The 4Cs of Primary Care, Leveraging Artificial Intelligence, and Improving Clinical Practice

Improving Clinical Practice

The newly developed and externally validated FluScoreVax risk score is a simple risk score for influenza diagnosis, using vaccination history and patient-reported symptoms.¹ The score is accurate, correctly classifying over 60% of patients in the low-risk group. Liu-Galvin et al.² provide a different perspective on upper respiratory tract infections in describing the impact of Long COVID on the US workforce and missed days from work.

González-Vidal et al.³ provide guidance on next steps for patients with asymptomatic, mild hypoglycemia noted incidentally on routine blood tests. Chen et al.⁴ describe promising findings from a 12-week telemedicine diabetes “boot camp,” with a mean A1c reduction of 2 percentage points among enrolled patients.

A cross-sectional cohort study of 2016 older adults explores whether cognitive decline or participant demographic and clinical characteristics were associated with inadequate bowel preparation for colonoscopy.⁵ Fan et al.⁶ completed a systematic review on the impact of exercise on quality of life of stroke patients, including the effectiveness of a Virtual Reality exercise.

This issue includes several Priority Updates from the Research Literature (PURLs) that deserve attention. A moderate to high-intensity statin is recommended for patients with HIV who are 40 to 75 years old and who have an LDL-C 70 to 189 mg/dL and 10-year ASCVD risk of 7.5% or higher.⁷ Garner et al.⁸ investigate the impact of pitavastatin on incidence of major cardiovascular events within this patient population. Feijóo et al.⁹ describe an approach to reduce duration of anticoagulation for children with provoked deep venous thrombosis.

Heintzman et al.¹⁰ flag important racial and ethnic disparities in lung cancer screening (LCS) and reviewed LCS disparities by nativity among Latino patients. They report findings that should be considered in clinical screening workflows. Okah et al.¹¹ highlight that pooled cohort equations (PCE) to calculate ASCVD risk provide controversial race-specific estimates. They explore how clinicians use PCE and their understanding of race as it relates to ASCVD risk.

The 4Cs of Primary Care

This issue highlights the 4 core functions of primary care, described by Barbara Starfield as First Contact Access, Continuity, Comprehensiveness, and Coordination.^12,13 Wyte-Lake et al.¹⁴ examine the effects of hybrid team-based primary care models designed to improve access to care. Simon et al.¹⁵ evaluate continuity of care for over 1.3 million patients seen by 3,435 clinicians within two Federally Qualified Health Centers and describe considerations for improving long-term continuity. Maier et al.¹⁶ describe a novel measure of comprehensiveness, based on ICD-10 codes, that distinguishes primary care from specialty care.

Coordination of care is a repeated topic of research. Thind et al.¹⁷ evaluate the impact of eConsult platforms on coordination between primary and specialty care for Medicaid patients. They report the percent of eConsults that resulted in specialty advice and identify strategies that may improve the effectiveness of eConsults in other settings. JaKa et al.¹⁸ analyzed data from Minnesota clinics, to identify 4 distinct types of coordination used within primary care clinics. Their typology could help primary care practices understand how to operationalize different coordination approaches most effectively. Mallinson et al.¹⁹ describe the impact of maternal participation in the Wisconsin Medicaid’s Prenatal Care Coordination (PNCC) program on subsequent children’s well-child visit (WCV) receipt.

Leveraging Artificial Intelligence and Large Language Models in Primary Care

The American Board of Family Medicine (ABFM) is integrating large language models (LLMs) into the Continuous Knowledge Self-Assessment (CKSA) platform. A commentary by Wang et al.²⁰ considers how LLMs can improve diagnostic education through more efficient question generation and personalized feedback, as well as implications for certification, lifelong learning, and patient outcomes. In a Correspondence titled “Balancing AI and Integrity: The Future of Board Certification,” Dr. Karim Hanna cautions that LLMs could present a challenge to the integrity of certification systems.²¹

Primary Care Research and Policy

A commentary by Tong et al.²² highlights that although 20% of Americans live in rural areas, few research teams effectively engage rural communities. They describe activities designed by 2 practice-based research networks to improve rural clinical and community engagement in research. These PBRNs were recently the recipients of a new National Institutes of Health (NIH) program grant to create a primary care research hub for research-to-clinic connectivity.²³

Shukla et al.²⁴ emphasize that health care professionals are in a unique position to enact health-related social change. They provide a timely analysis of the engagement of family physicians in state-level political processes.

A Letter to the Editor by Reavis et al.²⁵ responds to “The Gender Wage Gap among Early-Career Family Physicians.” In the letter, the authors call for institutional changes to address the gap. Callen et al.²⁶ investigated discrimination and harassment experienced by physicians.

Armin et al.²⁷ reviewed 107 articles to understand how team science is documented in published family medicine research. The authors suggest that improved documentation of interdisciplinary partnerships could normalize team science as a key part of primary care research.

Behavioral Health and Substance Use

An article by Shaughnessy et al.²⁸ provides a critical look into the factors that shape our views of depression, from historic roots to treatment approaches.

Two qualitative studies provide insights about challenges facing primary care practices in the wake of the opioid epidemic. Hall et al.²⁹ explore primary care challenges to providing MOUD through home, office, and telehealth induction. Sanders et al.³⁰ identify barriers and facilitators to the use of CDCs guidelines around opioid prescribing and the implementation of a controlled substance safety committee.