Advanced Practice Providers in Departments of Family Medicine: Status, Supervision, and Services.

BACKGROUND: Nurse practitioners (NP), physician assistants (PA), and other advanced practice providers (APP) are one solution to meet health care workforce shortage. Our study examined clinical workforce decisions and perceptions of APPs and family physicians (FPs) from the perspective of a national survey chairs of Departments of Family Medicine. METHODS: A survey was developed and distributed to family medicine department chairs as identified by the Association of Departments of Family Medicine (ADFM). In addition to demographic information, respondents were asked if their department directly employs APPs, major factors influencing departments of family medicine to hire APPs, services to patients currently being provided by APPs, and services preferentially provided by APPs. Descriptive statistics were reviewed. Bivariate analyses and Chi-square were computed comparing perceptions of APPs and FPs by how these types of health care providers are currently used in the respondent's clinical operation. RESULTS: The overall response rate for the survey was 48.4% (109/225). Most departments of family medicine (62.4%) use APPs. Access to care and filing gaps in team-based care are the primary factors for APP employment. Although most departments have APPs provide services that include complex chronic conditions complicated by coexisting conditions or not yet controlled, most department chairs do not prefer APPs provide these services. DISCUSSION: The role APPs in terms of specific patient care activities and services in the health care team of departments of family medicine is often in conflict with preferred roles as delineated by the chair.

Enhanced Scheduling to Improve Resident Continuity in a Family Medicine Teaching Clinic.

BACKGROUND AND OBJECTIVES: Continuity of care is a core concept at the heart of primary care practices. Increased patient-provider continuity of care is associated with better satisfaction scores, better clinical outcomes, decreased hospitalizations and emergency department utilization, improved completion of preventive health services, adherence to medical treatment plans, and improved show rates. Compared to traditional outpatient practices, resident teaching clinics traditionally have lower rates of continuity and face unique challenges in improving continuity given the curricular demands, complex scheduling, and high turnover of providers. The objective of our study was to assess the impact of front office training and new electronic medical record (EMR) scheduling protocols on resident continuity in a family medicine teaching clinic. METHODS: From July 2021 through May 2022, optimized scheduling through a provider search function in the EMR was implemented in a family medicine teaching clinic. We compared the monthly continuity rates between corresponding months in the prior year and the intervention year. RESULTS: Over an 11-month implementation process, continuity for resident physicians increased from 36.4% to 64.6% (χ2=675.41, P<.001) using EMR tools and scheduling search functions to improve and sustain continuity over the study period. CONCLUSIONS: This intervention to enhance continuity in a family medicine residency clinic led to rapid and sustained improvement in provider continuity. This result demonstrates that optimization of EMR scheduling with tools and protocols can improve overall continuity. This scheduling process can likely be applied to clinical sites for residency programs across disciplines.

From COVID to Couch Potato: The Importance of Physical Activity Promotion and Education.

For many, the lockdowns of the COVID-19 pandemic resulted in drastic behavior changes. While the immediate uncertainty and fear surrounding the initial lockdown has subsided, there are still significant changes to our daily lives and work that may have lasting impact on our health and well-being. One such change is the increase in physical inactivity and sedentarism, a result of decreased group activities, organized events, work and school from home mandates, and physical distancing. Physical inactivity represents one of the strongest modifiable risk factors for poor health outcomes and a preventable cause of early morbidity and mortality from many common chronic diseases. Overall, health care providers are inconsistent and often ineffective at screening and counseling patients on the benefits of regular physical activity. Additionally, there is very little structured curricula for medical learners to address physical inactivity and other lifestyle factors that contribute to the health of our patients. As we adjust to new social practices and behaviors as a result of the COVID-19 pandemic, it is critical that we emphasize the need for education, screening, evidence-based interventions, advocacy, and effective role modeling on the importance of physical activity for our patients, communities, and our own well-being.

Atrial Fibrillation Induced From Commotio Cordis.

CASE: A 20-year-old male collegiate basketball player was evaluated for sudden chest pain, shortness of breath, dizziness, and blurry vision, following an elbow to the anterior chest by another player. His symptoms improved over 10 minutes of observation, but rhythm strip performed onsite showed atrial fibrillation, and the athlete was transmitted to the emergency department for further evaluation. Electrocardiogram in the ER confirmed atrial fibrillation with a rate of 85 bpm. Electrocardioversion was being arranged when he spontaneously converted to normal sinus rhythm, 2.5 hours from the traumatic event. CONCLUSIONS: Our case illustrates an unusual example of atrial fibrillation induced by commotio cordis (AFCC). Although less acutely life threatening and much less frequently described than ventricular fibrillation induced by commotio cordis, AFCC should be considered in the differential after blunt chest wall trauma. Currently, there are little data regarding management of patients with AFCC.

Preparticipation Evaluation.

Although the specific content has been recommended, debated, and extensively reviewed over the past several decades, the preparticipation evaluation (PPE) has become standard of care for athletes as they prepare for organized athletic participation. The PPE seeks to detect conditions that predispose the athlete to injury or limit full participation in certain activities. Of particular interest, underlying cardiovascular and musculoskeletal conditions are sought because they are frequently associated with mortality and morbidity in athletes.

Hip and Knee Injuries.

Hip and knee injuries are a common presenting concern for patients to a primary care office. This pathology represents a large differential and it can often be a diagnostic challenge for providers to determine the etiology of a patient's symptoms. This article discusses several of the most common causes for hip and knee pain while providing an evidence based review of physical examination maneuvers, imaging studies and treatment modalities to assist a primary care provider when encountering active patients with underlying hip or knee pain.

Acute Sports-Related Head Injuries.

Injuries from sports-related head trauma are commonly encountered by primary care providers. These injuries vary in clinical presentation, severity, and outcome, with sports-related concussion (SRC) being the most common and more severe sports-related head trauma, such as hemorrhage, and "second impact syndrome" occurring rarely. Understanding the importance of immediate recognition, removal from play, multimodal evaluation, and typical patterns of recovery is necessary to safely manage an athlete with SRC. Proper care of athletes with severe sports-related head trauma requires a high index of suspicion and appropriate initial management to maximize survival and minimize morbidity.

Consider these exercises for chronic musculoskeletal conditions.

Exercise interventions reduce pain and improve function in knee/hip OA, chronic low back pain, shoulder pain, Achilles tendinopathy, and lateral epicondylitis.

Patients' preference for physician attire: a survey of patients in family medicine training practices.

BACKGROUND: Conflicting evidence exists about how patients would like their doctors to dress. This is complicated by new evidence showing elements of common physician attire (white coat or ties) can be contaminated with pathogens. METHODS: We conducted a survey on a convenience sample of adult patients in three academic primary care offices in South Carolina and Ohio during the summer of 2010. The survey asked about patient preferences for physician attire and how their doctor usually dressed. After a brief statement regarding evidence of microbial contamination of coats and ties, the preferences were reexamined. RESULTS: A total of 432 patients participated in the survey. No clear preference was stated by patients, and patients' initial preference was not closely related to their own physicians' customary attire. After reading the statement about microbial contamination, a significant percentage of patients changed their preference to select categories that did not include a tie or a white coat and tie. This information was associated with a large shift in preference to having physicians wear dress shirts and slacks with no tie (from 16% to 41%). CONCLUSIONS: Patients in these three academic family medicine practices did not show any consistent preference for their physicians' attire. However, providing information about potential microbial contamination of clothing was associated with a shift in patient preferences for physicians not wearing a tie and a white coat.

Exercise for the treatment of depression and anxiety.

Depression and anxiety are the most common psychiatric conditions seen in the general medical setting, affecting millions of individuals in the United States. The treatments for depression and anxiety are multiple and have varying degrees of effectiveness. Physical activity has been shown to be associated with decreased symptoms of depression and anxiety. Physical activity has been consistently shown to be associated with improved physical health, life satisfaction, cognitive functioning, and psychological well-being. Conversely, physical inactivity appears to be associated with the development of psychological disorders. Specific studies support the use of exercise as a treatment for depression. Exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression and has also been shown to improve depressive symptoms when used as an adjunct to medications. While not as extensively studied, exercise has been shown to be an effective and cost-efficient treatment alternative for a variety of anxiety disorders. While effective, exercise has not been shown to reduce anxiety to the level achieved by psychopharmaceuticals.