Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
EditorialEditors' Note

Research in Family Medicine by Family Physicians for the Practice of Family Medicine

Marjorie A. Bowman, Anne Victoria Neale and Dean A. Seehusen
The Journal of the American Board of Family Medicine July 2016, 29 (4) 427-429; DOI: https://doi.org/10.3122/jabfm.2016.04.160159
Marjorie A. Bowman
MD, MPA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne Victoria Neale
PhD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dean A. Seehusen
MD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

This issue lays out challenges for family medicine researchers. Each article increases our understanding of solutions to common problems in family medicine, yet with each, one can readily see the next challenge based on the newly gained knowledge. One of the goals of the JABFM is to encourage research in family medicine for family medicine. Here we combine our usual editors' notes with thoughts about what the next research studies could, and hopefully will, be.

C-reactive protein is not an adequate diagnostic marker for more serious illness in young febrile children.1 The research needed: Is there a simple and inexpensive test that helps physicians determine when more intense workup and treatment are necessary for febrile children? We know that physicians can often identify young children with serious illness through physical examination2 but yet miss others. Could photographs or videos of sick children help clinicians decide who needs additional examination and/or treatment?

Defroda et al3 review what is known about the need for antibiotic prophylaxis in patients with joint replacements who are having a procedure or surgery. The research questions: What are the true rates of infections among patients who have had joint replacement? Does the rate differ with different surgeries? Mining large data sets, and possibly better coding, would be helpful.

The big business of mobile “apps” seems to trump accuracy, as evidenced by the utility of the currently available apps to help women avoid pregnancy. From the findings of Duane et al,4 one could say that some apps actually increase the chances of pregnancy, not decrease them. Natural family planning, when correctly applied, can work much better than some popular apps. The needed research: how to help patients decide between more and less accurate apps—do they base their decision on cost, visual appeal, or effectiveness?

Jortberg et al5 report on multiple family medicine offices that undertook the Fit Family Challenge office intervention to decrease pediatric obesity. The good news is that this intervention seems modestly successful. The ouch: both pediatrics and family medicine practices found it difficult to sustain, and, obviously, many families also found it hard to sustain and dropped out. Food insecurity, which is associated with obesity, was also associated with noncontinuance. The needed research: how to make the successful aspects of this program a part of routine practice.

Patient portal use6 may make physicians' lives a little easier, but unfortunately it did not change high blood pressure outcomes. This study included a large number of patients. The research questions: Is there a way that portals could be used to improve blood pressure? What can maximize the value of the patient portals for patient centered-outcomes?

Raffoul et al7 remind us that 2500 patients per family physician—a “classic” panel size—is not based on evidence; in fact, many large systems maintain fewer patients per physician. Angstman et al8 tried to determine the ideal panel size in their system at the Mayo Clinic, where physicians are in a team of 2 to 4 physicians along with nurse practitioners, physician assistants, registered nurses, plus license practical nurses. The average family physician in these large teams had 2954 patients. The time to the third available appointment and diabetes quality measures were all worse when the panel size exceeded this number. However, this team structure is much more robust than that available to the average family physician. The research question: What team composition is ideal for which type of practice organizational structure?

In the intense, time-pressured clinical work of a usual day in a busy family medicine office, it is not easy to make sure all of those red-flagged items are handled.9 Further, even with excellent triage, some do not need to be handled urgently, which can create a sense of relief (“Great, I do not have to deal with this one now”) or an “ugh” (“I should not have to look at this at all”). Red-flag fatigue is as bad as alarm fatigue in a hospital. The needed research: How can we increase the accuracy of red flags for truly urgent issues, and how can we improve office strategies to handle these in the flow of a typical day?

Two of this issue's articles are about patient-centered medical home (PCMH) transformation and its impact. Elder et al10 tackle the question of pain management in PCMHs, a huge issue now, in part because of the opioid addiction epidemic. Compared with other practice styles, PCMH practices were better at documenting and performing recommended office activities for chronic opioid prescribing. The needed research: Our dream is to know whether the medical homes actually decrease overall opioid overdoses or death. The detailed assessment by Carlin et al11 of 87 practices in Minnesota considers health care utilization for individuals with chronic illness, specifically with increasing levels of practice change. The results are intriguing, yet confusing. Clearly, the stage of practice change makes a difference. The research: Family medicine wants to know what parts of practice change are key to improved patient outcomes.

And telehealth? Coffman et al12 present current data. A minority of offices participate in telehealth. The research: We can think of many researchable questions about telehealth, from accuracy to best uses to its impact on actual health and costs.

The Choosing Wisely™ campaign is making a difference, decreasing unnecessary testing or procedures, albeit modestly. One reason the campaign is even needed is illustrated by Lin and Yancey,13 who found that most of the Choosing Wisely recommendations are based on expert opinion, Strength of Recommendation Taxonomy14 category C evidence, rather than category A or B, which would reflect more research-based evidence. Family medicine researchers: give us better evidence to help us choose more wisely.

And that is a good ending to this editors' note: We want to choose wisely. Calling on all family medicine researchers: please help! We looked forward to your research advances. Thank you!

Notes

  • Conflict of interest: The authors are editors of the JABFM.

References

  1. 1.↵
    1. Kool M,
    2. Elshout G,
    3. Koes BW,
    4. Bohnen AM,
    5. Berger MY
    . C-reactive protein level as diagnostic marker in young febrile children presenting in a general practice out-of-hours service. J Am Board Fam Med 2016;29:460–8.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Van den Bruel A,
    2. Haj-Hassan T,
    3. Thompson M,
    4. Buntinx F,
    5. Mant D
    . European Research Network on Recognising Serious Infection investigators. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet 2010;375:834–45.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. DeFroda SF,
    2. Lamin E,
    3. Gil JA,
    4. Sindhu K,
    5. Ritterman S
    . Antibiotic prophylaxis for patients with history of total joint replacement. J Am Board Fam Med 2016;29:500–7.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Duane M,
    2. Contreras A,
    3. Jensen ET,
    4. White A
    . The performance of fertility awareness-based method apps marketed to avoid pregnancy. J Am Board Fam Med 2016;29:508–11.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Jortberg BT,
    2. Rosen R,
    3. Roth S,
    4. et al
    . The Fit Family Challenge: a primary care childhood obesity pilot intervention. J Am Board Fam Med 2016;29:434–43.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Manard W,
    2. Scherrer JF,
    3. Salas J,
    4. Schneider FD
    . Patient portal use and blood pressure control in newly diagnosed hypertension. J Am Board Fam Med 2016;29:452–9.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Raffoul M,
    2. Moore M,
    3. Kamerow D,
    4. Bazemore A
    . A primary care panel size of 2500 is neither accurate nor reasonable. J Am Board Fam Med 2016;29:496–9.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Angstman KB,
    2. Horn JL,
    3. Bernard ME,
    4. et al
    . Family medicine panel size with care teams: impact on quality. J Am Board Fam Med 2016;29:444–51.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Meyer AND,
    2. Murphy DR,
    3. Singh H
    . Communicating findings of delayed diagnostic evaluation to primary care providers. J Am Board Fam Med 2016;29:469–73.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Elder N,
    2. Penm M,
    3. Pallerla H,
    4. et al
    . Provision of recommended chronic pain assessment and management in primary care: does patient-centered medical home (PCMH) recognition make a difference? J Am Board Fam Med 2016;29:474–81.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Carlin CS,
    2. Flottemesch TJ,
    3. Solberg LI,
    4. Werner AM
    . System transformation in patient-centered medical home (PCMH): variable impact on chronically ill patients' utilization. J Am Board Fam Med 2016;29:482–95.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Coffman M,
    2. Moore M,
    3. Jetty A,
    4. Klink K,
    5. Bazemore A
    . Who is using telehealth in primary care? Safety net clinics and health maintenance organizations (HMOs). J Am Board Fam Med 2016;29:432–3.
    OpenUrlAbstract/FREE Full Text
  13. 13.↵
    1. Lin KW,
    2. Yancey JR
    . Evaluating the evidence for Choosing Wisely™ in primary care using the strength of recommendation taxonomy (SORT). J Am Board Fam Med 2016;29:512–5.
    OpenUrlAbstract/FREE Full Text
  14. 14.↵
    1. Ebell MH,
    2. Siwek J,
    3. Weiss BD,
    4. et al
    . Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Am Board Fam Med 2004;17:59–67.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 29 (4)
The Journal of the American Board of Family Medicine
Vol. 29, Issue 4
July-August 2016
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Research in Family Medicine by Family Physicians for the Practice of Family Medicine
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
8 + 7 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Research in Family Medicine by Family Physicians for the Practice of Family Medicine
Marjorie A. Bowman, Anne Victoria Neale, Dean A. Seehusen
The Journal of the American Board of Family Medicine Jul 2016, 29 (4) 427-429; DOI: 10.3122/jabfm.2016.04.160159

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Research in Family Medicine by Family Physicians for the Practice of Family Medicine
Marjorie A. Bowman, Anne Victoria Neale, Dean A. Seehusen
The Journal of the American Board of Family Medicine Jul 2016, 29 (4) 427-429; DOI: 10.3122/jabfm.2016.04.160159
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Notes
    • References
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Research on the Social Context of Medicine and the Modern Family Physician
  • Improving Health Through Family Medicine: New Opportunities, Missed Opportunities
  • Clinically Relevant Family Medicine Research: Board Certification Updates
Show more Editors' Note

Similar Articles

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire