Family Medicine Practice Research Articles

Editors' Picks: Top 10 Diversity, Equity, Inclusion, and Antiracism Papers in Family Medicine Journals.

Physicians within the family medicine workforce are the most diverse compared to other medical specialties in both primarily clinical and academic settings. Family physicians also provide care to the most diverse patients and communities across the United States. As such, research and scholarly work from family physicians on diversity, equity, inclusion, and antiracism (DEIA) can be incredibly impactful. Yet many practicing and teaching physicians are unaware of their colleagues' scholarly DEIA work, which aims to elucidate inequities and barriers to optimal care and, importantly, to educate on ways physicians and learners can recognize and address specific needs of patients and communities marginalized by health care policies and practices. In collaboration with editors from several family medicine journals, the authors move beyond the traditional editorial space to share recent practice-changing and innovative articles, adding voice and momentum to improve DEIA efforts in all spaces where the practice and teaching of family medicine exists.

Priority of competencies in the professional activities of general practitioners (family doctors)

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Impact of a diabetic retinal exam screening program on quality measure gaps at a family medicine practice

BackgroundDiabetic retinopathy is a common complication in people with diabetes, and annual screening is recommended by the American Diabetes Association. This annual exam is also a Health Effectiveness Data and Information Set quality measure. Barriers such as lack of access to healthcare or cost of specialist visits may impact the number of patients who receive these exams. ObjectiveThe objective of this study is to describe the impact of a diabetic retinal exam screening program at a rural family medicine center on the number of quality measure gaps resolved. Practice descriptionThis study occurred at a rural family medicine center in southwestern Pennsylvania with a medically underserved patient population. A pharmacist at the site holds board certifications in Advanced Diabetes Management and as a Diabetes Care and Education Specialist and manages diabetes through a collaborative practice agreement. Practice innovationA regional Medicaid plan provided a list of patients with a quality measure gap for an annual diabetic retinal exam and loaned a RetinaVue 700 Imager to take retinal photos. After screening eligible patients via phone, retinal exams were administered by student pharmacists and medical assistants to consenting patients over the course of 9 days. Images were then sent to an ophthalmologist to be interpreted. Evaluation methodsThe rate of quality measure gaps closed and satisfaction survey results are reported using descriptive statistics. ResultsA total of 61 patients were included in the analysis. This program closed quality measure gaps for 11 (18.0%) patients who were able to receive an in-office eye exam. ConclusionThis pilot project shows that offering in-office diabetic retinal exams may be an effective strategy to close quality measure gaps and provide access to screening among a medically underserved population.

The Day I Almost Walked Away: Trust, Gratitude, and the Power of Teamwork.

Practicing family medicine is really hard; the emotional toll of sharing patients' distress, vulnerability, and trauma can build up and become overwhelming. A family physician experienced such a moment during one particularly complex morning. Feeling nearly ready to walk out of patient care, she reached out to the team nurse, who helped her get through the moment and re-engage with the waiting patients. Sharing vulnerability in the moment, and later reflecting and deciding to write about it shows the power of prioritizing teamwork in practice.

Exploring the link between leptin levels and metabolic syndrome in elderly Indian patients: Implications for family medicine and primary care practices.

The metabolic syndrome (MetS), according to the Adult Treatment Panel III of the National Cholesterol Education Programme, is a collection of metabolic abnormalities that includes one, two, or all three of the following traits: obesity in the abdomen, dyslipidemia, hypertension, fasting blood sugar, or insulin resistance. This study's aim was to assess the relationship between fasting serum leptin and MetS in elderly adults with T2DM in the Northern Indian population. The following information was collected from all the participants: (1) anthropometric data, (2) biochemical data, and (3) a lifestyle questionnaire on sociodemographic data, dietary practices, smoking, and alcohol intake to identify their risk factors for diabetes mellitus, CVD, and hypertension. A total of 36 older participants (56.30%) had a history of hypertension, while 29 elderly participants (44.61%) had diabetes mellitus. A total of 32 elderly participants (49.2%) had MetS, and this group had higher serum leptin (P 0.003), body weight (P = 0.019), BMI (P 0.001), waist circumference (P 0.001), CRP (P = 0.021), insulin (P = 0.001), and HOMA-IR (P = 0.003) values as well as higher percentages of females (P = 0.001), and those with type 2 diabetes mellitus (P = 0.002) and hypertension (P = 0.039) than those in the non-MetS group. In older persons with T2DM, our study discovered a favorable correlation between serum leptin and MetS. It can act as a standalone indicator of MetS, offering a way to spot populations at risk for associated consequences and enabling early intervention.

Leveraging an Electronic Health Record Patient Portal to Help Patients Formulate Their Health Care Goals: Mixed Methods Evaluation of Pilot Interventions.

Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption. The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians. The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website's questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians. In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care. Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care.

Advice to future family physicians: findings from qualitative interviews with family medicine residents and early-career family physicians

BackgroundCanadians continue to report challenges accessing primary care. Practice choices made by primary care providers shape services available to Canadians. Although there is literature observing family medicine practice trends, there is less clarity on the reasoning underlying primary care providers’ practice intentions. Advice offered by residents and early-career family physicians may reveal challenges they have experienced, how they have adapted to them, and strategies for new residents. In this paper, we examine advice family medicine residents and early-career family physicians would give to new family medicine residents.MethodsSixty early-career family physicians and thirty residents were interviewed as part of a mixed-methods study of practice patterns of family medicine providers in Canada. During qualitative interviews, participants were asked, “what advice would you give [a new family medicine resident] about planning their career as a family physician?” We inductively analyzed responses to this question.ResultsAdvice consisted of understanding the current climate of family medicine (need for specialization, business management burden, physician burnout) and revealed reasons behind said challenges (lack of support for comprehensive clinic care, practical limitations of different practice models, and how payment models influence work-life balance). Subtheme analyses showed early-career family physicians being more vocal on understanding practical aspects of the field including practice logistics and achieving job security.ConclusionMost advice mirrored current changes and challenges as well as revealing strategies on how primary care providers are handling the realities of practicing family medicine. Multi-modal systemic interventions may be needed to support family physicians throughout the changing reality of family medicine and ensure family medicine is an appealing specialty.

PROMOTE: An Innovative Curriculum to Enhance the Maternity Care Workforce.

Maternal morbidity and mortality disproportionally affect marginalized populations in both rural and urban settings. While the workforce of family physicians (FPs) who provide maternity care is declining, an enhanced obstetrics (OB) curriculum during residency training can help prepare future FPs to provide competent pregnancy care, particularly in marginalized communities. We developed an innovative OB curriculum-PROMOTE: Primary care obstetrics and maternal outcomes training enhancement-in an urban underserved residency program in Pennsylvania that directly addressed barriers previously known to impact maternity care practice. We created a clinical competency assessment aligned with Accreditation Council for Graduate Medical Education requirements, and we reviewed resident feedback and logs throughout and upon completion of the track. After 3 years of implementation, 23 of 48 (48%) total residents entered and/or completed PROMOTE, compared to 17 of 45 (38%) total residents who chose the OB track in the 5 years prior to implementation. Postimplementation, 29.6% of total graduates practice inpatient obstetrics, compared to 26.6% prior to implementation. Twice annual competency evaluations were completed for all residents on the track. Our review of resident submitted feedback, logs, and competency assessments suggests that the curriculum has positively impacted their knowledge, skills, and clinical care provision. PROMOTE's curricular innovation enhances obstetrical training by addressing known facilitators and barriers to practicing family medicine obstetrics. PROMOTE was implemented in an existing family medicine residency with an obstetrics track and could be adapted by other residency programs to enhance the future maternity care workforce.

SOCIO-DEMOGRAPHIC AND CLINICAL PREDICTORS OF FAILURE TO ACHIEVE THE TARGET LEVEL OF BLOOD PRESSURE IN OUTPATIENTS WITH ISOLATED ARTERIAL HYPERTENSION AND IN COMBINATION WITH CARDIOVASCULAR COMORBIDITY

The problem of achieving the target level of blood pressure (TBP) is extremely relevant today, as arterial hypertension (AH) is the leading modifiable risk factor for cardiovascular complications.The aim of the study is to investigate the relationships between achievement/failure of TBP and socio-demographic and clinical characteristics in outpatients with isolated AH and in combination with cardiovascular comorbidity and to determine probable predictors of failure to achieve TBP.Material and methods. The study was carried out on the basis of the municipal non-profit enterprise “Gulsk outpatient clinic for general practice of family medicine” of the Strievsky village council, the village of Striyevo, Zvyagelsky district, Zhytomyr region The study involved 140 patients with AH, divided into three groups: isolated AH (n=60), AH+coronary heart disease (CHD) (n=35), AH+CHD+chronic heart failure (HF) (n=45). Patients were considered to have achieved the TBP if their office BP was <140/90 mm Hg when measured twice with an interval of 1 month.Results. The absence of statistically significant changes according to achievement/failure of TBP between outpatients with isolated AH and AH with cardiovascular comorbidity (χ2=3.37; p=0.185) was revealed, while in the group with isolated AH 65.00%, in the group with AH + CHD – 45.71%, in the group of AH + CHD + HF – 57.78% of people did not reach the TBP. Analyzing the relationships between the achievement/failure of TBP and age, gender, social status and modifiable risk factors (smoking, alcohol abuse and salt abuse), statistically significant differences were found only in relation to salt abuse in outpatients with AH and cardiovascular comorbidity (in the group of AH + CHD 100.00%, and in the group AH + CHD + HF 96.15% of people who abuse salt did not reach the TBP). The results of the logistic regression analysis showed that the female gender is by 4.1 times more likely to be associated with failure to achieve TBP compared to the male gender in the group with isolated AH, by 3.5 times – in the group of AH+CHD, by 3.4 times – in the group of AH+CHD+HF; salt abuse increases the risk of not reaching the TBP in the group with isolated AH by 19.4 times; by 20.8 times – in the group of AH + CHD; by 21.1times – in the group of AH + CHD + HF. Analyzing the relationship between achievement/failure of TBP and clinical characteristics of outpatients with isolated AH, the duration of the disease in persons who did not reach TBP is 2.0 times longer than the catamnesis of persons who reached TBP (p<0.001); the degree and stage of arterial hypertension significantly affects achievement/failure of TBP (χ2=22.27; p<0.001 and χ2=7.66; p=0.022, respectively). The results of the logistic regression analysis show that an increase in BP (in particular, each subsequent degree of AH) is more often associated with failure to achieve TBP both in patients with isolated AH and in patients with AH and cardiovascular comorbidity: by 2.7 times in the group with isolated AH; by 2.8 times in the group of AH + CHD; by 3.0 times – in the group of AH+CHD+HF.Conclusions. Female gender, salt abuse, and the degree of AH are statistically significant factors associated with an increased risk of not reaching the target blood pressure level both in outpatients with isolated AH and in patients with AH combined with cardiovascular comorbidity.

Communication quality predicts patients’ colorectal cancer screening behavior

The purpose of the present study was to investigate the quality of patient/clinician communication as one potential factor that impacts colorectal cancer screening behavior. As part of a larger randomized controlled trial conducted between 2011 and 2016 in the setting of community and academic family medicine or internal medicine practices in Michigan, USA, patients completed a pre-encounter survey, completed their regularly scheduled visit with their primary care clinician (which was audio-recorded), completed a post-encounter survey, and allowed 6-month follow-up chart audit. We trained 10 coders to rate 216 of the audio-recorded conversations between 216 patients and their primary care physicians for 6 specific features of communication quality (using 7-point scales), including the extent to which participants enacted attention to medical content, engagement, emotional expression, relationships, face, and accommodation. At least 3 coders rated each conversation, and intraclass correlations (i.e., reliability assessment) were in the good to excellent range. We found that patient and clinician attention to face (an identity goal) was a significant predictor of colorectal cancer screening at 6 months follow up. Measuring communication in terms of attention to multiple goals reveals unexpected findings about the aspects of communication that impact colorectal cancer screening behavior. The focus of many interventions to improve colorectal cancer screening rates is on the content (i.e., task goals) of clinicians' communication (such as presenting the different options for screening), yet the content of communication was not a significant predictor of screening in the present study. Rather, clinicians' and patients’ attention to identity goals predicted screening behavior, which suggests that interventions may not need to be overly complex and that simply improving the quality of attention to identity goals in clinician communication might be one of the most straightforward yet impactful ways to improve colorectal cancer screening uptake among patients.

Predictors of a positive attitude towards rural practice in female osteopathic medical students.

Women outnumber men in medical school. Given the growing need for rural physicians and the underrepresentation of women in rural medicine, understanding predictors of rural practice among female students is imperative for addressing future healthcare workforce shortages in rural areas. Utilizing current evidence, medical schools should seek to admit students with a rural background and interest in pursuing a primary care specialty; however, whether this holds true for female osteopathic medical students is unknown. This study aims to determine if a rural background, a plan to practice family medicine, and motivation toward civic duty are associated with attitudes toward eventual practice of rural medicine in female osteopathic medical students. An anonymous online survey was administered to actively enrolled female students at Arkansas Colleges ofHealth Education College of Osteopathic Medicine. The survey assessed the respondents' presence of a rural background, degree of civic-mindedness, intention to practice family medicine, and attitudes to rural work and life. Demographics of ethnicity and year of study in medical school were also collected. In total, 129 students responded to the survey, with 97 complete responses for analysis. Hierarchical regression was utilized to compare nested models and interpret interactions. Of the 97 survey respondents, 34.0 % described themselves as first-year students, 37.1 % as second-year students, 16.5 % as third-year students, and 12.4 % as fourth-year students. Linear regression modeling indicated that for female medical students at Arkansas Colleges of Health Education, having a rural background had no relationship with their attitude toward practicing in a rural setting, β=-0.97, standard error (SE)=1.96, t=-0.49, p>0.05, CI [-4.86, 2.92]. Civic-mindedness had a positive relationship with their attitude toward practicing in a rural setting, β=0.17, SE=0.07, t=2.44, p=0.016, CI [0.03, 0.31], accounting for 4.57 % of its variance. Plan to practice family medicine was positively associated with a student's attitude toward practicing in a rural setting, β=4.38, SE=0.85, t=5.15, p<0.001, CI [2.69, 6.07], accounting for 20.25 % of its variance. Civic-mindedness appeared to moderate the relationship between planning to practice family medicine and attitudes toward practicing in a rural setting, F(1, 91) = 3.91, p=0.05, R 2=0.31. The p value for this interaction term was 0.05, but its effect size measure and graphical representation revealed a substantive effect. The regression analysis showed that, for thewomen in this study, the greater the student's civic-mindedness, the more favorable her attitude toward practicing in a rural setting. Additionally, the stronger thestudent's plan to practice family medicine, the more favorable her attitude toward eventual rural practice was. Lastly, the student's civic-mindedness influenced the predictive value of having a plan to practice family medicine.

I Think, Therefore I Am: A Reflection of Family Nurse Practitioners

&lt;p&gt;隨著台灣人口老化和社區醫療照護需求增加，在原本的內外婦兒、精神和麻醉專科護理師外應運而生「家庭專科護理師」，從傳統的急性照護邁向基層照護，更多的在門診、社區、居家、長照、偏鄉離島等場域提供民眾專業健康照護服務。本文從簡介國人健康形態的轉變延伸到對家庭專科護理師的需求、發展與培育，以國立陽明交通大學為例，分享家庭專科護理師養成的核心能力架構，並佐以核心訓練理念，達到：全生命歷程轉銜（從新生兒到老人）、急慢性疾病無縫接軌（照護能力養成）、醫護進階合作、國際領航訓練和無邊界學習擴充（線上虛擬實境），同時配合學生過去的教育背景（有無專科護理師碩士學位）提供完整或是轉銜家庭專科護理師訓練，讓學習更有效率。期待家庭專科護理師不僅僅是第一線的民眾健康照護提供者，更是具有國際觀和科技識能的進階護理專家。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Taiwan is going to be a super-aged society and has increased needs of primary care providers. There-fore, the demand for family nurse practitioners (FNPs) is expected high and strong in addition to the roles in medical, surgical, women health, pediatric, psychological, and anesthetic areas that nurse practitioners have contributed in Taiwan. FNPs are specialized in providing preventative and primary care to individuals and families across the lifespan in various care settings, including primary care clinics, family medicine practice, urgent care centers, long-term care facilities, home health agencies or in the places where medical services needed. National Yang Ming Chiao Tung University&amp;rsquo;s FNP master program emphasizes hands-on, real-life care in meeting all core competence requirements across the lifespan from infants to the elderly, from acute illness to chronic diseases, physician-nurses advanced collaborations, international visits and virtual education. We expect that our FNP graduates have the competence and confidence in their clinical practices and leading the advanced nursing prac-tice with global vision and technology skills in the new era&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Bipolar disorder in the practice of family medicine

In recent years, the subject of discussion among world psychiatrists has been the issue of the large spread of mental illnesses among the population, including bipolar disorder, its diagnosis and modern principles of therapy. It is known that bipolar affective disorder (BAR) is more common for young and able-bodied people, while their usual state is replaced by an alternation of severe depression and mania with episodes of even background mood. It is also worth noting that the BAR is often associated with suicidal thoughts, disability and a tendency to alcoholism. This problem can be stopped by effective therapy initiated in a timely manner and return a person to his usual life, therefore, the study of this issue carries a high social significance.

Family medicine viewed through the public lens: A national cross-sectional study in Lebanon.

Family medicine (FM) is a medical specialty that provides continuing, comprehensive health care for the individual and the family. This study aimed to describe Lebanese citizens' knowledge, attitudes, and practices toward FM as a specialty. This is a national cross-sectional phone-based survey targeting the knowledge of the public about FM and its scope of practice. Questions were asked whether participants had primary health care doctors and their specialties. A total of 373 participants were included, with a response rate of 85.2%. Two-thirds were aware of the specialty of FM, while only 16.6% of the participants had previously visited a family physician. Most participants (69.7%) had a doctor they regularly consulted. One-third of participants had a general practitioner as their regular doctor. More than 80% of the participants agreed that FM physicians treat all family members with common and chronic diseases. Around 60% to 75% of participants knew that family physicians provide medical care to children, treat patients with psychiatric impairments, and perform minor surgeries. There was a significant gap in the participants' knowledge of FM physicians' role in managing obstetric or gynecologic patients. Despite public awareness of FM, limited understanding and system challenges hinder its utilization in Lebanon. Educational campaigns, government-supported FM practices, and collaborations with public health initiatives are crucial to bridging the knowledge gap and establishing FM as the cornerstone of primary care. This knowledge gap challenges the specialty's identity and necessitates promoting FM as the cornerstone of primary care, potentially requiring a system-wide endorsement.

The Premier Medical Education Model: Improving Preceptor Recruitment in Underserved Areas.

Building on research highlighting the success of tribal, rural, and underserved clerkships to increase students' intention to practice family medicine in these areas, we explored the perspectives of prospective precepting physicians and administrators to develop an optimal structure to facilitate recruitment of external preceptors. We conducted semistructured interviews with family physicians (N=14) and health system administrators (N=14) working in tribal, rural, and underserved areas. Discussions were recorded, transcribed verbatim, and coded independently by two researchers. Applying rapid assessment qualitative research methods, we used a framework method to identify emergent themes that were applied to improve the recruitment of external preceptors. Physicians identified key facilitating factors and barriers to serving as a preceptor, which paralleled those common within the existing literature. However, administrators were motivated to serve as a precepting site to increase the potential of recruiting future physicians. We developed the Premier Medical Education Hub model to align these different but compatible interests with the goal to increase preceptor participation. In this model, each host site dedicates staff and adopts standardized procedures to manage rotations, hosts at least five students annually, provides housing, has procedures to facilitate electronic health record access, and offers student immersion experiences. As practice ownership shifts from physician-owned to health system ownership, administrators become the gatekeepers for prospective preceptors. Our findings demonstrate that integrating the compatible interests between physicians and administrators allows for the creation of a synergistic model that facilitates preceptor recruitment.

Artificial Intelligence and Family Medicine.

Artificial intelligence (AI) is certainly going to have a large, potentially huge, impact on the practice of family medicine. The specialty is fortunate to have leading experts in the field to guide us along the way. One such team of forward thinkers provides insights into where AI can take the specialty. Another article reports on how well AI performed on the American Board of Family Medicine In-Training Examination. In addition to AI, we have 3 articles that investigate the intersection of social needs and the practice of medicine. Four clinical review articles cover nonalcoholic fatty liver disease, headache treatments, single maintenance and reliever therapy for asthma, and the use of cannabis in the setting of chronic pain. The clinical research articles cover point-of-care hemoglobin A1c testing, continuous glucose monitoring, and screening for HIV. Another group of articles examines the profession of family medicine, covering topics ranging from how women family physicians negotiate their first jobs to the words we use to define primary care.

Hepatitis-B immune status and vaccination in Family Medicine Practice: A retrospective study.

To examine the relationship between Hepatitis B vaccination status and demographic and hepatitis B markers of individuals receiving healthcare services. The study designed in a retrospective structure using quantitative research methods was conducted with a total of 1837 individuals including medical school students and other healthcare professionals (975 female, 862 male) aged 19-77 who were registered to the Family Health Center between March 1, 2023, and March 31, 2023. In the study, sociodemographic characteristics, infancy and adult full-dose hepatitis-B vaccines, and marker laboratory measurements of these individuals who were registered to the Family Health Center were examined. SPSS 25.00 program was used for statistical analysis and the level of significance was determined as 0.05. In general, the rate of three doses of vaccination in infancy was 55.1%. Vaccine doses administered to individuals were one with 15.1%, two with 22.9%, and three with 62.1%. In the study, it was determined that anti-HBs levels before and after vaccination differed significantly according to vaccine doses (p=0.01). It was determined that the anti-HBs levels of the three doses vaccine group were 100 and above (p=0.01). Although the Universal Hepatitis-B Vaccination Program was followed in our study, it was determined that antibody levels in healthcare workers decreased or ended over time, and hepatitis-B antibody levels increased significantly with each dose of vaccine administered. For this reason, it is of great importance to determine regular antibody levels and develop standard vaccination programs, especially in healthcare workers.

Rhythm and Conduction disturbances in patients with COVID-19 and their significance in family medicine practice

Rhythm and Conduction disturbances in patients with COVID-19 and their significance in family medicine practice

Asynchronous online training increased knowledge, confidence, and intent to screen and treat substance use disorders among primary care clinicians practicing in Texas

IntroductionDespite increasing prevalence of substance use disorders (SUD), few patients are diagnosed and treated in primary care settings. This study evaluated changes in knowledge, confidence, and intention to implement screening and brief intervention (SBI) and SUD treatment after clinicians participated in an asynchronous online education course. MethodsA self-selected sample of primary care clinicians in Texas participated in online SBI and SUD education March 2021–July 2023. Baseline and post-training surveys evaluated changes in knowledge, confidence, and intent to implement SBI and SUD treatment. Changes were compared using paired t-tests. Multivariable linear regression examined factors potentially associated with confidence and intention to implement changes. Clinician feedback regarding the course was included. ResultsOf 613 respondents, 50.9% were practicing family medicine clinicians. Knowledge of adolescent screening tools increased from 21.9% to 75.7% (p < 0.001). Knowledge about the number of drinks that define excessive drinking among non-pregnant women increased from 24.5% at baseline to 64.9% (p < 0.001). Clinicians reported lowest confidence in providing opioid use disorder pharmacotherapy, which improved after program participation. Intent to implement SBI and medication for alcohol, nicotine and opioid use disorders increased (p < 0.001) after training. No factors were associated with change in confidence or intention to implement in multivariable models (p > 0.05). Satisfaction was high and nearly 60% reported intention to change their clinical practice because of the program. ConclusionKnowledge, confidence, and intent to implement SBI and SUD treatment increased after completing the online course. Clinician satisfaction was high and demonstrated improved intention to implement SBI and SUD treatment.

Remote Blood Pressure Monitoring With Social Support for Patients With Hypertension

Hypertension management has traditionally been based on office visits. Integrating remote monitoring into routine clinical practices and leveraging social support might improve blood pressure (BP) control. To evaluate the effectiveness of a bidirectional text monitoring program focused on BP control and medication adherence with and without social support in adults with hypertension. This randomized clinical trial included adults aged 18 to 75 treated at an academic family medicine practice in Philadelphia in 2018 and 2019. Patients had been seen at least twice in the prior 24 months and had at least 2 elevated BP measurements (>150/90 mm Hg or >140/90 mm Hg for patients aged 18-59 years or with diabetes or chronic kidney disease) during visits. All participants had a cell phone with text messaging, offered at least 1 support partner, and were taking maintenance medications to treat hypertension. Patients were randomized 2:2:1 to remote monitoring of BP and medication adherence (RM), remote monitoring of BP and medication adherence with feedback provided to a social support partner (SS), or usual care (UC). Data were analyzed on an intention-to-treat basis between October 14, 2019, and May 30, 2020, and were revisited from May 23 through June 2, 2023. The RM and SS groups received an automatic home BP monitor, 3 weekly texts requesting BP measurements, 1 weekly text inquiring about medication adherence, and a weekly text with feedback. In the SS arm, support partners received a weekly progress report. The UC group received UC through their primary care practice. Clinicians caring for the patients in the intervention groups received nudges via electronic health records to adjust medications when 3 of 10 reported BP measurements were elevated. Patients were followed up for 4 months. The primary outcome was systolic BP at 4 months measured during the final follow-up visit. Secondary outcomes included achievement of normotension and diastolic BP. In all, 246 patients (mean [SD] age, 50.9 [11.4] years; 175 females [71.1%]; 223 Black individuals [90.7%] and 13 White individuals [5.3%]) were included in the intention-to-treat analysis: 100 patients in the RM arm, 97 in the SS arm, and 49 in the UC arm. Compared with the UC arm, there was no significant difference in systolic or diastolic BP at the 4-month follow-up visit in the RM arm (systolic BP adjusted mean difference, -5.25 [95% CI, -10.65 to 0.15] mm Hg; diastolic BP adjusted mean difference, -1.94 [95% CI, -5.14 to 1.27] mm Hg) or the SS arm (systolic BP adjusted mean difference, -0.91 [95% CI, -6.37 to 4.55] mm Hg; diastolic BP adjusted mean difference, -0.63 [95% CI, -3.77 to 2.51] mm Hg). Of the 206 patients with a final BP measurement at 4 months, BP was controlled in 49% (41 of 84) of patients in the RM arm, 31% (27 of 87) of patients in the SS arm, and 40% (14 of 35) of patients in the UC arm; these rates did not differ significantly between the intervention arms and the UC group. In this randomized clinical trial, neither remote BP monitoring nor remote BP monitoring with social support improved BP control compared with UC in adults with hypertension. Additional efforts are needed to examine whether interventions directed at helping patients remember to take their BP medications can lead to improved BP control. ClinicalTrials.gov Identifier: NCT03416283.