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EditorialEditors' Note

Clinical and Practice Innovation Improving the Practice of Family Medicine

Marjorie A. Bowman, Dean A. Seehusen, Jacqueline Britz and Christy J. W. Ledford
The Journal of the American Board of Family Medicine May 2024, 37 (3) 357-359; DOI: https://doi.org/10.3122/jabfm.2024.240144R0
Marjorie A. Bowman
MD, MPA
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Dean A. Seehusen
MD, MPH
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Jacqueline Britz
MD, MSPH
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Christy J. W. Ledford
PhD
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  • Article
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Abstract

Quite a lineup showcasing JABFM’s emphasis on research and information for family medicine to improve patients’ lives. Articles cover many topics: telemedicine, a clinical decision support tool, control of cardiovascular risk factors, opioid dose reduction, cancer survivorship care, patient engagement with case management/navigation, primary care physician capacity and usual source of care, marketing practices of Medicare Advantage programs, review articles (new diabetes medicine and treatment CHF with reduced ejection fraction), and more.

Patient Management and Support

Heart failure and diabetes are common diagnoses in family medicine practices. Williamson and Tong1 review the treatment of a subtype, specifically heart failure with reduced ejection fraction. Morrison et al2 review new medications for diabetes [glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium glucose cotransporter-2 inhibitors (SGLT2-Is)], including cardiovascular and renal effects.

Controlled substances are often needed but can generate other problems. Sanders et al3 describe a cohort-based study within a family practice. Results generate evidence for the use of controlled substance safety committees (CSSC) to decrease the use of opioids, including as examined through the lens of health equity. Hooker et al4 suggest that Clinical Decision Support (CDS) tools can also support management of opioid use. CDS tools are designed to help primary care clinicians implement evidence-based guidelines for chronic disease care. Dr. Hemler et al5 report on innovations in survivorship care for primary care. Opioids are sometimes necessary, but the goal is to only use them when truly needed.

Another study6 describes telemedicine use among primary care clinicians in safety net settings, including variation in telemedicine modalities used and impact on access. This survey, fielded between September 2020 and April 2023, found that though safety net providers were more likely to report barriers to telemedicine use (eg, lack of broadband), they were also more likely to report telemedicine reduced no-shows and potentially improved access to care.

There is disappointing news in an article describing the proportion of patients who accept health and social needs case management initiated by practices.7 How much is due to how case managers contact patients, competing demands in patients’ lives, or other patient concerns? Despite the limitations, it seems that clinicians assist with these issues,8 as community health center clinicians described routinely adjusting patient care plans based on their patients’ social contexts. Somewhat in contrast, Aronstam et al9 report on caregivers’ description of 3 pathways through which a navigation program reportedly affected overall child and/or caregiver health, including increasing knowledge, connection, and emotional support. Participants suggested that navigation programs can influence health even when they do not directly impact resource access. Specific and individualized navigation may be key.

This issue’s correspondence includes information about the opportunity for lactating people living with HIV to chest-feed/breast-feed infants.10 Another letter reports on an outbreak of hand, foot, and mouth disease at a university.11 Baltazar et al introduce readers to elastic scattering spectroscopy12 with data from the experience of family physicians evaluating 155 patients’ lesions. The first PURL for this issue includes the potential for less aggressive hydration for acute pancreatitis.13 The second PURL reviews the relative efficacy of various medication classes for osteoporosis management.14

Policy Affects Patient Care

Many family physician offices will relate to the issues created by the marketing practices of Medicare Advantage programs as noted in a commentary by Bohler and Adashi.15 The authors note the associated astonishingly high rate of complete or partial overturning of the initial plan decisions to deny patients’ appeals, and their high average gross margin per enrollee. Many family practices feel this pain directly in the extra work generated and indirectly in the angst that patient needs are not met.

There are also health policy lessons in the report by Topmiller et al.16 Primary care physician capacity and having a usual source of care do not always correlate and the ratio of primary care physician capacity to population varies by region. Thus, the type of health policy interventions needed to improve access to primary care may need to be targeted to geographic region.

Practice facilitation may not be familiar to all primary care clinicians. Cole et al17 report on the perceived usefulness of different types of facilitated intervention strategies in 44 practices, which informs intervention priorities for others. The availability of practice facilitation likely needs encouragement by the provision of financial support.

Medical school policy also affects patient care through the type of, and expectations for, faculty. Alvarez et al18 discuss 3 reasons why black and other minoritized faculty should be afforded the opportunity to achieve tenure status in their academic health centers.

Short, Interesting, and Helpful

We have several letters or short articles that address topics central to the practice of family medicine. For example, one provides an enthusiastic report about the use of person-centered, goal-oriented care to improve patients’ Quality of Life (QOL),19 and another set of authors write about their experience creating a unique direct primary care clinic20 for patients from vulnerable communities. A third letter expresses concerns about the adequacy of data by race and ethnicity to assess early-career compensation trends for family physicians in a previously published article21 with an explanatory reply by the authors of the original article.

Notes

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

  • To see this article online, please go to: http://jabfm.org/content/37/3/357.full.

References

  1. 1.↵
    1. Williamson B,
    2. Tong C
    . Management of chronic heart failure with reduced ejection fraction. J Am Board Fam Med 2024;37:364–371.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Morrison L,
    2. Gabison J,
    3. Oshman L
    . GLP-1 RAs and SGLT2-Is to lower glucose and reduce the risk of cardiovascular and diabetic kidney disease. J Am Board Fam Med 2024;37:372–382.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Sanders M,
    2. Fiscella K,
    3. Devine M,
    4. Hunter J,
    5. Mohamed Y,
    6. Fogarty CT
    . Opioid dose reductions by sex and race in a cohort of patients in a family medicine clinic. J Am Board Fam Med 2024;37:383–388.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Hooker SA,
    2. Solberg LI,
    3. Miley KM,
    4. Borgert-Spaniol CM,
    5. Rossom RC
    . Barriers and facilitators to using a clinical decision support tool for opioid use disorder in primary care. J Am Board Fam Med 2024;37:389–398.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Hemler JR,
    2. Crabtree BF,
    3. O’Malley D,
    4. et al
    . Recent innovations in primary care cancer survivorship care. J Am Board Fam Med 2024;37:399–408.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Foumena Nkodo A,
    2. Gonzalez MM,
    3. Reves S,
    4. Etz RS
    . Telemedicine adoption during COVID-19 pandemic: perspectives from primary care clinicians in safety-net settings. J Am Board Fam Med 2024;37:409–417.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Lo CH,
    2. Knox MJ,
    3. Hernandez EA,
    4. Brewster AL
    . Factors associated with patient engagement in a health and social needs case management program. J Am Board Fam Med 2024;37:418–426.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. De Marchis EH,
    2. Aceves B,
    3. Razon N,
    4. Chang Weir R,
    5. Jester M,
    6. Gottlieb LM
    . Adjusting clinical plans based on social context. J Am Board Fam Med 2024;37:466–478.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Aronstam A,
    2. Velazquez D,
    3. Wing H,
    4. et al
    . Families’ perspectives on social services navigation after pediatric urgent care. J Am Board Fam Med 2024;37:479–486.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. White B,
    2. Ringwald B,
    3. Gorman E
    . Chestfeeding for lactating people living with HIV. J Am Board Fam Med 2024;37:512.
    OpenUrlFREE Full Text
  11. 11.↵
    1. Spotts PH
    . Outbreak of hand, foot, and mouth disease among university residential students. J Am Board Fam Med 2024;37:513.
    OpenUrlFREE Full Text
  12. 12.↵
    1. Tepedino M,
    2. Baltazar D,
    3. Hanna K,
    4. Bridges A,
    5. Billot L,
    6. Zeitouni NC
    . Elastic scattering spectroscopy on patient-selected lesions concerning for skin cancer. J Am Board Fam Med 2024;37:427–435.
    OpenUrlAbstract/FREE Full Text
  13. 13.↵
    1. Mott T,
    2. DePriest T,
    3. Fry P,
    4. Linder T
    . Less aggressive hydration may be more in acute pancreatitis? J Am Board Fam Med 2024;37:487–489.
    OpenUrlAbstract/FREE Full Text
  14. 14.↵
    1. Furr N,
    2. Ulmer A,
    3. Cardon B
    . Shoring up osteoporosis management: a fresh start? J Am Board Fam Med 2024;37:490–493.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Bohler F,
    2. Adashi EY
    . Addressing the marketing practices of Medicare advantage programs. J Am Board Fam Med 2024;37:494–496.
    OpenUrlAbstract/FREE Full Text
  16. 16.↵
    1. Topmiller M,
    2. Shadowen H,
    3. Byun H,
    4. et al
    . Relationship between primary care physician capacity and usual source of care. J Am Board Fam Med 2024;37:436–443.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Cole AM,
    2. Keppel GA,
    3. Baldwin L-M,
    4. Holden E,
    5. Parchman M
    . Implementation strategies used by facilitators to improve control of cardiovascular risk factors in primary care. J Am Board Fam Med 2024;37:444–454.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Alvarez C,
    2. Boston DM,
    3. Norman LW,
    4. et al
    . Why opportunities for tenure matter for minoritized faculty in academic medicine. J Am Board Fam Med 2024;37:497–501.
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    1. Jennings LA,
    2. Mold JW
    . Person-centered, goal-oriented care helped my patients improve their quality of life. J Am Board Fam Med 2024;37:506–511.
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. Liaw W,
    2. King B,
    3. Olaisen H,
    4. et al
    . How an academic direct primary care clinic served patients from vulnerable communities. J Am Board Fam Med 2024;37:455–465.
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    1. Oluyadi FO,
    2. Cordon-Duran A,
    3. Lambert CE. Jr.
    Re: early-career compensation trends among family physicians. J Am Board Fam Med 2024;37:514.
    OpenUrlFREE Full Text
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The Journal of the American Board of Family   Medicine: 37 (3)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 3
May-June 2024
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Clinical and Practice Innovation Improving the Practice of Family Medicine
Marjorie A. Bowman, Dean A. Seehusen, Jacqueline Britz, Christy J. W. Ledford
The Journal of the American Board of Family Medicine May 2024, 37 (3) 357-359; DOI: 10.3122/jabfm.2024.240144R0

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Clinical and Practice Innovation Improving the Practice of Family Medicine
Marjorie A. Bowman, Dean A. Seehusen, Jacqueline Britz, Christy J. W. Ledford
The Journal of the American Board of Family Medicine May 2024, 37 (3) 357-359; DOI: 10.3122/jabfm.2024.240144R0
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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
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