Table of Contents
PLAIN LANGUAGE ARTICLE SUMMARIES
Special Annals of Family Medicine Supplement Focuses on Improving Care through Equity, Collaboration, and Education
Articles appearing in an Annals of Family Medicine special supplement contain observations, insights, and ideas for advancing health
care equity, promoting interprofessional collaboration, transforming education, and
improving primary care practices.
The supplement, titled, “Advancing Primary Care through Research, Education and Practice:
Work of the Health Resources and Services Administration–Supported Academic Units
for Primary Care Training and Enhancement,” highlights activities of six HRSA-funded
academic units for primary care training enhancement. These units were tasked with
examining and improving health equity; bolstering primary care training to better
serve the needs of patients, families, and communities; and generating new research
in these focus areas.
HRSA is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.
This supplement consists of seven original research articles, one theory article, one scoping review, seven special reports, two essays, and one editorial, from nationally recognized experts in primary care research and practice transformation.
Researchers present a model for education that integrates care in both primary care
and dental settings
The Teaming and Integrating for Smiles and Health project was established at Harvard School of Dental Medicine to help health care organizations accelerate progress in integrating oral and primary care delivery. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and gingivitis in the primary care setting, and to increase the rate of bi-directional referrals between oral and primary care partners. Although gingivitis screening and referral to oral health care were not significantly improved, the collaborative demonstrated that virtual learning is an accessible and productive avenue to improve interprofessional education, promote and strengthen oral and primary care partnerships, and support practical progress in integrated care.
Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams
by Kaitlyn Cardenas, BS, et al, Boston, Massachusetts
Study evaluates the current state of teaching about antiracism in undergraduate and
graduate medical education
Medical schools inconsistently teach students about the impact of structural racism
on health care access, quality, and outcomes, instead focusing primarily on human
biological function as the foundation for medical education. This is despite evidence
that structural racism and other social injustices have perpetuated health inequities
for decades. Research authors argue that inclusion of anti-racism in medical education
requires additional training of instructors; focused institutional policies; enhanced
foundational awareness of the impact of racism on patients and communities; and changes
at the level of institutions and accreditation bodies.
by Chyke A. Doubeni, MD, MPH, et al, Columbus, Ohio
Opioid use disorder-related stigma is commonly observed and impedes medically assisted
treatment for OUD
Researchers assessed barriers and facilitators to successful program
implementation of medically assisted treatment for those with opioid use disorder.
The researchers assert that achieving stigma-free OUD care will ultimately require
a cultural shift in clinical and educational settings that readily dispels myths associated
with origin stigma and design curricula, as well as those that reinforce learning
opportunities to care for people with OUD.
by Chyke A. Doubeni, MD, MPH, et al, Columbus, Ohio
Study evaluates the current state of teaching about antiracism in undergraduate and
graduate medical education
Medical schools inconsistently teach students about the impact of structural racism
on health care access, quality, and outcomes, instead focusing primarily on human
biological function as the foundation for medical education. This is despite evidence
that structural racism and other social injustices have perpetuated health inequities
for decades. Research authors argue that inclusion of anti-racism in medical education
requires additional training of instructors; focused institutional policies; enhanced
foundational awareness of the impact of racism on patients and communities; and changes
at the level of institutions and accreditation bodies.
by Chyke A. Doubeni, MD, MPH, et al, Columbus, Ohio
Pediatric care provider network educates and motivates clinicians and non-clinicians
to improve patient access to oral health
Oral disease significantly impacts the overall health of U.S. children, with tooth
decay being the most prevalent chronic disease in children. With dental provider shortages
occurring nationwide, interprofessional clinicians and staff with proper training
can influence oral health access. A team of investigators found that the Oral Health
Knowledge Network, a collaborative of pediatric care providers, had a positive impact
on clinicians and non-clinicians by increasing their knowledge/skills and motivation
to improve their patients' access to oral health through resource sharing as well
as clinical practice change.
Evaluation of the Oral Health Knowledge Network's Impact on Pediatric Clinicians and Patient Care
by Tien Jiang, DMD, MEd, et al, Boston, Massachusetts
Clinicians can work proactively to reduce mental illness stigma by encouraging patient
self-disclosure and listening with more empathy
Stigma related to mental health can pose a significant barrier to individuals utilizing
mental and physical health care. Integrated Behavioral Health (IBH), in which behavioral/mental
health care services are situated within a primary care setting, may reduce the experience
of stigma. Study authors support health care clinicians engaging in patient conversations
that are patient centered and normalize mental health discussions as ways of reducing
stigma. Clinicians can also encourage patient self-disclosure by using greater empathy
and relating more to the patient. They can also strive to increase patients’ understanding
of their experiences as ways to reduce stigma and remove health care–seeking barriers.
by Sean M. Phelan, PhD, MPH, et al, Rochester, Minnesota
Researchers describe the development, implementation and integration of Mayo Clinic’s
pediatric and adult primary care psychotherapy tracking database
Many individuals experiencing behavioral health challenges receive services in
primary care. Integrated behavioral health (IBH) programs can help physicians gain
increased access to evidence-based interventions. IBH programs stand to reap significant
benefits from integrating standardized tracking databases that allow for the implementation
of measurement-based care to evaluate patient-, physician-, and practice-level outcomes.
Researchers from the Mayo Clinic describe the development and integration of a psychotherapy
tracking database, which they argue allows for better physician communication, examination
of patient outcomes, practice quality improvement efforts, and clinically relevant
research.
by Anne I. Roche, PhD, et al, Rochester, Minnesota
Mixed-methods study examines the integration of behavioral health topics into postgraduate
dental curriculum
Researchers evaluate the integration of behavioral health topics such as the identification
of eating disorders, depressive disorders, opioid use disorder, and intimate partner
violence in primary care postgraduate dental curricula. They argue that greater efforts
are needed by advanced education in graduate dentistry and general practice residency
programs to include behavioral health content so that those clinicians are able to
address these conditions.
Behavioral Health Within Primary Care Postgraduate Dental Curricula: A Mixed Methods Study
by Shenam Ticku, BDS, MPH, et al, Boston, Massachusetts
Editorial
Obstacles and Opportunities on the Path to Improving Health Professions Education
and Practice: Lessons From HRSA’s Academic Units for Primary Care Training and Enhancement
Stephen D. Persell, MD, MPH, and Christine A. Riedy, PhD, MPH, write the special supplement’s
editorial, placing the supplement’s articles within the wider context in which primary
care and family medicine doctors function today, outlining challenges, opportunities
and communities that foster education on how the profession can move forward. Supplement
articles tackle more specific areas of concern, including having in place a workforce
trained to care for those among marginalized groups; eliminating stigmas and barriers
associated with mental health care seeking; tackling socioeconomic issues; and making
primary care more all-encompassing in regard to health care provision, such as overlapping
services to address oral as well as mental health care. Although the research is new
and not widely implemented yet, Persell and Riedy hope that it will contribute momentum
to other existing efforts to reimagine primary care and create health care that is
whole-person oriented, interprofessional, community focused and equitable.
Guest Editors: Stephen D. Persell, MD, MPH, Division of General Internal Medicine, Department of Medicine and Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Christine A. Riedy, PhD, MPH, Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
Special Reports
Revolutionizing Health Professions Admissions to Achieve an Inclusive Workforce
By Mytien Nguyen, MS, et al, New Haven, Connecticut
100 Million Mouths Campaign: Creating a Pilot Program to Advance Oral Health Equity
by Shenam Ticku, BDS, MPH, et al, Boston, Massachusetts
Building Rural Primary Care Research by Connecting Rural Programs
By David F. Schmitz, MD, et al, Grand Forks, North Dakota
By Stephen D. Persell, MD, MPH, et al, Chicago, Illinois
By Aramandla Ramesh, PhD, et al, Nashville, Tennessee
By Memoona Hasnain, MD, MHPE, PhD, Chicago, Illinois and Ashley Darcy-Mahoney, PhD, NNP-BC, FAAN, George Washington University, Washington, D.C.
By Oluwatoyin Akinnusotu, BS, et al, Rochester, Minnesota
Theory Paper
By Aramandla Ramesh, PhD, et al, Nashville, Tennessee
Scoping Review
By Mita Sanghavi Goel, MD, MPH, et al, Chicago, Illinois
Essays
Why Are Family Doctors Still Not Addressing Oral Health?
By Hugh Silk, MD, MPH, FAAFP, et al, Worcester, Massachusetts
Our Souls Look Back and Wonder: Reflections on Belonging and Being Invisible in Medicine
By Alicia Gonzalez-Flores, MD, et al, Sacramento, California