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EditorialEditors' Note

Social Determinants of Health and Beyond: Information to Help Family Physicians Improve Patient Care

Marjorie A. Bowman, Anne Victoria Neale and Dean A. Seehusen
The Journal of the American Board of Family Medicine May 2016, 29 (3) 295-296; DOI: https://doi.org/10.3122/jabfm.2016.03.160099
Marjorie A. Bowman
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Anne Victoria Neale
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Dean A. Seehusen
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Abstract

Social determinants of health (SDOHs) are a theme in this issue. In addition, we include a series of clinical articles to inform family medicine. One helps to demystify the process of obtaining hearing care. Another provides a case report of how a vanishing twin can confuse a newly available test. We also share articles on the early symptoms and signs of femoral insufficiency fractures and a simple test to help diagnose basal cell carcinomas. Family physicians provide their views on point-of-care tests. Positive outcomes are reported for behavioral health integration into family medicine offices and for diabetes education among patients cared for within patient-centered medical homes. A questionnaire can help family physicians identify and facilitate conversations with their patients about adverse childhood experiences.

In this issue, the clinical review article on hearing loss1 is wonderfully practical and answers many questions asked by patients and clinicians in family medicine offices. The system for obtaining appropriate hearing tests and hearing aids is certainly opaque to many people, and this guidance can help.

Femoral insufficiency fractures are uncommon but can be related to bisphosphonate therapy for the common diagnosis of osteoporosis. Based on a clinical case, Shaikh et al2 provide a review of the often subtle symptoms and radiographic findings that suggest the possibility of an insufficiency fracture and thus prompt further evaluation.

In another clinical pearl, Quach et al3 describe a clinical finding—the “basal cell blanche”—that can estimate the extent of a basal cell cancer and, to a certain extent, help clinicians determine whether a skin lesion might be a basal cell carcinoma. Some clinicians may have already figured out this practical hint, but if you have not, it is a quick and useful maneuver.

In a fascinating twist, the accuracy of a new prenatal test may be less than expected, creating potential uncertainty and anxiety for expecting parents and their clinicians. Vanished twins have long been known to happen, at least since the time of prenatal ultrasound. The new noninvasive test is cell-free DNA testing, which can determine the (presumed) sex of an infant with a simple maternal blood draw. Kelley4 provides a case report describing an instance when this noninvasive blood test led to confusion at the time of the infant's birth, and therefore led to additional testing of the infant to verify the correct sex. This situation may be rare, but clinicians need to be aware, and families forewarned, of this possibility.

Family physicians use a large number of point-of-care tests in the office, and generally we can expect this trend to increase as technology makes accurate office testing more feasible. In general, this is good. Years ago, family physicians did far more testing in the office, providing patient convenience and helping office finances. In recent years, testing has shifted to their health system employers or outside corporations. In the article by Sohn et al.5, primary care physicians rate what are, or could be, the most useful point-of-care tests.

Increasingly, we learn of the benefits of the patient-centered medical home (PCMH) model. Manard et al6 report on a system with primary care offices, some of which were PCMH designated and some of which were not. Patients from the PCMH office with prediabetes or diabetes were more likely to receive diabetes education referrals. A strength of this study is the large sample size of ≥1000 patients with at least 2 visits for prediabetes or diabetes.

Several articles in this issue are about behavioral health in family medicine. Behavioral health collaboration and partnership is important in family medicine, and is considered key in the PCMH. As shown in the JABFM supplement on behavioral health integration,7 it is not simple to successfully and efficiently incorporate behavioral clinicians into family medicine offices. In the study by van Eeghen et al,8 all measures showed positive improvement after various office changes, some of which involved in-office behavioral health clinicians. Over 8000 patients were cared for in the outpatient office during the study period, with >700 behavioral health referrals. Although there was no measure of improvement in mental health, the increase in the number of patient visits with a behavioral clinician is a wonderful start.

Adverse childhood experiences are an example of situations that lead to the need for behavioral health interventions. These traumatic events are associated with long-term effects, often into adulthood. Glowa et al9 report using a previsit childhood adverse experience questionnaire with adults visiting family physicians. The questionnaire results were provided to the physicians. The physicians reported changes in discussion or actions based on the questionnaire and noted an appreciation of the information, which was often new to them. For more on the integration of behavioral health in family medicine, see the articles related to the theme of social determinants of health in this issue, along with the associated commentary by Hughes et al.10

Notes

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

  • See Related Commentary on Page 297.

References

  1. 1.↵
    1. Contrera KJ,
    2. Wallhagen MI,
    3. Mamo SK,
    4. Oh ES,
    5. Lin FR
    . Hearing loss health care for older adults. J Am Board Fam Med 2016;29:394–403.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Shaikh W,
    2. Morris D,
    3. Morris S
    . Signs of insufficiency fractures overlooked in a patient receiving chronic bisphosphonate therapy. J Am Board Fam Med 2016;29:404–7.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Quach OL,
    2. Barry M,
    3. Roberts Cruse A,
    4. Wilson BB
    . “Basal cell blanche”: a diagnostic maneuver to increase early detection of basal cell carcinomas. J Am Board Fam Med 2016;29:408–10.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Kelley JF,
    2. Henning G,
    3. Ambrose A,
    4. Adelman A
    . Vanished twins and misdiagnosed sex: a case report with implications in prenatal counseling using noninvasive cell-free DNA screening. J Am Board Fam Med 2016;29:411–13.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Sohn AJ,
    2. Hickner JM,
    3. Alem F
    . Use of point-of-care tests (POCTs) by US primary care physicians. J Am Board Fam Med 2016;29:371–6.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Manard WT,
    2. Syberg K,
    3. Behera A,
    4. et al
    . Higher referrals for diabetes education in a medical home model of care. J Am Board Fam Med 2016;29:377–84.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    Advancing care together by integrating behavioral health and primary care. J Am Board Fam Med 2015;28(Suppl 1):S1–110. Available from: http://jabfm.org/content/28/Supplement_1.
    OpenUrlFREE Full Text
  8. 8.↵
    1. van Eeghen C,
    2. Littenberg B,
    3. Holman MD,
    4. Kessler R
    . Integrating behavioral health in primary care using lean workflow analysis: a case study. J Am Board Fam Med 2016;29:385–93.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Glowa PT,
    2. Olson AL,
    3. Johnson DJ
    . Screening for adverse childhood experiences in a family medicine setting: a feasibility study. J Am Board Fam Med 2016;29:303–7.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Hughes LS,
    2. Phillips RL Jr.,
    3. DeVoe JE,
    4. Bazemore AW
    . Community vital signs: taking the pulse of the community while caring for patients. J Am Board Fam Med 2016;29:419–22.
    OpenUrlAbstract/FREE Full Text
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The Journal of the American Board of Family     Medicine: 29 (3)
The Journal of the American Board of Family Medicine
Vol. 29, Issue 3
May-June 2016
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Social Determinants of Health and Beyond: Information to Help Family Physicians Improve Patient Care
Marjorie A. Bowman, Anne Victoria Neale, Dean A. Seehusen
The Journal of the American Board of Family Medicine May 2016, 29 (3) 295-296; DOI: 10.3122/jabfm.2016.03.160099

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Social Determinants of Health and Beyond: Information to Help Family Physicians Improve Patient Care
Marjorie A. Bowman, Anne Victoria Neale, Dean A. Seehusen
The Journal of the American Board of Family Medicine May 2016, 29 (3) 295-296; DOI: 10.3122/jabfm.2016.03.160099
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  • Family Physicians Can/Should Do: What? Where? And How?
  • Clinically Useful Family Medicine Research
  • Mental Health of Patients and Clinicians Before and During the COVID-19 Pandemic
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