A cross-sectional and population-based study from primary care on post-COVID-19 conditions in non-hospitalized patients.

BACKGROUND: Current research on post-COVID-19 conditions (PCC) has focused on hospitalized COVID-19 patients, and often lacks a comparison group. This study assessed the prevalence of PCC in non-hospitalized COVID-19 primary care patients compared to primary care patients not diagnosed with COVID-19. METHODS: This cross-sectional, population-based study (n = 2539) analyzed and compared the prevalence of PCC in patients with a positive COVID-19 test (n = 1410) and patients with a negative COVID-19 test (n = 1129) never hospitalized for COVID-19 related conditions. Participants were identified using electronic health records and completed an electronic questionnaire, available in English and Spanish, including 54 potential post COVID-19 symptoms. Logistic regression was conducted to assess the association of PCC with COVID-19. RESULTS: Post-COVID-19 conditions are prevalent in both groups, and significantly more prevalent in patients with COVID-19. Strong significant differences exist for the twenty most reported conditions, except for anxiety. Common conditions are fatigue (59.5% (COVID-19 positive) vs. 41.3% (COVID-19 negative); OR 2.15 [1.79-2.60]), difficulty sleeping (52.1% (positive) vs. 41.9% (negative); OR 1.42 [1.18-1.71]) and concentration problems (50.6% (positive) vs 28.5% (negative); OR 2.64 [2.17-3.22]). Similar disparities in prevalence are also observed after comparing two groups (positive vs. negative) by age, sex, time since testing, and race/ethnicity. CONCLUSIONS: PCC is highly prevalent in non-hospitalized COVID-19 patients in primary care. However, it is important to note that PCC strongly overlaps with common health symptoms seen in primary care, including fatigue, difficulty sleeping, and headaches, which makes the diagnosis of PCC in primary care even more challenging.

Research on post-COVID-19 conditions (PCC), also known as Long COVID, has often involved hospitalized COVID-19 patients. However, many patients with COVID-19 were not hospitalized, therefore how commonly the condition affects individuals attending primary care services is not accounted for. Here, we assessed non-hospitalized primary care patients with and without COVID-19. Our results demonstrate that PCC is highly common among primary care patients with COVID-19 and often presents as fatigue, difficulty sleeping, and concentration problems. As these symptoms overlap with other non-COVID-related conditions, it is challenging to accurately diagnose PCC. This calls for improved diagnostics and management of PCC in primary care settings, which is often the first point of contact with the healthcare systems for many patients.

Assessment of Family Medicine Obstetrics Fellowship Websites in the United States: Content and Usability.

INTRODUCTION: The United States is experiencing maternity care shortages. Family physicians can play a role in addressing these shortages. Family medicine obstetrics fellowships train family physicians in obstetrics care. Fellowship websites are important for promoting programs and attracting applicants. However, whether websites provide sufficient program information is unknown. This study aimed to assess completeness and utility of family medicine obstetrics fellowship websites across the United States. METHOD: The study analyzed 46 family medicine obstetrics fellowship websites. The component analysis evaluated the presence of 17 components related to orientation, curriculum, program, personnel, and additional content. The qualitative analysis included ratings for navigation and application, information quality, and esthetics. Analysis included percentages for websites and components and average qualitative ratings. RESULTS: Common components included overviews, training requirements, and contact information. Description of the patient population was the least common component. Usability ratings varied across programs, with higher ratings observed for navigation and application, and information quality. Esthetics and visual appeal received lower ratings. Regional analysis indicated that websites from fellowships in the West and Southwest tended to include more components compared to those in the Southeast. DISCUSSION: Family medicine obstetrics fellowship websites serve as valuable sources of program information for prospective applicants. However, not all websites include essential program details. Some information is rarely provided. Given the shortage of maternity care providers, it is crucial to develop informative and functional websites to attract applicants. Improving website content and design could prove to be a cost-effective strategy to increase the number of applicants.

Evaluating maternal health capacity building in rural and underserved areas: a research protocol.

INTRODUCTION: The US is currently experiencing a maternal health crisis. Maternal morbidity and mortality in the US are higher than in other developed nations and continue to rise. Infant mortality, likewise, is higher in the US than in other developed nations. Limited availability of maternal health services, particularly in rural areas, contributes to this crisis. Maternal health outcomes are poorer, and maternal care workforce shortages are more severe in rural areas of the US. In rural areas where obstetric specialists are rare, many patients rely on family medicine physicians for maternity care. However, the number of family medicine physicians who provide maternal care services is decreasing, aggravating shortages. Calls have been made to build maternal care capacity in rural areas. The role family medicine will play in addressing the maternal health crisis is not clear. Maternal care shortages are complex issues resulting from multiple factors; likewise, efforts to build maternal health capacity are challenging and require multifaceted approaches. METHODS: With funding from the Health Resources and Services Administration (HRSA), the University of Utah seeks to address the shortage of quality maternity care in rural and underserved areas of Utah by strengthening partnerships, enhancing maternal care training of family medicine residents and obstetrics fellows, and improving the transition from training to rural practice for residents and fellows. This protocol describes the evaluation of the HRSA-funded project. The evaluation includes three components. Component 1 consists of qualitative interviews with a diverse group of maternal health providers, administrators, educators and academics, patients, and others. Interviews will be analyzed using qualitative content analysis. Component 2 is a survey of family medicine residents and obstetrics fellows, which aims to increase understanding of the factors and circumstances influencing intention to practice in rural or underserved areas and to provide maternal health services. Component 3 involves surveying fellowship alumni and tracking graduates to assess effectiveness of training programs in producing physicians who provide maternal health services in rural and underserved areas. Surveys will be analyzed with descriptive statistics including means, frequencies, and cross-tabulations. If sample size and participation provide sufficient power, statistical tests will be included in analyses. RESULTS: Evaluation results will help to fill an important gap in research literature concerning outcomes of projects and initiatives designed to build maternal care capacity in rural areas of the US. In addition, results will provide valuable information regarding effective practices for building capacity, which can be adopted elsewhere to address maternal care shortages. Finally, results will help to define the role of family medicine in addressing the maternal health crisis. Amid maternal care shortages, fewer and fewer family medicine physicians are providing maternal care in their practice. Evaluation results will clarify the role of training and preparation of family medicine residents in addressing workforce shortages. CONCLUSION: This evaluation will provide important contributions, but additional research is needed, including research protocols and studies of project outcomes, to understand how best to resolve the maternal care crisis in the US.

Impact of Virtual Recruitment on Costs, Time Spent, and Applicant Perspectives Within a Family Medicine Residency Program.

Background: Virtual recruitment for all residency programs was endorsed by the Accreditation Council for Graduate Medical Education (ACGME) for the 2021 and 2022 recruitment seasons. This study assesses the impact of virtual recruitment on cost and outcome in a family medicine residency program. Methods: We assessed program recruitment costs and interview-day time with applicants in one program for the 2019 to 2022 recruitment seasons, and we sent an anonymous survey to interviewed applicants (n=98) for the 2022 match year. In-person interviews were conducted in 2019 and 2020. Virtual interviews were conducted in 2021 and 2022. Results: Program recruitment costs decreased from over $70,000 annually for in-person interview seasons to between $10,000 and $20,000 annually for the virtual interview years. Applicant time with the program on interview days decreased from 515 minutes when held in-person, to 345 minutes when virtual. Applicants expressed that they were generally satisfied with the virtual interview format though their preference for the virtual format was only slightly greater than for in-person interviews (38.6% and 35.1%, respectively); 26.3% of the responding applicants had no preference for either format. During virtual interview years, applicants interviewed at an average of 16.6 programs with 80% indicating that virtual interviews allowed for consideration of more programs. Conclusion: The virtual interview format was associated with decreased interview-day costs for programs and interviewees, and decreased time on interview days for both groups. It allowed applicants to consider more programs.

Teaching Self-directed Learning Skills Through a Resident-Led Milestones Process.

Introduction: The Accreditation Council for Graduate Medical Education allows flexibility for resident roles in the Milestone assessment process. The University of Utah Family Medicine Residency implemented a resident-led Milestones process to cultivate the skill of self-assessment and promote resident ownership of their learning. Methods: Residents were provided comprehensive evaluation data and asked to self-assess their competency on each Milestone, with input from their advisor. Residents presented their self-assessment to the Clinical Competency Committee, who then determined the final score for each Milestone. A 10-question survey examined perceptions of the resident-led Milestones process by residents and faculty. We calculated means and standard deviations (SD). Results: A total of 16 of 24 residents (67% response rate) and 12 of 14 faculty (86% response rate) completed the survey. Residents agreed most highly with the following statements: "I have good support from my advisor in being prepared to lead my Milestones meeting," "I am actively engaged in guiding the development of my own Milestones ratings," and "Leading my Milestones meeting assists me in accurately self-assessing my progress." Residents showed high agreement that "My final Milestones scores accurately reflect my behavior and level of knowledge." Residents rated the stress as low, in response to the statement, "My Milestones meeting is stressful for me." Faculty responses were similar but tended toward lower scores than residents. Conclusion: The resident-led Milestones process engages residents actively in self-assessment. Residents and faculty believe the process provides accurate assessment results without undue stress; this process potentially increases residents' ability to understand their own learning needs and direct their own learning process.

Increasing URiM Family Medicine Residents at University of Utah Health.

INTRODUCTION: The Department of Family and Preventive Medicine is home for the University of Utah's Family Medicine Residency program. Although Utah's diversity is steadily increasing, the race/ethnic diversity of the program's family medicine residency does not reflect the state's general population. METHODS: From 2017 to 2021, the residency instituted several adjustments to recruitment processes, including modification of an existing screening system to better highlight resiliency in overcoming challenging life experiences; promotion of commitment to diversity during interview days; incorporation of increased participation from diverse faculty and residents on interview days; and addition of outreach from the Office of Health, Equity, Diversity, and Inclusion. Underrepresented in medicine (URiM) applicants were the first to be offered interviews in an identical screening score cohort, and were ranked highest in rank lists in cohorts with identical final rank scores. RESULTS: Over the past five match cycles, Latinx residents have increased from zero to six, and underrepresented Asian residents from zero to two. In the 2021 match cycle, five of 10 incoming residents (50%) are URiM. Overall, URiM residents are now 30%, and residents of color 36%, of a total of 30 residents across all 3 training years. We found that eight URiM interviews were needed for every one URiM match. CONCLUSION: Intentional resident recruitment initiatives can transform racial/ethnic diversity in a family medicine residency program in a short amount of time.

Implementing an Anonymous Closed-Loop Feedback Process and Associations With ACGME Annual Survey Scores in a Family Medicine Residency.

BACKGROUND AND OBJECTIVES: The annual Accreditation Council for Graduate Medical Education (ACGME) survey evaluates numerous variables, including resident satisfaction with the training program. We postulated that an anonymous system allowing residents to regularly express and discuss concerns would result in higher ACGME survey scores in areas pertaining to program satisfaction. METHODS: One family medicine residency program implemented a process of quarterly anonymous closed-loop resident feedback and discussion in academic year 2012-2013. Data were tracked longitudinally from the 2011-2019 annual ACGME resident surveys, using academic year 2011-2012 as a baseline control. RESULTS: For the survey item "Satisfied that evaluations of program are confidential," years 2013-2014, 2014-2015, and 2018-2019 showed a significantly higher change from baseline. For "Satisfied that program uses evaluations to improve," year 2018-2019 had a significantly higher percentage change from baseline. For "Satisfied with process to deal with problems and concerns," year 2018-2019 showed significantly higher change. For "Residents can raise concerns without fear," years 2013-2014 and 2018-2019 saw significantly higher changes. CONCLUSIONS: These results suggest that this feedback process is perceived by residents as both confidential and promoting a culture of safety in providing feedback. Smaller changes were seen in residents' belief that the program uses evaluations to improve, and in satisfaction with the process to deal with problems and concerns.

Health Maintenance in School-Aged Children: Part II. Counseling Recommendations.

School-aged children (five to 12 years) are establishing patterns of behavior that may last a lifetime; therefore, during health maintenance visits, it is important to counsel families on healthy lifestyle practices. Children should eat a diet high in fruits, vegetables, whole grains, low-fat or nonfat dairy products, beans, fish, and lean meats, while limiting sugar, fast food, and highly processed foods. Children should engage in 60 minutes of moderate to vigorous physical activity each day. A Family Media Use Plan should be used to individualize screen time limits and content for children. Nine to 12 hours of sleep per night is recommended for school-aged children. Inadequate sleep is associated with behavioral issues, difficulty concentrating at school, high blood pressure, and obesity. Children should brush their teeth twice per day with a pea-sized amount of toothpaste containing fluoride. Unintentional injury is the leading cause of death in this age group in the United States, and families should be counseled on vehicle, water, sports, firearm, home, environmental, and social safety. Because high-risk behaviors may start in early adolescence, many experts recommend discussing tobacco, alcohol, and drug use, including prescription drugs, beginning at 11 years of age. Sexually active adolescents should be counseled about the risk of sexually transmitted infections, and they should be screened for these infections if indicated.

Self-treatment and informal treatment for depression among resident physicians.

BACKGROUND AND OBJECTIVES: There is awareness of depression in resident physicians, yet limited information on self-treatment or informal treatment behaviors for depression. This study sought to identify the prevalence of moderate to severe depression, self-treatment, and informal treatment for depression in resident physicians. METHODS: A total of 704 residents at the University of Utah were sent a survey on depression in the fall of 2009, with a response rate of 36.9% (260). RESULTS: Moderate to severe depression was present in 17.7% (46/260) of residents. Only 1.2% (3/254) of all residents had prescribed their own antidepressant medication, and just 0.8% (2/257) of residents had self-treated for depression with samples from their clinic. Regarding informal prescribing, 5.9% (15/256) of residents had received prescription antidepressants from another provider without a formal clinical consultation or appointment, and 3.1% (8/254) of residents had informally prescribed antidepressant medications to another resident colleague. Merely 26.7% (12/45) of residents with moderate to severe depression scores were currently receiving treatment for depression. CONCLUSIONS: Moderate to severe depression in resident physicians is common and undertreated. Self-treatment behaviors of self-prescribing and use of clinical samples have a low prevalence but are present. Similarly, informally obtaining prescription antidepressants and informally prescribing antidepressants to other residents exist at a low rate.