Health is primary: Family medicine for America's health.

PURPOSE: More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to "renew the specialty to meet the needs of people and society," some of which bore important fruit. Family Medicine for America's Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). METHODS: Family Medicine for America's Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. RESULTS: The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support effective care; improving research underpinning primary care; and actively engaging patients, policy makers, and payers to develop an understanding of the value of primary care. The communications plan, called Health is Primary, will complement these strategies. Eight family medicine organizations have pledged nearly $20 million and committed representatives to a multiyear implementation team that will coordinate these plans in a much more systematic way than occurred with FFM. CONCLUSIONS: Family Medicine for America's Health is a new commitment by 8 family medicine organizations to strategically align work to improve practice models, payment, technology, workforce and education, and research to support the Triple Aim. It is also a humble invitation to patients and to clinical and policy partners to collaborate in making family medicine even more effective.

The Patient-centered Medical Home: a new perspective for the family medicine clerkship.

BACKGROUND AND OBJECTIVES: The Patient-centered Medical Home (PCMH) concept, essential functions of primary care, and an appropriate primary care workforce have been shown to improve health outcomes and reduce health care costs. This paper describes a curriculum that uses the PCMH and related health policy concepts as the foundation for didactic, clinical, and self-directed elements. The PCMH-focused curriculum improved overall student clerkship ratings and maintained student performance on the National Board of Medical Education subject exam.

Evaluation of syncope.

Though relatively common, syncope is a complex presenting symptom defined by a transient loss of consciousness, usually accompanied by falling, and with spontaneous recovery. Syncope must be carefully differentiated from other conditions that may cause a loss of consciousness or falling. Syncope can be classified into four categories: reflex mediated, cardiac, orthostatic, and cerebrovascular. A cardiac cause of syncope is associated with significantly higher rates of morbidity and mortality than other causes. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography. Additional testing should be based on the initial clinical evaluation. Older patients and those with underlying organic heart disease or abnormal electrocardiograms generally will need additional cardiac evaluation, which may include prolonged electrocardiographic monitoring, echocardiography, and exercise stress testing. When structural heart disease is excluded, tests for neurogenic reflex-mediated syncope, such as head-up tilt-table testing and carotid sinus massage, should be performed. The use of tests such as head computed tomography, magnetic resonance imaging, carotid and transcranial ultrasonography, and electroencephalography to detect cerebrovascular causes of syncope should be reserved for those few patients with syncope whose history suggests a neurologic event or who have focal neurologic signs or symptoms.

Research support infrastructure and productivity in U.S. family practice residency programs.

PURPOSE: To examine the associations between 11 research support infrastructural characteristics and measures of research productivity. METHOD: A questionnaire was mailed to 462 directors of non-military family practice residency programs in the United States. A total of 11 research support infrastructural characteristics and six research productivity measures were coded. Initial analyses indicated a skewness in responses given by larger versus smaller programs. Respondents were divided into those from programs with eight or fewer full-time faculty and those from programs with nine or more. Separate analyses were run for each. Logistic regression was employed to determine which research support characteristics would best predict productivity in the top quartile. RESULTS: Of the 461 recipients of deliverable questionnaires, 351 (76.1%) responded. A large proportion of programs reported no research productivity for the preceding 12 months. Separate stepwise logistic regression analyses were run for small and large programs; the ability of the 11 characteristics to predict research-productive programs varied with size. Employment of full-time research professionals was the only characteristic positively associated with research productivity for both groups. For small programs, research productivity was positively associated with the requirement of faculty members to do research. For large programs, it was positively associated with both the presence of fellowship programs and the presence of a specific, written research strategic plan. CONCLUSION: This study demonstrated a positive association between several elements of research infrastructure and research productivity but that such infrastructure is inconsistent across programs and seemingly insufficient to develop the necessary research culture and socialization.