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Journal of the American Board of Family Medicine: JABFM

Mark C Kendall
No abstract text is available yet for this article.
July 2018: Journal of the American Board of Family Medicine: JABFM
Jun Li, Helen Ding, Thomas B Richards, Iman Martin, Sarah Kobrin, Pamela M Marcus
PURPOSES: Despite recommendations against prostate cancer screening with prostate-specific antigen (PSA) tests, about one-fourth of men age ≥40 years received PSA tests in 2015. This study aimed to answer 3 questions for men who had a PSA test in the past year: (1) What percentage of these men received the test first suggested by physicians? (2) What factors were associated with physician-initiated PSA testing (PIPT) versus patient/someone else-initiated testing? (3) What percentage of patients ever had shared decision-making when tests were initiated by physicians? METHODS: We analyzed the 2000 and 2015 National Health Interview Survey data...
July 2018: Journal of the American Board of Family Medicine: JABFM
Ellen Einterz
On physical examination, refugees from countries in Africa, Asia, and the Middle East often present with findings that are unfamiliar to primary health care providers in the West. Previous traditional practices that may have left their mark include scarification and burning of the skin, excision of body parts, and subcutaneous insertion of foreign material. The descriptions detailed here introduce providers to some of the signs that result from body modification practices commonly encountered on physical examination of refugees...
July 2018: Journal of the American Board of Family Medicine: JABFM
Adam C Kaplan, Michael P Carson
Galactose-α-1, 3 galactose (α-gal) is a carbohydrate found in mammalian meat. In 2007, it was implicated as a cause of severe hypersensitivity reactions when a study found elevated levels of antibodies directed against this oligosaccharide among patients treated with cetuximab, a monoclonal antibody that contained an α -gal epitope. The majority of these cases were reported in the Southeast United States in a distribution similar to that of Rocky Mountain spotted fever and ehrlichiosis, and that geographic association led researchers to the conclusion that a bite from the Lone Star tick can induce this antibody...
July 2018: Journal of the American Board of Family Medicine: JABFM
Caitlin K Moynihan, Panne A Burke, Sarah A Evans, Amie C O'Donoghue, Helen W Sullivan
BACKGROUND: Prescription drug marketing to physicians often includes clinical trial data. Prior research has shown that physicians may not have the necessary knowledge to understand all clinical trial results and they can be influenced by how these results are reported. This study focused on physicians' reactions to and evaluations of clinical trial data presented in professional prescription drug promotion. METHODS: We conducted 60-minute interviews with practicing physicians across the United States (50 primary care physicians and 22 endocrinologists)...
July 2018: Journal of the American Board of Family Medicine: JABFM
Brian Penti, Joanne Timmons, David Adams
Intimate partner violence (IPV) is prevalent and has lasting impacts on the health and well-being of the entire family involved. Primary care physicians often interact with male patients who perpetrate IPV and are in a role potentially to intervene, but there is very little research and guidance about how to address perpetration of IPV in the health care setting. We reviewed the existing literature research related to physicians' interactions with male perpetrators of IPV and summarize the recommendations. If a male patient discloses IPV perpetration, physicians should assess for lethality, readiness to change, and comorbid medical conditions that could impact treatment, such as substance abuse and mental illness...
July 2018: Journal of the American Board of Family Medicine: JABFM
Muhammed Shahreyar, Salem A Salem, Mannu Nayyar, Lekha K George, Nadish Garg, Santhosh K G Koshy
Coronary artery disease is the leading cause of death in United States. Hyperlipidemia is an independent and potentially reversible risk factor for coronary artery disease. The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, collectively known as statins, have been the mainstay of pharmacologic therapy. Their availability, ease of administration, low cost, and strong evidence behind safety and efficacy makes them one of the most widely prescribed lipid-lowering agents. However, some patients may be intolerant to statins, and few others suffer from very high serum levels of cholesterol in which statin therapy alone or in combination with other cholesterol-lowering agents is insufficient in reducing serum lipid levels to achieve desired levels...
July 2018: Journal of the American Board of Family Medicine: JABFM
Pramern Sriratana, Joseph Norton
BACKGROUND: Immunotherapies in cancer treatment have a long history going all the way back to the very beginning of the field, and recent advances are extremely promising. These therapies are becoming a larger part in many patients' oncology treatment as the number of approaches, individual medicines, and indications increase. Furthermore, these novel therapies have different side effect profiles from those traditional chemotherapies which have, until recently, typified the oncologist's approach to treatment together with surgery and radiation...
July 2018: Journal of the American Board of Family Medicine: JABFM
Leah Zallman, Karen Finnegan, David Roll, Martina Todaro, Rawan Oneiz, Assaad Sayah
BACKGROUND: Medical scribes are a clinical innovation increasingly being used in primary care. The impact of scribes in primary care remain unclear. We aimed to examine the impact of medical scribes on productivity, time spent facing the patient during the visit, and patient comfort with scribes in primary care. METHODS: We conducted a prospective observational pre-post study of 5 family and internal medicine-pediatrics physicians and their patients at an urban safety net health clinic...
July 2018: Journal of the American Board of Family Medicine: JABFM
Evan S Cole
Direct Primary Care (DPC), where patients pay a fee to a primary care provider to obtain access to services, is a delivery model that has received notable attention and enthusiasm from some providers. Proponents of DPC believe that the model increases accessibility, reduces overhead, and ultimately improves care for patients; however, there is little evidence in the peer-reviewed literature to support these claims. The objective of this analysis was to apply Starfield's adaptation of Donabedian's Structure-Process-Outcome conceptual model to evaluate primary care to formally display the links between potential changes in clinical structure and processes from DPC adoption...
July 2018: Journal of the American Board of Family Medicine: JABFM
Brian Park, Stephanie B Gold, Andrew Bazemore, Winston Liaw
INTRODUCTION: Prior research has demonstrated the associations between a strong primary care foundation with improved Quadruple Aim outcomes. The prevailing fee-for-service payment system in the United States reinforces the volume of services over value-based care, thereby devaluing primary care, and obstructing the health care system from attaining the Quadruple Aim. By supporting a shift from volume-based to value-based payment models, the Medicare Access and Children's Health Insurance Program Reauthorization Act may help fortify the role of primary care...
July 2018: Journal of the American Board of Family Medicine: JABFM
Karen J Sherman, Rod L Walker, Kathleen Saunders, Susan M Shortreed, Michael Parchman, Ryan N Hansen, Manu Thakral, Evette J Ludman, Sascha Dublin, Michael Von Korff
OBJECTIVE: This analysis examined patients' perceptions about trust within the doctor-patient relationship related to managing opioid pain medications. We compared perceptions among chronic opioid therapy (COT) patients who were and were not exposed to opioid risk reduction initiatives. METHODS: Between 2014 and 2016, we surveyed 1588 adults with chronic pain receiving COT about their trust in their prescribing doctor, their perceptions of their doctor's trust in them, their concerns about opioid prescribing, and their knowledge of opioid safety concerns...
July 2018: Journal of the American Board of Family Medicine: JABFM
Carola van Dipten, Wim J C de Grauw, Jack F M Wetzels, Willem J J Assendelft, Nynke D Scherpbier-de Haan, Marianne K Dees
INTRODUCTION: It is unknown what patients in primary care with mild-to-moderate chronic kidney disease (CKD) know, think, and feel about their diagnoses and how they value the information provided. The aim of the study was to explore their knowledge, thoughts, and experiences concerning their CKD and the information given to them. METHOD: Qualitative interview study with patients with mild-to-moderate CKD who know their diagnoses and are treated mainly by family physicians...
July 2018: Journal of the American Board of Family Medicine: JABFM
Toshiaki Wakai, Madeline Simasek, Urara Nakagawa, Masaji Saijo, Michael D Fetters
BACKGROUND: Early Periodic Screening, Diagnosis, and Treatment visits are designed to address physical, mental, and developmental health of children enrolled in Medicaid. METHODS: We conducted a mixed methods intervention by using a quality improvement theory. We assessed preintervention and postintervention screening rates of development, anemia, lead, oral health, vision and hearing, interventions for improvement, and barriers for the well-child visits at an academic family medicine clinic...
July 2018: Journal of the American Board of Family Medicine: JABFM
Toren Davis, Albert Meyer, Janalynn Beste, Sonali Batish
BACKGROUND AND OBJECTIVE: The goal of this study was to decrease avoidable, low-acuity emergency department (ED) use among pediatric patients at Coastal Family Medicine. The rationale behind this focus was to improve continuity for our patients while decreasing the cost burden for low-acuity ED visits. The family medicine residency clinic pediatric panel has grown by 35% over the past 3 years, bringing this issue of same-day acute access in our clinic to the forefront. METHODS: A survey was created to better understand the needs of our high users of the ED...
July 2018: Journal of the American Board of Family Medicine: JABFM
Jessica Powell, Catherine Skinner, Drake Lavender, Daniel Avery, James Leeper
BACKGROUND: The closure of obstetrics (OB) units at rural hospitals is thought to have implications for access to prenatal care (PNC) and infant mortality rate (IMR). The objective of this study was to determine whether local availability of PNC and OB services, specifically as provided by family physicians (FPs), would be associated with a lower IMR in 1 rural Alabama county. METHODS: Data from 1986 to 2013 from Pickens County was compared with data from 2 sets of control counties: Clarke/Monroe (full OB care) and Coosa/Conecuh (no local OB care)...
July 2018: Journal of the American Board of Family Medicine: JABFM
Tanen T St Clair-Brown, Kaitlin E Schwerer, Godwin Y Dogbey
PURPOSE: Thrush is an opportunistic infection of the buccal cavity by the organism Candida albicans . It is most commonly seen in infants and becomes relatively uncommon between 6 to 9 months of age implying the infection is possibly dictated by risk factors present at or around the time of birth. The objective of this study is to determine if there is an association between the development of thrush and cesarean delivery, as we hypothesize. METHODS: Neonatal records were obtained through retrospective chart review of the past 10 years from an outpatient clinic and hospital records in Sandusky Ohio...
July 2018: Journal of the American Board of Family Medicine: JABFM
Batel Blechter, Nan Jiang, Charles Cleland, Carolyn Berry, Olugbenga Ogedegbe, Donna Shelley
BACKGROUND: Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (<5 providers). METHODS: We conducted a cross-sectional analysis by using data collected from 235 providers practicing in 174 small independent primary care practices in New York City. RESULTS: The rate of provider-reported burnout was 13.5%. Using bivariate logistic regression, we found higher adaptive reserve scores were associated with lower odds of burnout (odds ratio, 0...
July 2018: Journal of the American Board of Family Medicine: JABFM
Dilip Nair, Andrea Hart
BACKGROUND: Obesity is a serious and highly prevalent health problem. Behavioral modification for weight loss is effective, and physician nutrition counseling is encouraged. Nevertheless, several studies have reported that physicians provide nutrition counseling infrequently. Time constraints and lack of patient compliance are among frequently reported barriers. AIM: In this pilot study, we aimed to examine physician weight loss nutrition counseling among family physicians in Huntington, West Virginia, an area with the highest obesity prevalence in the United States...
July 2018: Journal of the American Board of Family Medicine: JABFM
Amy S Williams, Bin Ge, Greg Petroski, Robin L Kruse, Jane A McElroy, Richelle J Koopman
BACKGROUND: Childhood obesity in the United States is a critical public health issue. Although multiple child and parental factors are associated with childhood obesity, few models evaluate how socioeconomic status influences these risk factors. We aimed to create a model to examine how socioeconomic status modifies risk factors for child obesity. METHODS: We conducted a secondary data analysis of the Early Childhood Longitudinal Birth Cohort. Using logistic regression, we modeled childhood obesity status from known parental and child risk factors for childhood obesity and tested interactions with socioeconomic status...
July 2018: Journal of the American Board of Family Medicine: JABFM
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