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Quite a lineup showcasing JABFM's emphasis on research and information for family medicine to improve patients' lives. Articles cover many topics: telemedicine, a clinical decision support tool, control of cardiovascular risk factors, opioid dose reduction, cancer survivorship care, patient engagement with case management/navigation, primary care physician capacity and usual source of care, marketing practices of Medicare Advantage programs, review articles (new diabetes medicine and treatment CHF with reduced ejection fraction), and more.
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Medicina de Família e Comunidade , Medicina de Família e Comunidade/organização & administração , Humanos , Estados Unidos , Telemedicina/organização & administração , Melhoria de QualidadeRESUMO
PURPOSE: High-ranking educational leaders in academic medicine oversee multiple clinical programs. This requires them to prioritize dozens of emergent tasks and responsibilities daily, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Identifying their key responsibilities and frequently used skills and competencies may clarify the educational needs of senior educational leaders and facilitate targeted professional development to promote effective and efficient performance. METHOD: In August 2022 researchers interviewed 12 designated education officers (DEOs) from U.S. Department of Veterans Affairs (VA) Veterans Health Administration medical centers about their daily work and most challenging responsibilities. Content analysis of interview transcripts identified key responsibilities and activities identified by participants and prioritization of the perceived skills needed to complete them. RESULTS: Participants emphasized 4 key areas of responsibility: fiscal, administrative, affiliate partnership, and educational duties. They identified 12 skills as baseline requirements for effective performance for which additional professional development would be useful and suggested that both new and more established educational leaders receive targeted professional development and mentoring to foster these capacities. CONCLUSIONS: The key skills participants identified by area of perceived responsibility are relevant to VA DEOs, designated institutional officers, and senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. Structured orientation programs and ongoing professional development for senior educational leaders could emphasize these areas of responsibility, potentially enriching DEOs' performance and reducing burnout.
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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?
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COVID-19 , Atenção à Saúde , Medicina de Família e Comunidade , Pandemias , Medicina de Família e Comunidade/métodos , Big Data , Telemedicina , Inteligência Artificial , Atenção à Saúde/tendências , COVID-19/epidemiologia , Médicos de Família/economia , Salários e BenefíciosRESUMO
INTRODUCTION: Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. MATERIALS AND METHODS: Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs. RESULTS: The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains. CONCLUSIONS: Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.
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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.
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Mudança Climática , Medicina de Família e Comunidade , Idoso , Humanos , Estados Unidos , Medicare , Analgésicos OpioidesRESUMO
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.
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Neoplasias da Mama , COVID-19 , Neoplasias Pulmonares , Medicare Part C , Idoso , Estados Unidos/epidemiologia , Gravidez , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Detecção Precoce de Câncer , MamografiaRESUMO
Objective: Using health records from the Department of Veterans Affairs (VA), the largest healthcare training platform in the United States, we estimated independent associations between the intensity of attending supervision of surgical residents and 30-day postoperation patient outcomes. Background: Academic leaders do not agree on the level of autonomy from supervision to grant surgery residents to best prepare them to enter independent practice without risking patient outcomes. Methods: Secondary data came from a national, systematic 1:8 sample of n = 862,425 teaching encounters where residents were listed as primary surgeon at 122 VA medical centers from July 1, 2004, through September 30, 2019. Independent associations between whether attendings had scrubbed or not scrubbed on patient 30-day all-cause mortality, complications, and 30-day readmission were estimated using generalized linear-mixed models. Estimates were tested for any residual confounding biases, robustness to different regression models, stability over time, and validated using moderator and secondary factors analyses. Results: After accounting for potential confounding factors, residents supervised by scrubbed attendings in 733,997 nonemergency surgery encounters had fewer deaths within 30 days of the operation by 14.2% [0.3%, 29.9%], fewer case complications by 7.9% [2.0%, 14.0%], and fewer readmissions by 17.5% [11.2%, 24.2%] than had attendings not scrubbed. Over the 15 study years, scrubbed surgery attendings may have averted an estimated 13,700 deaths, 43,600 cases with complications, and 73,800 readmissions. Conclusions: VA policies on attending surgeon supervision have protected patient safety while allowing residents in selected teaching encounters to have limited autonomy from supervision.
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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.
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Saúde Mental , Telemedicina , Humanos , Pandemias , Medicina de Família e Comunidade , Atenção à Saúde , Médicos de FamíliaRESUMO
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?
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Medicina de Família e Comunidade , Médicos de Família , Humanos , FamíliaRESUMO
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.
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Medicina de Família e Comunidade , Fumar , Humanos , Fumar Tabaco , Farmacêuticos , ProfissionalismoRESUMO
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.
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Inteligência Artificial , Medicina de Família e Comunidade , HumanosRESUMO
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.
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COVID-19 , Sarampo , Caxumba , Rubéola (Sarampo Alemão) , Recém-Nascido , Criança , Adulto , Humanos , Médicos de Família , Vacinação , Vacina contra Sarampo-Caxumba-RubéolaRESUMO
What is next for family medicine? After the long, rough road since the beginning of the COVID-19 pandemic, other topics are again receiving renewed attention. Family medicine researchers continue to consider issues important to our patients and practices. There is a collection of clinical research on children's health care. One article outlines practical actions to move medical academia past racism. The need for physician trust in patients is also often overlooked. Other articles address how to improve the practice of family medicine and a framework for thinking about legal and ethical issues in sports medicine. Three in-depth clinical reviews cover lumps and bumps of wrists and hands, spondylosis/spondylolistheses, and vitamin D association with specific disease entities.
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COVID-19 , Medicina de Família e Comunidade , Criança , Humanos , Pandemias , COVID-19/epidemiologia , Família , Atenção à SaúdeRESUMO
Background: The US Department of Veterans Affairs designated education officer (DEO) is a unique facility-based leadership role responsible for training of > 40 health professions in cooperation with affiliated academic institutions. Methods: We conducted mixed methods analyses of data from a DEO needs assessment. Quantitative analysis identified differences between DEOs who are physicians and DEOs who are other professions on role characteristics and self-perceived task effectiveness. Qualitative analysis using rapid analysis procedures was applied to open-ended responses on facilitators and barriers. Results: Responses were received from 127 DEOs (96% response rate). About 80% were physicians. There were no statistically significant differences between physician and other professional DEOs self-ratings for general tasks. For profession-specific tasks, physician DEOs were significantly less confident than other professional DEOs in working with associated health (P < .001-.01) and nurse training programs (P < .001-.03). DEOs identified multiple facilitators that assist their individual effectiveness (eg, training, mentorship, communication) and common barriers (eg, not enough staff). Conclusions: Our findings are supportive of individuals from various health disciplines serving in the DEO role with responsibilities that span multiple health profession training programs. Future quantitative and qualitative work should include additional measures of individual and organizational characteristics, and actual measures of educational effectiveness.
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The mental health of patients and clinicians before and during the pandemic are investigated and reported by multiple investigators. Improving health through practice change is challenging but possible. Telehealth increased dramatically since the beginning of the pandemic; what is its future?
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COVID-19 , Telemedicina , Humanos , COVID-19/epidemiologia , Pandemias , Saúde MentalRESUMO
As usual, this issue of the JABFM contains research as broad as the specialty of family medicine itself. The social determinants of health are again a prominent topic. COVID-19 topics in this issue include over-the-counter supplements as adjunct treatments and the influence of public health safety measures on influenza rates during the pandemic. Two separate reports look at the way cancer survivors interact with primary care and the difficulties encountered. A CERA study describes how departments of family medicine are tackling the challenge of training tomorrow's family physicians in point-of care-ultrasound. Physician workforce studies examine pay inequities and burnout. An impressive number other commonly encountered issues in family medicine are addressed using a wide variety of methods and data sources.
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COVID-19 , Sobreviventes de Câncer , Neoplasias , COVID-19/epidemiologia , Medicina de Família e Comunidade , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Médicos de Família , Determinantes Sociais da SaúdeRESUMO
BACKGROUND: Graduate medical education is centered in hospitals despite a care system where patients mostly receive their care in an outpatient setting. Such gaps may exist because of inadequate funding for residency positions in community and hospital-based clinics. OBJECTIVE: Determine if physician residents' contribution to outpatient workload offsets their costs for supervision, salary, and fringe benefits as residents acquire skills to become independent practitioners. RESEARCH DESIGN: VA's electronic patient records from 2005 through 2018 were analyzed using generalized linear mixed models to estimate resident and staff contributions to workload in relative value units. MEASURES: Resident participation rate is resident contributed workload net of supervision as a percent of total clinic workload. Productivity is per diem resident workload as a percent of per diem staff workload. Efficiency is per dollar resident workload as a percent of per dollar staff workload. Progressive independence is annual rate of change in resident productivity. RESULTS: Average participation rates varied by specialty from 6% to 22%, with 11% (primary care) and 13% (psychiatry). Productivity rates ranged from 21% to 94%, with 57% (primary care) and 61% (psychiatry). Efficiency rates varied from 0.63 to 3.81, with 1.69 (primary care), 1.89 (psychiatry). Progressive independence rates varied from 2.7%/year (psychiatry) to 39.7%/year (specialty care). CONCLUSIONS: Although residents rotating through most VA clinics generate revenue to cover their direct costs as they learn, some federal subsidies may be necessary to encourage hospital- and community-based clinics to accept residents from the less profitable primary care and mental health specialties.
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Internato e Residência , Médicos , Educação de Pós-Graduação em Medicina , Humanos , Pacientes Ambulatoriais , Carga de TrabalhoRESUMO
After years of slow progress, the COVID-19 pandemic forced a rapid adoption of telehealth and telemedicine. The transition was not uniform across demographic groups, reflecting social determinants of health. This special issue of JABFM highlights many lessons learned and reviews insights gained by patients, clinicians, and health care administrators about telehealth and telemedicine during the pandemic. The focus on research on the COVID-19 pandemic is turning increasingly toward the long-term impact of the pandemic. Reports on Medicare wellness visits, drug safety, medical abortion, and the differences in scope and location of practice by race and ethnicity of family physicians can also be found in this issue.
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COVID-19 , Telemedicina , Idoso , COVID-19/epidemiologia , Humanos , Medicare , Pandemias , Médicos de Família , Estados UnidosRESUMO
This issue continues our tradition of advancing family medicine by publishing articles on issues that affect patients and the practice of family medicine, specifically with an emphasis on inequity and the COVID pandemic, which are often intertwined. We have articles on topical issues such as appropriate transgender care, newer diabetes medications, transportation as a social risk, and a thought-provoking commentary on ableism. A clinical review on olfactory loss takes on new meaning. Oregon Medicaid coverage policy supported family physicians assisting their patients by decreasing their opioid use, and a article suggests that buprenorphine should be decriminalized. Strengthening the desire to enter family medicine before starting medical school can help meet future patient needs.