Women’s Health Care, Prevention in Practice, and Common Medical Illnesses

Prevention

Not a classic screening tool, but an unexpected finding that should not be missed is the detection of leukemia on a Complete Blood Count (CBC) done for another reason.⁵ The illustrative figure is more memorable than the average in a medical journal.

Lesser et al⁶ report on the use of automated push notifications from their electronic medical record to patients through texts or e-mails – the newest method replaciopng other types of reminders to encourage preventive services. Within 4 weeks, those receiving push notifications had higher rates of completion of needed services, including visits and laboratory tests. Hopefully, many readers can use the description of their methods to replicate these results.

Two articles highlight the Medicare Annual Wellness Visit. Telehealth has been permitted for the Medicare Annual Wellness Visit since March 2020. While these visits are decreasing in frequency, family physicians are the predominant billing specialty.⁷ Wilkinson et al⁸ find that both clinicians and patients believe more patient preparation for the visit, with an understanding of expectations, would be helpful.

Family physicians know that their care prevents emergency department use – right? Actually, there is little recent data from large databases, including data on small areas to look at geographic disparities, to support this claim, particularly given changes in the medical environment such as the increase in emergency department use, changes in services available in emergency rooms and urgent care centers, and the relative decrease in primary care availability in recent years. Topmiller et al⁹ take on this challenge with the use of a large, Virginia state-wide database. It would be nice to follow this study with an updated investigation of the relative costs and outcomes. As expected, primary care and emergency department use varied by geographic area.

Recognizing the impact of multiple influences on diabetes care adherence, Cohen et al¹⁰ undertook a trial of the feasibility and acceptability of INTEGRATE-D (a type of psychosocial care support) for patients with type 2 diabetes. This was undertaken in 2 control and 2 intervention clinics. The support provided was significant – training on psychological care plus ongoing facilitation to enhance treatment adherence. More study is needed to ascertain wider feasibility and impact.

Pain

Family physicians are often front-line for care of both acute and chronic pain. Licciardone et al¹¹ studied shared decision making for opioid discontinuation, an intervention that can be difficult. The authors compared outcomes for 328 patients from a national pain registry, comparing those reporting more, or less, shared decision making with their clinician. In a separate qualitative interview study of care providers, Johnson et al¹² endeavored to achieve greater understanding of how primary care clinicians successfully undertake integrative pain management. The clinicians interviewed believed that team care across disciplines had the potential to enhance treatment.

Social Determinants of Health

Park et al¹³ used data collected from more than 2,000 physicians involved in the certification process of the American Board of Family Medicine to assess documentation of the Social Determinants of Health …in electronic health records. More documentation was associated with a greater number of patients from neighborhoods with higher social deprivation and having more resources to assist with those difficulties. Separately, male African-American veterans trust their personal clinicians, but frequently mistrust the overall health system.¹⁴ Clinicians who have established relationships with this population should recognize and use this trust to ensure appropriate care.

Physician Shortages and Changes in State Licensure Requirements

Given shortages of physicians, at least 15 states are either enacting or considering measures that reduce licensing barriers for International Medical Graduates.¹⁵ In some cases, provisional licensing of IMGs has replaced requirements for graduate medical education.

Gender Wage Gap

Sadly, Sanders et al¹⁶ estimate that the gender wage gap between male and female family physicians over a working career could amount to millions of dollars (yes, millions). A former article looked at specific differences that were most associated with income differences, such as degree, hours and location of work for early career family physicians.¹⁷

Implications of Treatment for Common Medical Conditions

Margolis et al¹⁸ found that lower adherence to blood pressure medication was reported by the third of patients who reported symptoms they believed to be side effects of their medications. This study should prompt family physicians to ask about antihypertensive side effects more often.

For asthma, a strategy that reduces asthma exacerbations compared with usual treatment includes rescue short-acting β agonist (SABA) supplemented with inhaled corticosteroid (ICS), known as Patient-Activated Reliever-Triggered Inhaled Corticosteroid (PARTICS). Cardet et al¹⁹ found that many Black and Latinx adults with moderate-severe asthma who started on PARTICS as part of a clinical trial continued using this strategy at 2 years post initiation.

A significant minority of the patients undergoing bariatric surgery for obesity develop symptomatic hypoglycemia after surgery or postbariatric hypoglyemia (PBH). Lawler et al²⁰ review how to diagnose and distinguish PBH from dumping syndrome, and provide guidance on treatment selection.

American Board of Family Medicine New Examination Processes

The American Board of Family Medicine presents the process for developing Domain Weights for the 2025 Family Medicine Certification Scale along with upcoming changes. “The American Board of Family Medicine approved the use of a new blueprint for the Family Medicine Certification Examination, the In-Training Examination, Family Medicine Certification Longitudinal Assessment, and the Continuous Knowledge Self-Assessment. It will go into effect in January 2025.” More details can be found in the article.²¹

Interesting Miscellaneous

It is difficult to know what to say about the short piece called ‘The Owl’²² except that it gives the Editors chills and reminds us of similar experiences reported by others.