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.

Headache Treatment Options.

Family medicine physicians often see headache as the chief complaint when meeting patients within their practice. The goal is to try different treatment modalities without having to send the patient to a specialist. Headaches affect different individuals during their lifetime. Before any treatment begins, it is best that one rules out possible causes of the headache, for example, drug interactions or structural cerebrum conditions. Nonpharmacological treatment is recommended first before attempting a stepwise approach to cost-effective pharmacological treatment options. Pharmacological treatment options should include preventive and on-demand options. A family physician has all the resources to assist patients with different types of headaches.

Family Medicine Must Prepare for Artificial Intelligence.

Artificial Intelligence (AI) is poised to revolutionize family medicine, offering a transformative approach to achieving the Quintuple Aim. This article examines the imperative for family medicine to adapt to the rapidly evolving field of AI, with an emphasis on its integration in clinical practice. AI's recent advancements have the potential to significantly transform health care. We argue for the proactive engagement of family medicine in directing AI technologies toward enhancing the "Quintuple Aim."The article highlights potential benefits of AI, such as improved patient outcomes through enhanced diagnostic tools, clinician well-being through reduced administrative burdens, and the promotion of health equity by analyzing diverse data sets. However, we also acknowledge the risks associated with AI, including the potential for automation to diverge from patient-centered care and exacerbate health care disparities. Our recommendations stress the need for family medicine education to incorporate AI literacy, the development of a collaborative for AI integration, and the establishment of guidelines and standards through interdisciplinary cooperation. We conclude that although AI poses challenges, its responsible and ethical implementation can revolutionize family medicine, optimizing patient care and enhancing the role of clinicians in a technology-driven future.

Aborder les troubles liés à la chaleur.

OBJECTIF: Décrire les troubles liés à la chaleur et présenter des stratégies de traitement en pratique familiale. SOURCES DE L'INFORMATION: Une recension à l'aide des expressions MeSH en anglais heat-related illness et primary care a été effectuée dans PubMed. Les essais cliniques, les évaluations de la pratique et les revues systématiques ont été inclus dans la présente révision. Les listes de références ont été examinées pour trouver des articles additionnels. MESSAGE PRINCIPAL: Les épisodes de canicule augmentent en fréquence en raison du changement climatique et peuvent directement causer un épuisement dû à la chaleur, un coup de chaleur ou la mort. L'exposition à la chaleur extrême peut aussi exacerber les problèmes de santé sous-jacents. Les patients peuvent être à risque accru d'un trouble lié à la chaleur à cause d'une sensibilité sous-jacente ou d'une plus grande exposition à la chaleur, ou encore en raison d'obstacles pour accéder aux ressources. CONCLUSION: Les médecins de famille peuvent aider à prévenir les troubles liés à la chaleur en identifiant les patients qui sont à risque plus élevé et en plaidant en faveur d'interventions qui réduisent le risque de tels troubles.

Relationship Between Blood Pressure Control and Self-Care Practices Among Hypertensive Patients Attending Family Medicine Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: Hypertension is one of the most prevalent chronic diseases worldwide and poses a global health challenge. Self-care practices are essential for blood pressure control and reduction of complications of hypertension such as cardiovascular and renal diseases. AIM: The study aimed to assess the relationship between blood pressure control and hypertension self-care practices among hypertensive patients attending the Family Medicine clinic of Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. METHODOLOGY: A descriptive, hospital-based, cross-sectional study was conducted among 407 hypertensive patients attending the outpatient clinic. The participants were recruited using systematic sampling with a sampling interval of 1 in 4. An interviewer-administered questionnaire was used to obtain relevant data. Data analysis was performed using SPSS version 23. RESULTS: A total of 407 participants were enrolled in the study. In this study, 56.8% of the participants had good blood pressure control. On hypertension self-care practices, only 1 % of the participants adhered to low salt diet; 45% adhered to recommended physical activity; 52.8% adhered to weight management; 71.5% had good medication adherence; 93.9% abstained from alcohol and 96.8% of participants abstained from smoking. Overall, none of the domains of hypertension self-care practice was associated with blood pressure control even though there was a trend that those who adhered to the domains of self-care practice had better blood pressure control. CONCLUSION: Hypertension self-care practice among participants could be better. Participants who had good self-care practice had better blood pressure control however; this was not statistically significant.

CONTEXTE: L'hypertension est l'une des maladies chroniques les plus répandues dans le monde et représente un défi de santé publique mondial. Les pratiques d'autosoins sont essentielles pour contrôler la pression artérielle et réduire les complications de l'hypertension telles que les maladies cardiovasculaires et rénales. OBJECTIF: L'étude visait à évaluer la relation entre le contrôle de la pression artérielle et les pratiques d'autosoins de l'hypertension chez les patients hypertendus fréquentant la clinique de médecine familiale de l'hôpital universitaire d'enseignement de l'État de Lagos (LASUTH), Lagos, Nigéria. MÉTHODOLOGIE: Une étude descriptive, hospitalière, transversale a été menée auprès de 407 patients hypertendus fréquentant la clinique externe. Les participants ont été recrutés en utilisant un échantillonnage systématique avec un intervalle d'échantillonnage de 1 sur 4. Un questionnaire administré par un intervieweur a été utilisé pour obtenir les données pertinentes. L'analyse des données a été effectuée à l'aide de SPSS version 23. RÉSULTATS: Un total de 407 participants ont été inclus dans l'étude. Dans cette étude, 56,8 % des participants avaient un bon contrôle de la pression artérielle. En ce qui concerne les pratiques d'autosoins de l'hypertension, seulement 1 % des participants adhéraient à un régime pauvre en sel ; 45 % adhéraient à l'activité physique recommandée ; 52,8 % adhéraient à la gestion du poids ; 71,5 % avaient une bonne observance médicamenteuse ; 93,9 % s'abstenaient d'alcool et 96,8 % des participants s'abstenaient de fumer. Dans l'ensemble, aucun des domaines des pratiques d'autosoins de l'hypertension n'était associé au contrôle de la pression artérielle, même s'il existait une tendance selon laquelle ceux qui adhéraient aux domaines des pratiques d'autosoins avaient un meilleur contrôle de la pression artérielle. CONCLUSION: Les pratiques d'autosoins de l'hypertension chez les participants pourraient être améliorées. Les participants qui avaient de bonnes pratiques d'autosoins avaient un meilleur contrôle de la pression artérielle, mais cela n'était pas statistiquement significatif. MOTS CLÉS: Hypertension, Contrôle de la pression artérielle, Pratiques d'autosoins, Gestion du mode de vie.

Approach to heat-related illness.

OBJECTIVE: To describe heat-related illness and provide approaches for treatment in family practice. SOURCES OF INFORMATION: The MeSH terms heat-related illness and primary care were searched in PubMed. Clinical trials, practice reviews, and systematic reviews were included in this review. Reference lists were reviewed for additional articles. MAIN MESSAGE: Extreme heat events are increasing in frequency due to climate change and can directly result in heat exhaustion, heat stroke, or death. Exposure to extreme heat also exacerbates underlying health conditions. Patients may be at increased risk of heat-related illness because of underlying sensitivity to heat, increased exposure to heat, or barriers to resources. CONCLUSION: Family physicians can help prevent heat-related illness by identifying and counselling patients who are at increased risk and by advocating for interventions that reduce the chance of heat-related illness.

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.

Contraception Initiation after Early Abortion in a Family Medicine Setting: A Retrospective Chart Review.

OBJECTIVES: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office. METHODS: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status. RESULTS: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%). CONCLUSIONS: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.

Otology: Vertigo.

Vertigo, an unexpected feeling of self-motion, is no longer characterized simply by symptom quality but by using triggers and timing. Evaluating vertigo by triggers and timing not only distinguishes serious central causes from benign peripheral causes, but also narrows the differential diagnosis by further classifying vertigo as spontaneous episodic vestibular syndrome, triggered episodic vestibular syndrome, or acute vestibular syndrome. A targeted physical examination can then be used to further delineate the cause within each of these three vestibular categories. Neuroimaging and vestibular testing are not routinely recommended. In the management of vertigo, vestibular hypofunction can be treated with vestibular rehabilitation, which can be self-administered or directed by a physical therapist. Pharmacotherapy sometimes is indicated for vertigo based on triggers, timing, and the specific condition, but it is not always beneficial and is used more often for symptom reduction than as a cure. Transtympanic corticosteroid or gentamicin injections are recommended for patients who do not benefit from nonablative therapy. Surgical ablative therapy is reserved for patients who have not benefited from less definitive therapy and have nonusable hearing.

"A day in the life" - telemedicine in family medicine and its relationship with practicing physicians' satisfaction: a cross-sectional study.

BACKGROUND: Telemedicine has expanded rapidly in recent years, and many encounters that were conducted in person now take place remotely. This study aimed to assess primary care physicians' (PCPs) attitudes towards the different modalities of patient care. METHODS: This is a cross-sectional nationwide descriptive study conducted in Israel. We asked PCPs to document an entire workday and answer a short questionnaire after each visit. The questions addressed the type of visit (face-to-face, remote synchronous [telephone/video], or remote asynchronous [online requests]), the perceived quality of the visit, and the physicians' feelings at the end of each visit. Before documenting their working day, we asked the participants to answer a questionnaire about their general attitudes toward different modalities of medical visits and how they affect their well-being and burnout. RESULTS: Sixty physicians documented 2,025 visits, of which 39% took place in person, 36% stemmed from online patient requests, 18% were telephone meetings, < 1% were video meetings, and 6% consisted of other types of contact. Mixed effects logistic regressions were used to model the visits' evaluation. The odds ratios (ORs) for perceived medical quality of visits focused on medical tasks were lower for non-face-to-face visits: OR = 0.39, 95% CI 0.25-0.59 for remote synchronous, and OR = 0.14, 95% CI 0.09-0.23 for remote asynchronous. The perceived medical quality of visits focused on administrative tasks was lower for remote asynchronous than for face-to-face visits (OR = 0.31, 95% CI 0.14-0.65). We found no association between medical quality and patients, physicians, or clinic characteristics. The inappropriateness of the visit modality was also associated with lower medical quality (OR = 0.13, 95% CI 0.09-0.18). We found a correlation between perception of medical quality and physicians' feelings at the end of the visits, Spearman's r = 0.82 (p < 0.001). CONCLUSIONS: A substantial portion of the visits was dedicated to administrative tasks and remote medicine. In comparison, physicians rated face-to-face visits' quality higher than remote visits. Policymakers should intervene to minimize administrative work, reduce PCPs' administrative workload, and direct patients to the optimal visit modality for their complaints. These steps would increase medical quality, reduce burnout, and mitigate the shortage of PCPs.

Assessment and management patterns for chronic musculoskeletal pain in the family practice setting.

BACKGROUND: Chronic pain affects 11% of the US population. Most patients who experience pain, particularly chronic musculoskeletal pain, seek care in primary care settings. Assessment of the patient pain experience is the cornerstone to optimal pain management; however, pain assessment remains a challenge for medical professionals. It is unknown to what extent the assessment of pain intensity is considered in context of function and quality of life. OBJECTIVE: To understand common practices related to assessment of pain and function in patients with chronic musculoskeletal disorders. DESIGN: Cross-sectional survey. METHODS: A 42-item electronic survey was developed with self-reported numeric ratings and responses related to knowledge, beliefs, and current practices. All physicians and non-physician clinicians affiliated with the AAFP NRN and 2000 AAFP physician members were invited to participate. RESULTS/FINDINGS: Primary care clinicians report that chronic joint pain assessment should be comprehensive, citing assessment elements that align with the comprehensive pain assessment models. Pain intensity remains the primary focus of pain assessment in chronic joint pain and the most important factor in guiding treatment decisions, despite well-known limitations. Clinicians also report that patients with osteoarthritis should be treated by Family Medicine. CONCLUSIONS: Pain assessment is primarily limited to pain intensity scales which may contribute to worse patient outcomes. Given that most respondents believe primary care/family medicine should be primary responsible for the care of patients with osteoarthritis, awareness of and comfort with existing guidelines, validated assessment instruments and the comprehensive pain assessment models could contribute to delivery of more comprehensive care.

Does Examination Table Paper Use Mitigate the Risk of Disease Transmission in a Family Medicine Clinic?

Reducing examination table paper (ETP) use may help curb carbon emissions from health care. Six participants applied Glo Germ (DMA International) to their hands before a common physical examination (abdominal, cardiorespiratory, hip and knee) both with and without ETP. After each exam, UV light was shined on the exam table and photographs were taken. The number of hand touches on ETP-covered areas and uncovered areas were tallied and compared using t tests. Despite covering more surface area, participants touched areas without ETP significantly more than ETP-covered areas (P <.05). Despite its continued use, patients do not have much hand contact with ETP during common clinical examinations.

[Organization and practice in family medicine. What's new in the 2024 literature?] / Organisation des soins en médecine de famille. Quoi de neuf dans la littérature scientifique en 2024 ?

This is a selection of some important studies recently published and dealing with several key organization and functioning features of family medicine. This year, the articles focus on organizational responses to emergencies in family medicine. In this field, the use of primary care professionals other than physicians is an interesting solution. One article examines direct access to a physiotherapist, with very positive results, while a second explores the wide-ranging skills of advanced practice nurses in the emergency field. In some countries, such as Belgium, the use of teleconsultation in primary care is also being considered to avoid inappropriate use of hospital emergencies. Finally, more macroscopic organizational aspects of the healthcare system and the role of primary care in health emergencies will be considered in the last article.

Cet article présente une sélection d'études récemment publiées et explorant différents aspects du fonctionnement de la médecine de famille (MF). Elles sont centrées sur les réponses organisationnelles face à l'urgence en MF. Dans ce domaine, le recours à d'autres professionnels de soins primaires que les médecins est une approche intéressante. Ainsi un premier article porte sur l'accès direct au physiothérapeute et montre des résultats très positifs ; un second décrit les compétences des infirmières de pratique avancée mobilisables dans l'urgence. Le recours à la téléconsultation est aussi envisagé pour une utilisation plus appropriée des urgences hospitalières dans certains pays. Enfin, les aspects organisationnels plus macroscopiques sur la place des soins primaires dans l'urgence sanitaire sont réfléchis dans un dernier article.