A Focus on Climate Change and How It Impacts Family Medicine
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* Dean A. Seehusen
* Marjorie A. Bowman
* Jacqueline Britz
* Christy J. W. Ledford

## Abstract

This issue highlights climate change, its effects on patients, and actions clinicians can take to make a difference for their patients and communities. The issue also includes several reports on current trends in family physician practice patterns and the influence of practice structure. Four articles focus on controlled or illicit substances. Noteworthy among them is the description of an innovative yet simple device that allows patients to safely discard unused opioids. Other research covers adverse childhood experiences (ACEs), smoking cessation programs, and the impact of Medicare reimbursement rates on influenza vaccination.

## Climate Change

How will family physicians rise to the health challenges caused by climate change? Perez1 asks the question, noting that communities are suffering from the health impacts of climate change. It is undeniable that from heat waves to flooding, climate change currently poses a risk to everyone’s health. Climate expert and family physician Dr. Sarfaty offers insight into how these changes interact with clinical practice.2 Dr. Webel et al.3 point out that even practice-based research networks (PBRNs) can unintentionally contribute to climate change. The authors suggest PBRNs may be able to modify their practices to reduce their environmental impact. The broader medical community is increasingly vocal about the health risks of climate change. In October 2023, the National Academy of Medicine (NAM) released a statement on the reduction of greenhouse gas emissions to slow the pace of climate change.4 Yet, in Muller et al,5 almost 1-third of primary care providers surveyed did not think global warming was occurring or was not caused by humans or affecting the weather. Many others felt they needed more information. To enhance family physicians’ understanding in the emerging field of Climate Health, fellowship training programs and residency curricula are available for collaboration, readily found through internet searching. Support for discovery of the health impacts of climate change is growing. For example, AHRQ recently announced special interest in funding this space.6 We expect to see much more climate-related family medicine research in the coming years.

In another survey of family physicians, many identified how weather had affected their practice and were concerned about raising the issue of climate change with their patients.7 Climate anxiety can affect patients,8 yet their clinicians may be unaware. Muller et al5 note that climate-harmful medication packaging contributes to greenhouse gases. Project Echo authors9 recommend actions to communicate with patients concerning climate change issues. Wolk and Porter10 note they personally emphasize how patients can reduce household air pollution to improve their respiratory health, adding environmental health to our holistic approach to medicine. Further, and quite unfortunately, minority communities face higher threats to their health from climate change and environmental disadvantage.

## Practice Patterns and Structures

Walter et al11 report the percentage of family physicians who perform women’s health procedures by gender and race. Discouraging patterns emerge that could exacerbate disparities in health care delivery for minority women. The authors suggest how to reverse this trend. Results of 2 national surveys of family physicians quantify the current trend toward narrowing scope of practice from a combination of outpatient and inpatient care to practicing just 1 or the other.12 The authors also compare the frequency of such narrowing for both recent graduates and seasoned family physicians.

With primary care clinician burnout continuing to rise, protective factors are important to understand. These factors may be different for rural versus urban clinicians, as reported from Minnesota.13 Primary care is often practiced in small multidisciplinary teams sometimes referred to as “teamlets.” When teamlets are high-performing, patients have better outcomes and clinicians are happier. But what makes a teamlet high performing? Through qualitative inquiry, Chen et al14 identify criteria for performance.

## Controlled and Uncontrolled Substances

Chronic back pain is a common and challenging clinical problem. A retrospective study of long-term (across 12 months) opioid prescribing for chronic back pain compared those given t opioids to those not given opioids.15 The results add to the growing body of evidence regarding opioids in noncancer chronic pain. Proper disposal of unused and expired medications in a safe and environmentally friendly way has been the subject of much research across the past 2 decades. As disposal for unused controlled substances is problematic, Otufowora et al16 describe an innovative approach to opioid disposal.

A separate study looks at the rate of sedative use among men in 2 Southeastern states.17 Veteran status and chronic pain correlated with increased sedative use. This study highlights the need to address our patients’ underlying reasons for sleep issues. Available at convenience stores across the country, kratom is a substance that family physicians need to be ready to talk to our patients about. A letter to the editor describes the risk of potential life-threatening overdoses from kratom, and the need for more research about this potential health threat.18

## More Research

Adverse childhood experiences (ACEs) have a significant long-term impact on future health. Clinicians and policy makers have implemented a variety of screening procedures for ACEs. Alcala et al19 used California Health Interview Survey data to understand screening implementation in the real world. The results reveal inequities in screening patterns.

Potter et al20 present the results of a pilot study comparing 2 smoking cessation programs. The results are mixed and interesting. One interpretation is that there may not be one best smoking cessation program and that the approach needs to be individually tailored, like much of the care family physicians provide.

Would increasing Medicaid reimbursement rates for preventive services increase delivery of those services? Marcondes et al21 show that adolescent influenza rates after the Affordable Care Act temporarily increased reimbursement rates. The results may not be representative of all preventive services but indicate the need for additional tools to increase influenza vaccination uptake.

Dr. Newton22 provides an update on how the American Board of Family Medicine is leading the way to identify competency-based outcome measurements for residency education.

Lastly, a reflection on the COVID-19 pandemic and its impact. Research during the COVID-19 pandemic demonstrated the impact of various public health measures (such as stay-at-home orders) on chronic disease outcomes (such as glucose control in diabetes). A new report looks at outcomes from prepandemic, through the pandemic responses, and into the postpandemic era in 2 primary care clinics in North Carolina.23

## Notes

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

*   To see this article online, please go to: [http://jabfm.org/content/37/1/1.full](http://jabfm.org/content/37/1/1.full).

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6.  6.National Institutes of Health. AHRQ announces interest in research on climate change and healthcare. Available at: [www.grants.nih.gov/grants/guide/notice-files/NOT-HS-23-006.html](http://www.grants.nih.gov/grants/guide/notice-files/NOT-HS-23-006.html): Accessed November 28, 2023.
    
    

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9.  9.Katzman JG, Wheat S, Christiano AS. When climate change shows up in the exam room. J Am Board Fam Med 2024;37:15–18.
    
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18. 18.Hatch A, Gonzalez E, Hanna K. Kratom: facts, fiction, and the unknown. J Am Board Fam Med 2024;37:153.
    
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19. 19.Alcalá HE, Ng AE, Tkach N, Yue D, Sharif M. Disparities in screening for adverse childhood experiences. J Am Board Fam Med 2024;37:73–83.
    
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20. 20.Potter MB, Tsoh JY, Lugtu K, Parra J, Bowyer V, Hessler D. Smoking cessation support in the context of other social and behavioral needs in community health centers. J Am Board Fam Med 2024;37:84–94.
    
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22. 22.Newton WP, Rode K. What assessments are being used in family medicine residencies? J Am Board Fam Med 2024;37:155–159.
    
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