A taxing problem: The impacts of research payment practices on participants and inclusive research.

Empirical data regarding payments to participants in research is limited. This lack of information constrains our understanding of the effectiveness of payments to achieve scientific goals with respect to recruitment, retention, and inclusion. We conducted a content analysis of consent forms and protocols available on clinicaltrials.gov to determine what information researchers provide regarding payment. We extracted data from HIV (n = 101) and NIMH-funded studies (n = 65) listed on clinicaltrials.gov that had publicly posted a consent form. Using a manifest content analysis approach, we then coded the language regarding payment from the consent document and, where available, protocol for purpose and method of the payment. Although not part of our original planned analysis, the tax-related information that emerged from our content analysis of the consent form language provided additional insights into researcher payment practices. Accordingly, we also recorded whether the payment section mentioned social security numbers (or other tax identification number) in connection with payments and whether it made any statements regarding the Internal Revenue Service or the tax status of payments. We found studies commonly offered payment, but did not distinguish between the purposes for which payment may be offered (i.e., compensation, reimbursement, incentive, or appreciation). We also found studies that excluded some participants from receiving payment or treated them differently from other participants in the study. Differential treatment was typically linked to US tax laws and other legal requirements. A number of US studies also discussed the need to collect Social Security numbers and income reporting based on US tax laws. Collectively, these practices disadvantage some participants and may interfere with efforts to conduct more inclusive research.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

BACKGROUND: While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. OBJECTIVE: This study investigated how social connectedness is associated with patient outcomes in a HaH program. DESIGN: The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. PARTICIPANTS: The quantitative phase included 100 patients (18 years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. ANALYSIS: Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. KEY RESULTS: Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. CONCLUSIONS: Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

Social connectedness and diabetes self-management across the COVID-19 pandemic: A mixed methods study.

INTRODUCTION: Structural social connectedness is the structure and size of a person's social network, including whether persons live with or have regular contact with others. The COVID-19 pandemic disrupted structures that facilitate social connectedness. This study investigated how a person's structural social connectedness influenced diabetes self-management strategies through the COVID-19 pandemic. METHOD: The study followed an explanatory sequential mixed methods design. First, quantitative data were collected via surveys of 54 patients living with diabetes (67% female, Mage of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, Mage of 62 [9] years) as a follow-up to the survey to help explain quantitative findings. Longitudinal mixed methods analysis integrated both phases to offer a holistic view of the factors influencing diabetes self-management. RESULTS: A full-factorial analysis of covariance tested home and workplace social connectedness effects onto glycemic control and four self-management measures. In integrated analysis, researchers categorized patients into four groups by level of home and workplace social connectedness. Individuals with home social connectedness were more likely to overcome pandemic-related self-management challenges than those without home social connectedness. Although the workplace provided social connectedness, it imposed structural barriers to self-management. DISCUSSION: Structural social connectedness influenced how patients navigated diabetes self-management challenges through the COVID-19 pandemic. Results suggest clinicians should consider how home and workplace connectedness interact to facilitate or impede patient self-management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Research to Improve Clinical Care in Family Medicine: Big Data, Telehealth, Artificial Intelligence, and More.

This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?

A Focus on Climate Change and How It Impacts Family Medicine.

This issue highlights climate change, its effects on patients, and actions clinicians can take to make a difference for their patients and communities. The issue also includes several reports on current trends in family physician practice patterns and the influence of practice structure. Four articles focus on controlled or illicit substances. Noteworthy among them is the description of an innovative yet simple device that allows patients to safely discard unused opioids. Other research covers adverse childhood experiences (ACEs), smoking cessation programs, and the impact of Medicare reimbursement rates on influenza vaccination.

Lingering Impact of COVID-19, Preventive Care Considerations, and US Health System Challenges.

This issue includes articles on the lingering impact of COVID-19, often negative but occasionally positive, on patients, treatment, practices, and health care personnel. Other articles inform on prevention, such as awareness of lung cancer screening among women undergoing screening mammography; failures on sports preparticipation physicals; advance care planning as prevention; and screening for social risk factors. Another article reports on patient experiences of legal recreational cannabis in Washington State. There is a review of perinatal depression recognition and treatment. Two articles separately identify the difficulties of the congressionally created Medicare Advantage & Pharmaceutical Benefit Managers.

Practicing Family Medicine in a Pandemic World: Lessons for Telemedicine, Health Care Delivery, and Mental Health Care.

In this issue of the Journal, several articles evaluate the strengths and weaknesses of telemedicine. Evidence demonstrates that telemedicine is not equally effective for all clinical situations. Another set of articles report research on the delivery of health care: electronic reminders for physicians, standing orders, guideline use, and screening for social determinants of health. Two studies report on the effects of the pandemic on the mental health of subpopulations. The impact of changing insurance status on chronic disease diagnoses, the implications of eliminating the X-waiver, and trends in early career family physician salaries are also studied.

Thinking and Practicing Thoughtfully and Thoroughly.

One of the unique characteristics of family medicine is that although we cannot meet every specific need of each patient at each visit we continuously advance the health of the communities that surround our practices. Family physicians aim to improve overall health outcomes across our practice populations, not just individual by individual, nor just for those who arrive in our office for care. We strive to care for individuals who fall through the cracks, for the social circles who surround our patients, such as family members or neighbors; we implement systems to facilitate the broad scope and needed intensity of care; and we build collaborations that assist in population care. Family medicine improves outcomes for everyone, including the unseen. This JABFM issue epitomizes many of these distinguishing characteristics of family medicine-what does it take (how)? When? Where?

Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South.

OBJECTIVE: The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South. METHODS: Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews. RESULTS: Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions. CONCLUSIONS: In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician. PRACTICE IMPLICATIONS: The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.

Infrastructure Features Associated With Increased Department Research Capacity.

PURPOSE: 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. METHOD: 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. RESULTS: 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<.001). CONCLUSIONS: 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.

Research Addressing the Ongoing Changes in the Practice of Family Medicine.

The articles in this issue are divided into 3 categories: 1) increasing our understanding of people's (patients') behaviors; 2) changing how we practice Family Medicine; and 3) rethinking common clinical problems. These categories include multiple topics: nonprescription antibiotic use, recording electronic smoking/vaping, virtual wellness visits, an electronic pharmacist consult service, documenting social determinants of health, medical-legal partnerships, local professionalism, implications of peripheral neuropathy, harm-reduction informed care, decreasing cardiovascular risk, persistent symptoms, and colonoscopy harm.

Research Representing the Changing Landscape of Family Medicine.

Family medicine continues to evolve in response to new technologies, new theories, and new problems to address. This issue of JABFM includes studies on the integration of artificial intelligence into primary care, thoughts on how medicine can address climate change, and some novel approaches to important issues in family medicine. Studies on medication assisted therapy, continuity of care, and periodontitis are among the original research in this issue. In addition, research on screening for social needs, updated guidelines, and case reports are included.

Clinical Outcomes of a Newly Instituted Hospital at Home Program During the COVID19 Pandemic.

Context: The COVID19 pandemic stressed U.S. health systems beyond their capacity and created worsening clinical outcomes. Hospital a Home (HaH) programs were utilized infrequently prior to pandemic. The Acute Care at Home Waiver was introduced in 2020 to facilitate the creation of HaH programs with a goal of promoting treatment in the home setting. A potential alternative approach to creating rapid inpatient level health system capacity is providing hospital-level care at home to substitute for inpatient hospitalization. The overall impact on clinical outcomes of a HaH program in patients with COVID19 is not well understood. Objective: To compare clinical outcomes of a HaH program versus usual hospital care for patients admitted for COVID19. Study Design: Matched case-control retrospective chart review. Setting or Dataset: Academic medical center. Population studied: Patients admitted with COVID19 and subsequently enrolled into the HaH program from February 1, 2021 to January 31, 2022. Patients aged <18 were excluded from consideration for enrollment. A case-control sample was matched on age, gender, and severity of illness. A total of 200 patients (100 HaH and 100 control) were included for analysis. Outcome Measures: Primary outcome: 30-day readmissions, Secondary outcomes: Inpatient length of stay (iLOS) defined as length of stay in the physical hospital, total length of stay (tLOS) (sum of iLOS and HaH program days), time to readmission, and 30-day emergency department visits. Results: Analysis included 200 patents. The mean age was 50.4. The sample was 55% female. 48.5% were black, 43.5% were white, and 8% were other races. Compared with usual care patients, HaH patients had no difference in 30-day readmissions (11% vs. 14%, p=0.648), mean days to readmission (9.0 vs. 11.8, p=0.201), or return ED visits (17% vs. 20%, p=0.701). Inpatient LOS (5.7 vs. 9.4 days, p=0.005) was shorter in the HaH group. Total LOS (13.0 vs. 9.4 days, p<0. 001) was longer in the HaH group. Conclusions: The HaH program was associated with no difference in readmissions, time to readmission, or return ED visits compared to usual hospital care. HaH programs were associated with shorter inpatient length of stays, but longer total length of stays. In surge times, HaH programs could potentially reduce iLOS and increase bed capacity. Future studies should look to evaluate the economic impact of HaH programs and investigate the drivers of the increased tLOS.

How Attributes of Place Threaten Community Trust in the American South: Opportunities for Improving Pandemic-Related Communication.

Trust and mistrust influence the utilization of health services, the quality of overall healthcare, and the prevalence of health disparities. Trust has significant bearing on how communities, and the individuals within them, perceive health information and recommendations. The People and Places Framework is utilized to answer what attributes of place threaten community trust in public health and medical recommendations.Augusta-Richmond County is ranked among the least healthy counties in Georgia despite being home to the best healthcare-to-residence ratios and a vast array of healthcare services. Semi-structured interviews were conducted with 31 neighborhood residents. Data were analyzed using the Sort & Sift, Think & Shift method. Threats to community trust were identified within four local-level attributes of place: availability of products and services, social structures, physical structures, and cultural and media messages. We found a broader web of services, policies, and institutions, beyond interactions with health care, that influence the trust placed in health officials and institutions. Participants spoke to both a potential lack of trust (e.g. needs not being met, as through lack of access to services) and mistrust (e.g. negative motives, such as profit seeking or experimentation). Across the four attributes of place, residents expressed opportunities to build trust. Our findings highlight the importance of examining trust at the community level, providing insight into an array of factors that impact trust at a local level, and extend the work on trust and its related constructs (e.g. mistrust). Implications for improving pandemic-related communication through community relationship building are presented.

Family Physicians Can/Should Do: What? Where? And How?

This issue's teasers: A broad scope of care by family physicians could be incentivized and has positive outcomes. Family physicians could do more dermoscopy-a mixed specialty group of experts provide information on diagnosis with associated features and proficiency standards for primary care clinicians. Clinicians could trust more, and do less, such as adult measles-mumps-rubella boosters. Family physicians differ from pediatricians on how to deliver vitamin D to newborns. Practice scope varies by location. Is monetary incentive a key to incentivize COVID vaccination? A new, useful, easy functional status questionnaire. This issue also includes articles on both adult and pediatric obesity, a systematic review of social determinants of health and documentation thereof, plus more.

The Power of One Word to Paint a Halo or a Horn: Demonstrating the Halo Effect in Learner Handover and Subsequent Evaluation.

PURPOSE: Learner evaluation based upon direct observation is a cornerstone of modern competency-based medical education. Learner handover has become a widely accepted practice. Cognitive attribution bias is a potential threat to the validity of learner evaluation following learner handover. METHOD: In this 2 x 2 (learner handover: halos/horns x learner gender: man/woman) factorial, nonequivalent comparison group experimental design, registered attendees at a national medical education conference watched 1 of 2 videos (depicting a woman learner or man learner) of simulated learner-patient encounters. Data were collected on April 30 and May 1, 2022. Participants received learner handover conditioning before watching the video. The conditioning was randomized to suggest the learner they were about to watch was either "above-average" (halos) or "below-average" (horns). Following the video, participants completed an evaluation form. RESULTS: Participants rated the learner in a video encounter preceded by a horns statement significantly lower than the learner in a video encounter preceded by a halo statement, F (1,65) = 10.15, P < .01, η 2 = .14, horns mean adj = 12.49 (CI 11.34, 13.63), halo mean adj = 15.10 (CI 13.93, 16.28). This represented a scoring difference of 2.61 points on a 30-point scale. More years of teaching experience was negatively associated with the score, F (1,65) = 13.44, P < .001, η 2 = .17. CONCLUSIONS: Learner conditioning differing by a single word, labeling a learner as either "above-average" or "below-average" resulted in a large difference in scoring by medical educators.