Competency Goals Self-evaluations from the Perspective of Family Medicine Residents for Emergency Medicine Rotation

Backround: The aim of this study is to evaluate how competent family medicine residents see themselves in the interventional competency goals targeted in emergency medicine rotation and the factors associated with their competency levels.
 Methods: The study is a methodological and cross-sectional study carried out between 01 May-31 October 2022. 138 family medicine residents who completed their emergency medicine rotation and agreed to participate in the study were included in the study. In the questionnaire used to collect data in the study, there were the Emergency Medicine Rotation Interventional Competence Scale (EMRICS) developed by the researchers based on the family medicine specialty training curriculum and sociodemographic characteristics.
 Results: The mean ages of the study group 29.71±4.27 (Mean±SD) years, and 60.10% (n:83) were women. The mean scores obtained from the scale in the study group were 59.86±11.72 (Mean±SD). While the interventional competence in which family physician residents had the highest proficiency was arterial blood gas with 97.80% (n:135), the lowest was tracheostomy with 15.20% (n:21). Evaluation of BLS (p:0.037), intubation (p:0.028), tracheostomy (p:0.034), trauma patient assessment (p:0.004) in the study group who applied five or more applications received higher EMRICS than those who did not apply at all.
 Conclusion: In order to achieve the desired competence in interventional competency goals, it is recommended to be repeated at least 5 times.

Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis

BackgroundAt an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic.MethodsThis study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction.ResultsThe study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors.ConclusionPhysician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.

Is primary care ready for a potential new public health emergency in the wake of the COVID-19 pandemic, now subsided?

The lingering burden of the COVID-19 pandemic on primary care clinicians and practices poses a public health emergency for the United States. This study uses clinician-reported data to examine changes in primary care demand and capacity. From March 2020 to March 2022, 36 electronic surveys were fielded among primary care clinicians responding to survey invitations as posted on listservs and identified through social media and crowd sourcing. Quantitative and qualitative analyses were performed on both closed- and open-ended survey questions. An average of 937 respondents per survey represented family medicine, pediatrics, internal medicine, geriatrics, and other specialties. Responses reported increases in patient health burden, including worsening chronic care management and increasing volume and complexity. A higher frequency of dental- and eyesight-related issues was noted by respondents, as was a substantial increase in mental or emotional health needs. Respondents also noted increased demand, "record high" wait times, and struggles to keep up with patient needs and the higher volume of patient questions. Frequent qualitative statements highlighted the mismatch of patient needs with practice capacity. Staffing shortages and the inability to fill open clinical positions impaired clinicians' ability to meet patient needs and a substantial proportion of respondents indicated an intention to leave the profession or knew someone who had. These data signal an urgent need to take action to support the ability of primary care to meet ongoing patient and population health care needs.

Management of Hyperprolactinemia in Clinical Practice

Background &amp; objectives: Hyperprolactinemia is defined as an increased prolactin level above the normal reference range, in women more than 25 ng/dl; with a prevalence rate of 10% in the general population. Hyperprolactinemia is associated with different clinical presentations various from oligomenorrhea, amenorrhea, galactorrhea, and infertility. This study aims to be to assess the current practice regarding the management of hyperprolactinemia in non-pregnant women in the Kurdistan region, Iraq. Subjects and Methods: An electronic questionnaire on current practice concerning diagnosis and treatment of hyperprolactinemia in non-pregnant women was sent through e-mail to 167 clinicians, 166 of them completed the survey and they were from different cities (Duhok, Sulaymaniyah, Erbil, and Halabja) of the Kurdistan region, Iraq. Results: A total of 166 valid questionnaires were collected. The response received from 166 clinicians. Almost 97 % of the responders were asking about the presence of symptoms of prolactinoma in patients with hyperprolactinemia and the majority of responders were made an exclusion of physiological causes related to hyperprolactinemia. When hyperprolactinemia occurred, only 81.3% of the respondents would test for thyroid-stimulating hormone routinely. Majority of the responders (79.5%) did not confirm the biochemical diagnosis of hyperprolactinemia before starting treatment and only two-thirds of them do pituitary imaging. Also, our results show an important role of clinician’s characteristics like age group on the management outcome, as the age group 25-35 was better when compared to the age group 46-55 (p-value =0.044) and the internist specialty and family medicine specialty have a better impact on management outcome in comparison to endocrinologist with (p-value =0.046 and 0.043 respectively). Conclusions: We found that the current clinical practice for the management of hyperprolactinemia is not uniform with some scientific defects. Therefore, it is necessary to develop national guidelines for the management and treatment of hyperprolactinemia.

Advancing primary care: Establishing family medicine specialty in Tanzania

Family medicine has existed as a training pathway through a private university in Tanzania since 2004. As global calls have increased to embrace primary health care as a pathway to ensuring universal health coverage, so has Tanzania recently turned to explore family medicine as a specialty to improve access to comprehensive, high-quality healthcare for her entire population. This article outlines ongoing efforts to define competencies and skills of a family medicine physician in Tanzania, engage government support and open the first public university training programme for family medicine postgraduate education.

Advancing primary care: Establishing family medicine specialty in Tanzania.

Family medicine has existed as a training pathway through a private university in Tanzania since 2004. As global calls have increased to embrace primary health care as a pathway to ensuring universal health coverage, so has Tanzania recently turned to explore family medicine as a specialty to improve access to comprehensive, high-quality healthcare for her entire population. This article outlines ongoing efforts to define competencies and skills of a family medicine physician in Tanzania, engage government support and open the first public university training programme for family medicine postgraduate education.

Abstract 17466: Impact of the Covid-19 Pandemic on Pediatric Cholesterol Screening Rates

Introduction: Universal cholesterol screening during childhood has been recommended by the American Academy of Pediatrics since 2011, but most children remain unscreened. We hypothesized that the COVID-19 pandemic and subsequent disruptions in routine healthcare impacted pediatric cholesterol screening rates and may have disproportionately affected children based on race, ethnicity, socioeconomic status (SES), or rural/urban status. Hypothesis: The COVID-19 pandemic impacted pediatric lipid screening rates based on race, ethnicity, SES, and rural/urban status. Methods: The provider order placement rate (OPR) for a screening cholesterol panel was calculated for established patients 9-21 years old at a single institution pre-pandemic (3/18/2019-3/17/2020), mid-pandemic (3/18/2020-3/17/2021), late-pandemic (3/18/2021-3/17/2022), and post-pandemic (3/18/2022-12/31/2022). OPR was analyzed, including a chi-squared test, based on race, ethnicity, SES, rural/urban status, and the department of the visit. Results: Overall OPR fell over time and in both pediatric and family medicine specialties. There was a decrease in OPR across all race and ethnicity groups, though most did not reach statistical significance. Urban advantaged, urban, and rural underserved had a disproportionately larger decrease in OPR, though all groups had a lower OPR at the end of the study. Conclusions: The OPR decrease in late- and post-pandemic stages may be due to the pandemic. Though OPR differences existed between some rural/urban statuses and the ordering department pre-pandemic, these factors may have worsened these gaps. Future studies are needed to identify and address barriers to pediatric cholesterol screening.

Approach of Female Patients to Screening Tests in the Prevention of HPV-Related Cervical Cancer and the Effect of Physician's Recommendation

The aim of our study was to evaluate the cervical cancer screening test status of female patients between the ages of 30-65 who applied to the family medicine outpatient clinic for any reason. If they have not had the screening test, it is aimed to provide information and relevant education to the patients about the test, and then to include the patient in the national cervical cancer screening program by improving the patient's knowledge and awareness and also to contribute to preventive health care, which is our principle of family medicine specialty. Our study was prospective observational research in which evaluating the status of having a cervical cancer screening test after appropriate information. Patients were asked about their cervical cancer screening test status, and all participants were informed about this issue, and the patients who did not get tested were contacted again by phone one month later to evaluate the status of taking the test. A unique structured questionnaire form was used for the study. A total of 146 women who agree to participate voluntarily were included in the study. The mean age of the patients was 44.39±9.26 years and 64.4% had not gone through menopause. Of the patients, 87% were married, 48.6% were university graduates, and 49.3% were not employed. 66.4% of patients had had a cervical cancer screening test at least once, while 28.9% of them had been tested more than five years ago, 2.1% did not remember when they had the test. Of those who had the screening test, 57.7% had the test for health check-up, 73.5% of those who did not get tested they did not have a test because they did not need or had any complaints. 73.3% of the patients had not received training on the screening tests. 51.3% of those receiving training stated that they received training from the hospital and 28.2% from the family health center. After being informed about the cervical cancer screening test, 58.9% (n=86) of the patients considered having the test. It was determined that 26.6% of the patients (n=79) who did not have the screening test in accordance with the screening program and who never tested, had the screening test done after being informed. Consider the average age of the patients, it was determined that their participation in the cervical cancer screening program was quite low. The fact that more than half of the participants considered having a screening test after the physician's recommendation and training, and the fact that one quarter of the participants who were due to have the screening test after one month had the screening test, shows the importance of the physician's recommendation and education.

Specialty preference for cardiovascular prevention practice in the Southeast US and role of a preventive cardiologist.

Cardiovascular disease (CVD) prevention is practiced concurrently by providers from several specialties. Our goal was to understand providers' preference of specialties in CVD prevention practice and the role of preventive cardiologists. Between 11 October 2021 and 1 March 2022, we surveyed providers from internal medicine, family medicine, endocrinology, and cardiology specialties to examine their preference of specialties in managing various domains of CVD prevention. We examined categorical variables using Chi square test and continuous variables using t or analysis of variance test. Of 956 invitees, 263 from 21 health systems and 9 states responded. Majority of respondents were women (54.5%), practicing physicians (72.5%), specializing in cardiology (43.6%), and working at academic centers (51.3%). Respondents favored all specialties to prescribe statins (43.2%), ezetimibe (37.8%), sodium-glucose cotransporter-2 (SGLT2) inhibitors (30.5%), and aspirin in primary prevention (36.3%). Only 7.9% and 9.5% selected cardiologists and preventive cardiologists, respectively, to prescribe SGLT2 inhibitors. Most preferred specialists (i.e. cardiology and endocrinology) to manage advanced lipid disorders, refractory hypertension, and premature coronary heart disease. The most common conditions selected for preventive cardiologists to manage were genetic lipid disorders (17%), cardiovascular risk assessment (15%), dyslipidemia (13%), and refractory/resistant hypertension (12%). For CVD prevention practice, providers favored all specialties to manage common conditions, specialists to manage complex conditions, and preventive cardiologists to manage advanced lipid disorders. Cardiologists were least preferred to prescribe SGLT2 inhibitor. Future research should explore reasons for selected CVD prevention practice preferences to optimize care coordination and for effective use of limited expertise.

Perception of family medicine as the career option among young Indian graduates

Aims and Objectives: 1. To estimate the number of graduates who had exposure to family medicine specialty. 2. To estimate the number of graduates who consider family medicine as the carrier option. 3. To compare the perception of family medicine as career option among the young graduates who had exposure to family medicine during their training or practice with no exposure. Materials and Methods: It is a cross-sectional, questionnaire-based study. The doctors graduated 2018 onwards were contacted through SIMSA (South Indian Medical Students Association) and WhatsApp groups (students doing the rural health service and intern WhatsApp). Subjects who consented for the study filled the google form. Filled Google forms were evaluated. Results: First choice of among the graduates is general medicine followed by general surgery and paediatrics. Family medicine is 4th in the order. There is overall a very positive perception about the family medicine among the respondents irrespective of exposure to family medicine. Majority of them feel that it gives good financial gain (55.55%), interesting (67.03%), work and family balance (75.55%), which contributes to individual and community health (84.07%) and essential part of healthcare system (83.33%). Graduates feel that career growth (26.66%) and academic growth (33.70%) are less and it is not popular (38.88%). If there is an opportunity, majority would choose family medicine (54.44%). Conclusions: Around 5.9% are open to choose family medicine as the career option. Medical graduates perceive family medicine subject to give them good work and family balance and the subject is essential part of healthcare system and contributes to the individual and community health, and at the same time, it may not give them great financial gain, academic and career growth.

Evaluation of Patients aged over 65 years who applied to Ankara Training and Research Hospital Family Medicine Outpatient Clinics: Comparison Before and After Covid-19 Pandemic

Aim: Taking into account the importance and priority of the geriatric age group, the aim of our study was to examine the reasons for and the number of visits to primary health care institutions, to compare them before and after the Covid-19 pandemic, and to draw attention to the importance of geriatric sciences in family medicine specialty training in the light of this evaluation.&#x0D; &#x0D; Materials and Methods: Patients who applied to the Ankara Training and Research Hospital (EAH) Family Medicine Outpatient Clinics between 01.03.2020-31.12.2022 constitute the population of the study. Patients were retrospectively evaluated before and after the Covid-19 pandemic according to their admission rates and diagnoses. The outpatient clinics they applied to were analyzed. Musculoskeletal system problems were analyzed under a separate heading according to diagnoses.&#x0D; Results: Out of 47014 diagnoses above the age of 65 during the pandemic period, I10 - Essential (Primary) Hypertension was the most common diagnosis, except for general medical examinations and screening examinations. In the post-Covid-19 period, 45928 diagnoses were made in 14398 patients over the age of 65. After general medical and laboratory examinations, the most common diagnose was I10 Essential Hypertension in both period. Musculoskeletal complaint during the pandemic period was the second most common with the diagnosis of M79.1 Myalgia in both period. Musculoskeletal complaints especially myalgia was more common in the pandemic period than the post-covid period (p

Examining the perceived impact of the COVID-19 pandemic on cervical cancer screening practices among clinicians practicing in Federally Qualified Health Centers: A mixed methods study.

The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs). Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic. A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women's health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement. Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future. This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.

Factors associated with adherence to provider referrals for lung cancer screening with low dose computed tomography before and during COVID-19 pandemic

BackgroundLung cancer has been the leading cause of American deaths from cancer. Although Medicare started covering lung cancer screening (LCS) with low-dose computed tomography (LDCT) in 2015, the uptake of LDCT-LCS remains low. This study examines the changes in adherence to provider referrals for LDCT-LCS and the factors at patient, provider, and health system levels that influence the completion rate of LDCT-LCS orders before and during the COVID-19 pandemic.MethodsOur study examined electronic health record data (December 2013 - December 2020) from a large, community-based clinical healthcare delivery system in California. We plotted monthly trends in the frequency of LDCT-LCS orders and completion rate and compared the annual LDCT-LCS completion rate between LCS-eligible, LCS-ineligible, and unknown eligibility groups. We then explored multilevel factors associated with the completion of LDCT-LCS orders using hierarchical generalized linear models.ResultsThere was an increase in LDCT-LCS orders (N = 12,469) from 2013 to 2019, followed by a sharp decline in March 2020 due to the onset of the COVID-19 pandemic. Thereafter, LDCT-LCS orders slowly increased again in June 2020. The completion rate of LDCT-LCS increased from 0% in December 2013 to approximately 70% in 2018–2019 but declined to 50–60% in 2020 during the pandemic. Ineligible patients had lower completion rates of LDCT-LCS. Patients who were new to the healthcare system, Black, received the LDCT-LCS order in the first few years after Medicare coverage (2016 or 2017), during the pandemic, had major comorbidities, and smoked less than 30 pack-years were less likely to complete an order. Patients were more likely to complete LDCT-LCS orders if they were younger, received the LDCT-LCS order from a physician (vs. nonphysician provider), from family medicine or other specialties (vs. internal medicine), or saw a provider with more experience in LDCT-LCS.ConclusionsThe beginning of the COVID-19 pandemic largely decreased the volume of LDCT-LCS orders, but rates have since been slowing recovering. Future interventions to improve lung cancer screening should consider doing more targeted outreach to new patients and Black patients as well as providing additional education to nonphysician practitioners and those providers with lower rates of LDCT-LCS referral orders.

Development of Practice Guidelines for Peripartum Depression in Primary Healthcare

Abstract Background Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present): 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3)Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts or 7) Psychomotor excitation or delay, that start throughout pregnancy or during the first 4 weeks postpartum respectively. Objective To develop Egyptian practice guidelines for peripartum depression in Primary Healthcare (PHC). Methods The current study was conducted thorough Delphi technique by participation of Thirteen experts at psychiatry and family medicine specialties from different governmental universities, Ministry of Health and Population (MOHP), World Health Organization (WHO) and World Organization of Family Doctors (WONCA) via email thorough three consecutive phases of Delphi technique. Results The current study recommended health education programs, provision of awareness about physical exercise’s importance for prevention of antenatal and postnatal depression, adding telephone- based peer support for the preventive measures of the antenatal depression and family therapy for the postpartum depression prevention. Screening for all the pregnant women every trimester by patient health questionnaire II and screening for all the new mothers every well child clinic visit in the first year after delivery by Edinburg Postpartum Depression Scale (EPDS). Diagnosis by beck depression inventory II questionnaire and Postpartum Depression Screening Scale (PDSS) for antenatal and postnatal depression respectively with post diagnosis evaluation for: 1) Comorbid anxiety; 2) Bipolar disorder; 3) Thoughts of harming intrauterine fetus or newborns; 4) Suicidal thoughts and 5) Psychotic features. Cognitive Behavioral Therapy (CBT) for treatment of mild cases and CBT with half dose sertraline for moderate cases of antenatal depression. Cognitive Behavioral Therapy (CBT) for mild cases, CBT and the usual dose sertraline for moderate cases with no hormonal therapy for any patient. Referral for patients with: 1) severe depression; 2) comorbid anxiety; 3) bipolar disorder; 4) thoughts of harming intrauterine fetus or newborns; 5) suicidal thoughts; 6) psychotic features; 7) substance abuse. Conclusion development of Egyptian practice guidelines for peripartum depression in PHC. Wide dissemination of the practice guidelines to all the Egyptian PHC facilities via a suitable method and training programs for the family physicians on practicing these guidelines must be ensured.

Preliminary Pilot-Testing of Intimate Partner Violence Screening for Transgender and Gender Diverse (TGD) Individuals in Med-Peds and Family Medicine.

Transgender and gender diverse (TGD) individuals, comprised of those whose gender identity does not correspond with the sex they were assigned at birth, represent approximately 1.4 million people in the U.S., with a higher prevalence among those 18-24 years old. TGD individuals experience high levels of intimate partner violence (IPV), which leads to disproportionately negative mental and physical health outcomes for this population. As a result, there is a resounding need to connect TGD populations to health-promoting services, supports and resources. Med-Peds and Family Medicine clinics may be particularly well-positioned to support these efforts due to physicians' focus on transitional-aged youth and young adults under 30. The current manuscript reports on processes and outcomes related to a quality improvement (QI) initiative that aimed to test the feasibility and acceptability of implementing IPV screening within both a Med-Peds and a Family Medicine specialty clinic serving TGD populations in Los Angeles, CA. This QI initiative included screeners that capture IPV in cisgender/non-TGD populations (Humiliation, Afraid, Rape, Kick [HARK]) as well as in TGD populations specifically (IPV-T). We utilized a mixed-methods approach to both quantify and qualify responses to existing IPV screening as well as informal feedback from clinic "champions" in each clinic. Quantitative and qualitative findings from this QI initiative, featuring both general and TGD-specific IPV screening measures with 140 TGD individuals, elucidated several important processes that can support effective IPV screening and referral to supports and services. These include the importance of interdisciplinary teams, the utility of an iterative approach to screener roll-out, and the essential role of solidifying a referral process in these efforts. This project additionally shed light on the potential utility and challenges of implementing both general and TGD-specific IPV screening measures. Our pilot test did not support the necessity of a TGD-specific IPV screener for identifying and responding to IPV in this population, yet additional data is critical to generate more conclusive recommendations. We recommend larger-scale data collection efforts to evaluate the utility of integrating general and TGD-specific screeners into clinic workflows to ensure optimal health promotion for the TGD population in Med-Peds and Family Medicine clinics.