Researchers Explore Why Patients Don’t Follow Up With their Doctors After Receiving a Positive Colorectal Cancer Test
While screening by Fecal Immunochemical Test (FIT) can detect colorectal cancers early, successful treatment depends on the patient undergoing follow-up colonoscopy after an unfavorable test result. A paper published by Dutch researchers examines the reasons why some people do not follow up after a positive at-home test. The researchers argue that understanding reasons people do not follow up with their doctors has global implications for all people at risk of the cancer as it is best treated early.
Reasons for lack of follow up include concerns about having a colonoscopy; lack of opportunity to discuss next steps with a medical provider; assumptions and perceptions about their personal risk; a belief that the test result is not indicative of cancer; and questioned effectiveness of polyp removal, as well as poor overall health behaviors. The strongest positive association with follow up was the patient's belief that their family physician would support colonoscopy, as well as fear of cancer. Researchers suggest that personalized screening counseling may help, as well as the involvement of family practitioners.
Lucinda S. Bertels, PhD, et al
Amsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center
Amsterdam and Amsterdam Public Health research institute, Amsterdam, and Erasmus
School of Health Policy and Management, Socio‐Medical Sciences, Rotterdam, The Netherlands.
New Risk Models May Help Doctors Predict Mortality in Hospitalized COVID Patients
As the COVID-19 pandemic continues, researchers have developed and validated two simple risk measurement tools to help clinicians more accurately estimate a hospitalized patient’s COVID-19 risk of death. The two measurement models are called COVID-NoLab and COVID-SimpleLab. In collaboration with the Biobanque Québécoise de la COVID-19 in Montreal, Quebec, Canada, researchers examined patient records of individuals receiving care for COVID-19 in 11 hospitals between March 2020 and February 2021. Patient records were separated into two groups, and each patient record was categorized as low-, moderate-, or high-risk, identified from both the COVID-NoLab and COVID-SimpleLab models.
Researchers found the two scoring systems could predict patient mortality rates with reasonable accuracy, offering clinicians a reliable way to quickly identify low-risk patients who could potentially be managed as outpatients in the event of a bed shortage. These prediction models may help decrease unnecessary hospital admissions during COVID-19 surges.
External Validation of the COVID-NoLab and COVID-SimpleLab Prognostic Tools
Mark H. Ebell M.D., MS, et al
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
Physicians With Beliefs About Long-term Harms of Benzodiazepene Are Less Likely to Prescribe It
Despite the continuing growth of benzodiazepine (BZD)-related overdoses, BZD prescription rates have held constant. Much is unknown about how a doctor’s own beliefs about BZD use and potential harms to patients might influence their willingness to prescribe the drug. Using a Medicare database, researchers identified primary care providers who had prescribed a BZD in 2017 and surveyed a random sample of 100 doctors on their attitudes around BZD prescribing. Approximately 62% of clinician respondents reported that they disagreed or strongly disagreed with the statement, “If a patient has been prescribed a benzodiazepine for years, the potential harms from continuing the benzodiazepine are low,” while 18.0% agreed or strongly agreed with the statement. When clinicians believed that the potential harms from continuing BZDs were low for patients on long-term treatment, they were more likely to prescribe a BZD to patients for whom they cared.
Donovan T. Maust, M.D., MS, et al
Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Emergency Department Visits More Likely for Dementia Patients With Interprofessional Primary Care Team
Individuals with dementia require care from a variety of healthcare providers. Interprofessional team care has been touted as most beneficial to this patient population. Researchers compared emergency department use and hospitalizations in people with dementia receiving care from an interprofessional primary care team and people seeking care from a physician-only group practice. Interprofessional primary care was associated with increased emergency department use but not hospitalizations in people recently diagnosed with dementia, as compared to those receiving care from a physician-only primary care practice. The researchers found no evidence of an association between interprofessional primary care and hospitalization outcomes. This unexpected finding regarding the increase in urgent and non-urgent ER visits raises concerns about the possible impact of interdisciplinary teams on ER visit volume. The authors, however, point out that it’s possible the observed increase in ER visits was appropriate. While interprofessional primary care may be well-suited to manage the growing and complex dementia population, a better understanding of optimal characteristics of team-based care is needed.
Nadia Sourial, Ph.D., et al
Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal and University of Montreal Hospital Research Center, Montreal, Quebec, Canada.
OTHER STUDIES IN THIS ISSUE:
Enhanced Primary Care Diabetes Model Helps Doctors Meet Quality Indicators in Disease Improvement
Most patients with diabetes are treated in the primary care setting. However, the primary care sector faces significant operational, regulatory and reimbursement pressures to improve care quality among those with diabetes. Researchers from the Mayo Clinic created and implemented an Enhanced Primary Care Diabetes (EPCD) model, which leveraged care team nurses, pharmacists and social workers to improve diabetes care quality. They measured the model’s impact on reported quality measures of diabetes care, including glycemic control, blood pressure, cholesterol, abstinence from tobacco, and aspirin use (also known as the D5). After EPCD implementation, staff clinician practices saw a significant improvement in patients meeting the D5. Trends in D5 achievement did not change among the resident physician practices with access to EPCD and worsened among staff clinician practices without access to EPCD. The authors concluded that implementation of the EPCD model was associated with improved diabetes care quality.
Evaluation of an Enhanced Primary Care Team Model to Improve Diabetes Care
Joseph R. Herges, PharmD, et al
Mayo Clinic, Rochester, Minnesota
Further Education Surrounding Use of CGM and Insurance Coverage Are Necessary For Increased Use of Continuous Glucose Monitoring in Primary Care
Continuous glucose monitoring (CGM) is associated with improved health outcomes for patients with diabetes. Primary care practices, however, have been slow to adopt the technology. Researchers used a web-based survey to assess CGM prescribing behaviors and resource needs of U.S. primary care clinicians. They found that clinicians located more than 40 miles from the nearest endocrinologist’s office (endocrinologists being more specialized in treating diabetes) were more likely to have prescribed CGM and to have more favorable attitudes toward prescribing the devices in the future compared to clinicians located within 10 miles of an endocrinologist. Clinicians who served more Medicare patients reported more favorable attitudes toward future prescribing and higher confidence in using CGM to manage diabetes than those with fewer Medicare patients. The authors assert that primary care doctors would benefit from consultation on insurance issues and CGM training to best support prescribing CGMs to their patients. The authors also advocate for continued expansion of Medicare and Medicaid coverage for CGMs.
Tamara K. Oser, MD., et al
University of Colorado Department of Family Medicine, Aurora, Colorado
Positive Reinforcement Can Spur Physicians and Health Practitioners to Promote Tobacco Cessation
University of Maryland Medical System researchers studied the effects of positive reinforcement to encourage physicians and health practitioners to promote referral to tobacco quitline resources. The researchers observed an uptick in referrals after physicians and health practitioners received letters and certificates acknowledging their referral efforts in January 2022, indicating that positive feedback and acknowledgment may improve tobacco cessation e-referral rates. The authors assert that providing physicians and health care providers with access to accurate EHR data can also be a valuable tool in improving clinical outcomes in vulnerable populations and that recognition of physicians’ and practitioners’ efforts can potentially be expanded beyond tobacco cessation to address other areas of practice.
Tobacco Cessation Champions: Recognizing Physicians Who Ask, Advise, and Refer
Niharika Khanna, M.D., MBBS, DGO, et al
Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Telephone-based Smoking Quitline Can Serve as a Successful Treatment Option for Spanish-Speaking Patients
Researchers conducted a study examining the differences in smoking quitline treatment between Spanish- and English-preferring primary care patients linked with evidence-based tobacco treatment using Ask-Advise-Connect (AAC). Researchers compared enrollment, engagement and smoking cessation outcomes. Patients who received treatment in Spanish (vs. English) were twice as likely to be abstinent at six months. Receipt of nicotine replacement therapy (NRT) increased abstinence for all patients. Language was not a factor in predicting abstinence through the use of NRT. The authors assert that automated point-of-care approaches such as AAC have great potential to reach Spanish-preferring smokers, who seem to appreciate treatment by those who speak concordant language.
Bethany Shorey Fennell, Ph.D., et al
Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
Researchers Document and Test New Continuity of Care Measure
Continuity of care is essential to the clinician/patient relationship within family medicine. However, researchers have few ways to track continuity of care as a measurement of clinical quality. Researchers developed the Physician Level Continuity of Care Measure (or CoC measure for short), which only recently received full National Quality Forum (NQF) endorsement. In this paper, researchers present the results of rigorous validity and reliability testing for the CoC measure required for NQF endorsement. The researchers found that when physician CoC scores increased, the number of patients with any emergency department visits decreased. The authors argue that conducting additional research on this validated measure of continuity could help shift physician and health system behavior to support care continuity.
Measuring the Value-Functions of Primary Care: Physician Level Continuity of Care Quality Measure
Mingliang Dai, Ph.D., et al
American Board of Family Medicine
Patient Satisfaction Scores Increase with Waiting Room Concierge Service
Staff at Stony Brook Primary Care collaborated with the Patient Family Advisory Council (PFAC) to help them improve patient information about delays in visit and wait times in the clinic. PFAC members created the “Waiting Room Concierge,” which provided waiting patients with personalized service. After the Waiting Room Concierge was implemented, patient satisfaction scores went from 60% to almost 90%. Additionally, patients commented that they felt more respected by being informed and welcomed in the waiting room. Based on feedback from both patients, staff, and clinicians, the team is continuing to fine tune the role of the waiting room concierge.
Patients Deserve Great Service: The Waiting Room Concierge
Susan Lee
Stony Brook University and Stony Brook Primary Care, East Setauket, New York
New Tool Allows Clinicians to Better Assess and Understand Patient Satisfaction Levels
Conducting research involving large amounts of information can be challenging. To address this issue, researchers created a spreadsheet tool to analyze large comment samples. The tool, called the HCP Review Comment Analysis Tool, is used to identify themes within patient comments and to measure thematic relationships with patient satisfaction. The tool allows users to analyze up to 5,000 comments and gives providers without qualitative research skills or tools the ability to easily analyze patient comments and identify actionable measures of patient satisfaction. Measuring how comments reflect themes provides insights ranging from specific, addressable actions by health care practitioners to breakdowns of structural processes. The authors assert that the tool can be used to measure other aspects of a comprehensive quality program beyond patient satisfaction.
Leveraging Free-form Patient Comments to Assess And Improve Patient Satisfaction
James Kroes, Ph.D., et al
Boise State University, College of Business and Economics, Boise, Idaho
Researchers Propose Competencies for Proper Use of Artificial Intelligence in Healthcare
Family medicine professional associations have sought to identify how Artificial Intelligence (AI) can support primary care. The associations have launched initiatives that bring together AI experts and primary care clinicians to tackle these challenges. In this study, researchers propose six domains of competency for the effective deployment of AI‐based tools in the primary care setting: 1) foundational knowledge (what is this tool?), 2) critical appraisal (should I use this tool?), 3) medical decision making (when should I use this tool?), 4) technical use (how do I use this tool?), 5) patient communication (how should I communicate with patients regarding the use of this tool?) and 6) awareness of unintended consequences (what are the “side effects” of this tool?). Through thoughtful development of these competencies, the primary care workforce can use AI to ensure that this digital revolution realizes its potential for the benefit of patients, clinicians, health systems, and society.
Competencies for the Use of Artificial Intelligence in Primary Care
Winston Liaw, MD, MPH, et al
Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, Texas
Authors Present Strategies to Adapt Primary Care Research Projects Amid Challenging Healthcare Landscape
Conducting family medicine-based research has been difficult during the COVID-19 pandemic. Two family medicine researchers describe common challenges and outline strategies in conducting research in present and future circumstances. They argue that project flexibility and attention to research context will become more common, important and necessary in the future. They call for more funding to help researchers adapt to new ways of conducting studies, such as via telehealth. They also suggest their fellow researchers take this opportunity to engage in research areas they are passionate about and to share lessons learned so that the research community can grow strong together.
Primary Care Research is Hard to Do During COVID-19: Challenges and Solutions
Jodi Summers Holtrop, Ph.D., MCHES, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and Melinda Davis, Ph.D., Department of Family Medicine and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
Medical Professionals Challenge Accepted Norms of Professionalism
A team of authors describes the ways vague definitions of “professionalism” reinforce White, cisgender, straight and able-bodied standards to police the boundaries of belonging in medicine. Through this essay, the authors seek to re-sculpt professionalism in a way that ensures the increasingly diverse physician workforce can effectively address the needs of patients often excluded from quality care.
Re-Sculpting Professionalism for Equity and Accountability
Jessica P. Cerdeña, Ph.D., et al
Yale University School of Medicine, New Haven, and Department of Anthropology, University of Connecticut, Storrs, Connecticut
Medical Student Realizes Supporting and Listening to Grieving Patients Can be Enough
Abigail Driscoll describes her first day of family medicine rotation in a resident-run clinic situated in a diverse, historically underserved community in Minneapolis. There, she encounters patients who must contend with broken systems that give rise to challenging social situations that may include gun violence, lack of health literacy, accidental drug overdoses, food insecurity and barriers to health. She realizes that her job is not to fix a broken system, but to bear witness to patients’ grief.
Abigail Driscoll, MS4
University of Minnesota Medical School
Family Physician Reflects on Missed Opportunities to Advocate
Curtis Kommer, M.D., a hospice medical director, reflects back on his 38-year career as a family physician who is now contemplating retirement. He realizes he has neglected to advocate for himself and his patients and has avoided pushing back against what he deems are an endless series of misguided policy decisions that have had an adverse impact on the health and well-being of his patients. This has made his job more difficult and stressful. He also explains what he is doing now to find his voice and effect change.
My Role in Health Care’s Existential Crisis
Curtis Kommer, M.D.
Accord Hospice of Sedona, Sedona, Arizona
# # #
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and The College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal’s website, www.AnnFamMed.org.
Media Contact:
Adrieanna Norse
Annals of Family Medicine
anorse@aapf.org
Follow Us:
Twitter: @annfammed
Facebook: Annals of Family Medicine