Annals of family medicine
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Annals of family medicine · Jan 2025
Randomized Controlled Trial Pragmatic Clinical TrialIntervention Stage Completion and Behavioral Health Outcomes: An Integrated Behavioral Health and Primary Care Randomized Pragmatic Trial.
We performed a pragmatic, cluster randomized controlled trial of a comprehensive practice-level, multistage practice transformation intervention aiming to increase behavioral health integration in primary care practices and improve patient outcomes. We examined associations between completion of intervention stages and patient outcomes across a heterogeneous national sample of primary care practices. ⋯ A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogeneous primary care practices treating patients with multiple chronic conditions when accounting for completion of intervention stages. Interventions that allow practices to flexibly improve care have the potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at the population level.
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There is a hum and drum to the clinical day, sounds and rhythms that pervade physician and patient's soundscape. We hear but we do not listen. ⋯ Masked in these sounds are tacit skills and auditory expertise that speak louder than words. In this essay, as 2 family doctors, we reflect on the sounds of a single day in the clinic.
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Annals of family medicine · Jan 2025
Interviews to Assess a Peer Health Navigator Service for People Who Are Transgender or Gender Diverse.
People who are transgender or gender diverse (PTGD) often experience difficulties navigating the health care system due to a variety of factors such as lack of knowledgeable and/or culturally competent clinicians, discrimination, and structural and/or socioeconomic barriers. We sought to determine whether a peer health navigator service in the Canadian province of Saskatchewan helped connect transgender and gender-diverse clients and health care practitioners (HCPs) to resources, and how this service changed their health care experiences. ⋯ Clients and HCPs alike emphasized that the navigator's lived experience was invaluable and allowed them to empathize with PTGD and provide support. Furthermore, the navigators acted as a direct connection to health care services, which helped improve access for clients. Our findings underscore the need for navigator positions to become permanent within the provincial health system to improve the health care experiences of PTGD in Saskatchewan.
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Annals of family medicine · Jan 2025
Impact of Financial Incentives and Department Size on Scholarly Activity Output.
Family medicine research is essential to improving population health. It has the unique ability to answer questions about health care outcomes and use those insights to impact communities. Increasing research capacity continues to be a challenge; however, recent literature has touted the success of incentivization in several academic medicine specialties. We used the 2022 CERA annual Family Medicine Department Chair survey to characterize the amount and type of scholarly activities by institutional financial incentive status (yes or no) and type (flat vs variable amount), to investigate the relationship between financial incentives and scholarly output. ⋯ Institutions aiming to increase their family medicine department scholarly productivity might benefit from focusing resources on increasing their faculty size such as adding consultants, statistical analysts, grant writers, or other research staff.
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Annals of family medicine · Jan 2025
Not Like They Used To: The Decline of Procedural Competency in Medical Training.
As a primary care pediatrician trained before work hour restrictions were enacted, I spent hours mastering procedures that trainees today rarely perform. The changing landscape of health care clinician roles, technology, and work hour restrictions have all contributed to a remarkable decline in trainees' procedural competence which has significant negative effects for patients, health care systems, and physicians themselves. I suggest simulation, live training, mentoring, and scheduled opportunities as ways to reemphasize the importance of learning these technical skills.