Practical Family Medicine: After-Hours Video Telehealth, Office Procedures, Polyp Follow-up in Older Patients, Terminology for Domestic Violence Intervention.

This issue primarily contains practice-based research reports. For a commentary on these articles, see Tapp.1 JABFM also has a call for submissions and accepted pre-print articles specifically on COVID at our Web site, www.jabfm.org These online COVID-related articles will be collated into a future print issue. This issue also has additional articles, encompassing a range of issues, as is common for JABFM.

Medications, Medicating, and Medicated-When, Where, and How-Opioids and Others.

Medication therapy emerged as a theme for this issue-from many perspectives and for different conditions. We have several articles on opioids, including for pain/noncancer pain; use by older drivers and their reported driving; and the advantages of family medicine treatment sites. A related article explores chronic widespread pain and concurrent low back pain. In addition, this issue covers the gamut of prescribing inappropriate medications for older individuals and prescribing antibiotics when a CT scan of the abdomen would not have found an indication for such treatment. Other included topics include social complexity and impact on primary care physician income.

Well-Being, New Technologies, and Clinical Evidence for Family Physicians.

This special issue contains several articles on well-being. Not surprisingly, many of these articles are specifically about burnout. The evidence shows differences in the rates of burnout between men and women family physicians as well as their responses. Clinical team structure and organizational change also contribute to burnout. What about the electronic medical record? We are also reminded that burnout is an international issue. There are also several articles on how technology is changing the way family physicians practice. Two articles report on issues regarding screening for frequently seen clinical entities, specifically breast cancer and alcohol misuse. There are also articles looking at the cost of medical assistant turnover in practices, the impact of continuity with a provider on the retention of patients in clinical trials, and much more of interest to family physicians.

Many Family Medicine Successful Interventions and Clinical Reviews for Common Illnesses.

Family physician researchers continue to provide assistance to improve family medicine care. Commentaries on social determinants of health lead off this issue. Next, we have several papers on successful interventions by clinicians and/or patients to improve diabetes control, and then other provide information on other practice interventions that make a difference in overall care. Drug advertising continues to mislead. There is costly and nonproductive overuse of specific types of care. Herein is also a Scoping Review of possible indices for determining timely initiation of advance care planning. The issue's clinical reviews on use of transgender care, cervical myelopathy, and inhaled steroids for chronic obstructive pulmonary disease are pertinent, thorough, and timely.

Increasing Article Visibility: JABFM and Author Responsibilities and Possibilities.

JABFM seeks to widely disseminate its peer-reviewed publications, increasing article visibility for the purpose of advancing scientific knowledge. We describe the journal's approach to dissemination and recommend a number of strategies for authors to implement, including press releases and social media. Providing the article's digital object identifier (DOI) is most useful, compared with links that can break, or attaching the article PDF, which will depress reader metrics. All JABFM articles are freely accessible online worldwide.

New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine.

From the United States and Netherlands, we have 2 articles on back pain, with findings that indicate significant treatment differences between the countries, and a high likelihood of persistence. The Inflammatory Diet is now shown to be related to diabetes. Multiple perspectives on palliative care for the homeless. Could pharmacists assist in preventing suicide? There are changes in the practice of family medicine. Social determinants of health substantially influence health and medical care. Moreover, care for patients from deprived communities is under-reimbursed. Patient pre-existing conditions increased after the Affordable Care Act, suggesting that repealing pre-existing condition protections would likely exacerbate disparities in health and health care.

Implementing Practice Changes in Family Medicine to Enhance Care and Prevent Disease Progression.

This issue epitomizes family medicine with a heavy emphasis on research to prevent illness and illness progression. Which patients will experience significant symptomatic knee osteoarthritis? Do the elderly use retail clinics, and what is the impact on care for chronic conditions? Does capitation payment enhance or decrease same-day access? How do primary care practices risk stratify to provide integrated care? Can risk screening and on-site providers enhance psychiatric care? What screening questions should we ask adolescents, to identify problematic drug use? A report on a practice intervention to improve opioid prescribing practices, and another on the significant level of depression in many patients taking opioid medications. Which works better for smoking cessation-e-cigarettes or nicotine gum? Reminders about teratogenic drugs and those that cause hyperpigmentation. Interdisciplinary care with pharmacists in the office does not help just the patients. We have several articles on diabetes-early diagnosis, and consideration of screening for prediabetes as a quality standard-with added commentaries about this possibility.

Family Medicine: Data Driven Practice with Emphasis on Underserved Patients.

Family physicians' role and interest in caring for underserved or undertreated patients is quite evident in this issue of JABFM. One in 5 family physicians provide urgent or emergency care, which is particularly important in rural areas. Methods and resources for obtaining information about social determinants of health are variable. A data-rich article considers how family medicine practice ownership might be associated with quality outcomes. We have articles on using text messages to increase HIV testing and colon cancer screening for Latino patients. For patients with significant behavioral health disorders, 1 article considers early posthospital follow-up to prevent readmission and another notes differences between the views of generalist physicians and psychiatrists on which specialty should test and manage antipsychotic-related metabolic disorders. Five articles provide topic-specific perspectives for diagnosis of systolic heart failure with preserved systolic function, primary care outpatient radiographs, polypharmacy in the elderly with dementia, supporting patients in self-management, and patient and family physician challenges in opioid prescribing. Furthermore, what happened to total opioid prescriptions when 1 version of opioid medication became more difficult to prescribe? Two articles provide treatment information for hepatitis C and initiation of basal insulin for diabetes.

Multiple Research Methodologies Can Advance the Science of Family Medicine.

This issue of the Journal evidences the wide variety of research methods that can effectively answer questions important to the practice of family medicine. For example, this issue includes 4 highly informative reports from qualitative or mix-methods research, plus surveys, a meta-analysis, a case report, and more. Mixed-methods were used to look at practice changes and to compare advance directive tools. Surveys were used to identify practical, but addressable, issues for mailed colon cancer screening tests, and the prevalence of atopic dermatitis, and emollient use in young children. Secondary analyses of national surveys were used to identify low-value patient requests, and how diabetes and prediabetes are being treated. Retrospective chart analysis of patients with frequent hospital admissions identified important characteristics of the patients and their problems. Meta-analysis methodology was used to stratify risks for pneumonia. And, a randomized trial was used to compare ways to train patients to use medical record patient portals.

Conversations, Communication and Counseling Are Key Family Medicine Tactics to Improve Patient Health.

This issue includes research on conversations, communication and counseling regarding depression treatment, the diagnosis of prediabetes, the topics of diversity and inclusion in medicine on Twitter, asthma treatment outcomes, muscle strengthening as an important form of exercise, multiple hospital readmissions, as well as after-visit summaries and advance care planning.

Attitudes towards health research participation: a qualitative study of US Arabs and Chaldeans.

BACKGROUND: The Arab Muslim and Chaldean Christian American community is unified by language but culturally diverse. Researchers are challenged to engage the Arab/Chaldean community to meet immigrant health needs. Arabs/Chaldeans are identified as white in clinical data sets making it difficult to identify health behaviours and patterns unique to the community. OBJECTIVES: To explore the views of members of the Arab/Chaldean community, including researchers and the lay public, regarding health research participation and the role of clinicians, researchers and community leaders in the research process. METHODS: A qualitative study of Arab and Chaldean adults and researchers conducted in a US community with a large Arab/Chaldean population. Five semi-structured focus group discussions were triangulated with five in-depth semi-structured interviews with Arab or Chaldean primary care researchers. Responses were audio-recorded and transcribed verbatim. Transcripts were coded and thematically analysed, and findings confirmed with community representatives. RESULTS: Three themes were identified: (i) research expectations: risks and benefits; (ii) health care environment: clinicians as recruiters and (iii) research participations: risks and benefits. Themes captured concerns with social relationships, reputation or trust and the cost and benefit of research participation. In the Arab/Chaldean community, institutional and political fears and distrust are amplified. Respect for physicians, teachers and faith leaders connected with or recruiting for studies enhances likelihood of research participation. CONCLUSION: Clinical researchers should address the cultural and immigration histories of Arab/Chaldean research participants. Studies that maximize trust will minimize participation bias and lay the groundwork for improved health. Institutional, sociocultural and personal factors require a pre-study phase to engage and educate participants.

Future Directions for Practice-Based Research Networks (PBRNs): A CERA Survey.

BACKGROUND: Thought leaders from family medicine and practice-based research networks (PBRNs) have put forth definitions and goals recommending future directions for PBRNs. Evidence demonstrating that PBRNs are acting in accordance with these trends supports future investment in PBRN infrastructure, funding, and training of clinician researchers. Our objective was to explore the alignment of PBRN research efforts with thought leader recommendations. METHODS: The 2017 Council of Academic Family Medicine Educational Research Alliance surveyed PBRN directors via emails to 126 respondents. This survey included 6 general background questions about PBRN characteristics. An additional 25 questions focused on current and future research directions, including the training of health care professionals about PBRN research. RESULTS: The survey response rate was 56/126 (44%). Physician faculty receive continuing medical education credit for PBRN training (reported by 12/56 of PBRN directors). PBRN provided continuing medical education for study participation (24/56), reviewing study results (7/56), attending a study results presentation (24/56), and attending study planning meetings (13/56). Practice-based research education of medical students and residents was reported at 11/56 and 14/56, respectively. Current PBRN research efforts were most frequent in the areas of community engagement, practice transformation, and quality improvement projects. CONCLUSION: PBRNs currently thrive on conducting research predominantly in quality improvement and practice transformation. However, the study findings suggest that moving forward, PBRNs should participate more in training the future generations of primary care researchers and to address health policy needs.

Health Care Integration and Coordination with Emphasis on Mental Health, but Not for Medical Marijuana.

Care coordination and behavioral health care integration are the subject of 4 of this month's articles. Patients with significant illness report that care coordination provides great challenges to them, and they expect family physicians to assist with the referrals and communication between the doctors. Patients' primary care providers were usually not the prescribers of patients' medical marijuana and were often unaware of its use, indicating lack of health care integration and coordination. Two articles provide insight into medication adherence. Also, how are family physicians addressing patient engagement at the practice level? Clinical topics in this issue include the following: specific exercises were not the answer to restless legs; epidural anesthesia may be associated with fewer, not more, vaginal lacerations; and fecal incontinence is less discussed but not necessarily less problematic than urinary incontinence. On the popular culture front, opioid mentions in top 100 songs are increasing. Lastly, what does it mean for the field of family medicine that some of us choose to become hospitalists?

The Potpourri of Family Medicine, in Sickness and in Health.

Some aspects of the health of Americans are declining, and family medicine is addressing these ailments. Obesity is one factor, and family physicians provide nutrition counseling. Despite new models such as direct primary care, we have not found an ideal method for providing primary care to everyone in our health system. Not all family physicians report burnout: what is their secret? Scribes: some positives and negatives from one group. Rural America is in need of more family physicians who provide prenatal and natal care, and the proof is in the infant mortality rate. We also have 2 articles on improving pediatric care, and research on the relationship of thrush to mode of infant delivery. We have reviews of new cancer and cholesterol drugs, raising awareness of important knowledge for the primary care clinicians seeing the patients who take these drugs. In addition: tick bites and delayed anaphylaxis-when and how, culture-related skin findings, and helping male perpetrators of domestic violence.

Advancing the Science of Implementation in Primary Health Care.

Implementation Science is commonly described as the study of methods and approaches that promote the uptake and use of evidence-based interventions into routine practice and policymaking. In this issue of JABFM, investigators share a wealth of new insights from the frontlines of Implementation Science in primary care: what it is, how we are doing it, and how it is advancing the evidence base of primary care. The breadth of implementation science in primary care is affirmed by the range of topics covered, from thought leader recommendations on future directions for the field, to reports on how best practices in policy and practice are shaping primary care implementation in the United States and Canada. There are also important updates on agents of primary care implementation themselves, such as practice facilitators, geriatric care teams, and family physicians interested in providing obstetric care. Other articles report on novel practice transformation efforts that advance health promotion and disease prevention, and innovative approaches to identifying and addressing social determinants of health in primary care practices and the communities they serve. The articles seem to generate as many new questions as they answer, and highlight the need for continued emphasis on advancing the science of implementation in primary health care.