Family Medicine Research Research Articles

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

Research interests of family physicians applying for research training

BackgroundThere is an ongoing need for research to support the practice of high quality family medicine. The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program is designed to build capacity for family medicine scientific discovery and innovation in the United States. Our objective was to describe the applicants and research questions submitted to the RapSDI program in 2019 and 2020.MethodsDescriptive analysis for applicant characteristics and rapid qualitative analysis using principles of grounded theory and content analysis to examine the research questions and associated themes. We examined differences by year of application submission and the applicant’s career stage.ResultsSixty-five family physicians submitted 70 applications to the RapSDI program; 45 in 2019 and 25 in 2020. 41% of applicants were in practice for five years or less (n = 27), 18% (n = 12) were in in practice 6–10 years, and 40% (n = 26) were ≥ 11 years in practice. With significant diversity in questions, the most common themes were studies of new innovations (n = 20, 28%), interventions to reduce cost (n = 20, 28%), improving screening or diagnosis (n = 19, 27%), ways to address mental or behavioral health (n = 18, 26%), and improving care for vulnerable populations (n = 18, 26%).ConclusionApplicants proposed a range of research questions and described why family medicine is optimally suited to address the questions. Applicants had a desire to develop knowledge to help other family physicians, their patients, and their communities. Findings from this study can help inform other family medicine research capacity building initiatives.

Ambient temperature and kidney function in primary care patients

IntroductionExposure to high ambient temperatures is associated with a risk of acute kidney injury. However, evidence comes from emergency departments or extreme weather exposures. It is unclear whether temperature-related adverse kidney outcomes can also be detected at a community level in a temperate climate zone.MethodsIn a 9.5-year retrospective cohort study we correlated estimated glomerular filtration rate (eGFR) values of Swiss adult primary care patients from the FIRE cohort (Family medicine Research using Electronic medical records) with same-day maximum local ambient temperature data. We investigated 5 temperature groups (< 15 °C, 15–19 °C, 20–24 °C, 25–29 °C and ≥ 30 °C) as well as possible interactions for patients with increased kidney vulnerability (chronic heart failure, diabetes, chronic kidney disease, therapy with renin–angiotensin–aldosterone-system (RAAS) inhibitors, diuretics or non-steroidal anti-inflammatory drugs).ResultsWe included 18,000 primary care patients who altogether provided 132,176 creatinine measurements. In the unadjusted analysis, higher ambient temperatures were associated with lower eGFR across all age and vulnerability groups. In the adjusted models, we did not find a consistent association.The highest ambient temperature differences (> 25 or > 30 versus < 15 °C) were associated with marginally reduced kidney function only in patients with ≥ 3 risk factors for kidney vulnerability, with a maximum estimated glomerular filtration rate reduction of −2.9 ml/min/1.73m2 (SE 1.0), P 0.003.DiscussionIn a large primary care cohort from a temperate climate zone, we did not find an association between ambient temperatures and kidney function. A marginal inverse association in highly vulnerable patients is of unclear clinical relevance.Graphical abstract

Infrastructure Features Associated With Increased Department Research Capacity.

Although researchers have identified factors associated with research capacity in academic medicine departments, less is known about how a department builds research capacity over time. The Association of Departments of Family Medicine's Research Capacity Scale (RCS) can be used by departments to self-categorize into five capacity levels. Our current study aimed to describe the distribution of infrastructure features and to evaluate how the addition of infrastructure features influences movement of a department along the RCS. An online survey was sent to US family medicine department chairs in August 2021. Survey questions asked chairs to categorize their department's research capacity in 2018 and 2021 and also about the presence of infrastructure resources and changes in these features across 6 years. The response rate was 54.2%. Departments identified substantial variation in research capacity. Most departments classified into the middle three levels. Departments in higher levels were more likely than those at lower levels to have any of the infrastructure resources in 2021. Department size, as measured by full time faculty, was highly associated with department level. From 2018 and 2021, 43% of responding departments climbed at least one level. Of these, more than half added three or more infrastructure features. Adding a PhD researcher was the feature most associated with increasing research capacity (P&lt;.001). Most departments that increased their research capacity added multiple additional infrastructure features. For chairs of departments without a PhD researcher, this additional resource may be the most impactful investment to increase research capacity.

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

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

Toward a Unified and Collaborative Future: Creating a Strategic Plan for Family Medicine Research.

Toward a Unified and Collaborative Future: Creating a Strategic Plan for Family Medicine Research.

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

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

Fostering clinical research in general practice and family medicine. Selected abstracts from the 93rd EGPRN conference Halle, Germany, 14–17 October 2021

Fostering clinical research in general practice and family medicine. Selected abstracts from the 93rd EGPRN conference Halle, Germany, 14–17 October 2021