Annals of family medicine
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Annals of family medicine · Nov 2024
Comparative StudyHealth Care Utilization After a Visit to a Within-Group Family Physician vs a Walk-In Clinic Physician.
Primary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group. ⋯ Compared to visiting a walk-in clinic physician, seeing a within-group physician after hours might decrease downstream emergency department visits. This finding could be explained by better continuity of care and can inform primary care service models and the policies that support them.
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Annals of family medicine · Nov 2024
Assessment and comparison of the ILI case definition in clinical and school-based community settings: ORCHARDS/IISP.
Context: Influenza-like illness (ILI) is commonly used in clinical and public health settings to identify influenza cases. CDC defines ILI as fever and either cough or sore throat, with symptom onset within 7 days. Objective: Assess performance of ILI criteria in two settings (clinical and community), comparing symptom profiles and laboratory detection of influenza in children. ⋯ Conclusions: ILI performed well in both clinical and community contexts. Factors most highly associated with increased odds of RT-PCR(+) results were cough, fever, and ILI. Inclusion of seasonality and influenza vaccination status improved the predictive value of ILI in both datasets.
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Annals of family medicine · Nov 2024
Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners.
For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR. ⋯ For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.
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Annals of family medicine · Nov 2024
Improving Early Detection of Cognitive Impairment in Older Adults in Primary Care Clinics: Recommendations From an Interdisciplinary Geriatrics Summit.
As the population ages, the prevalence of cognitive impairment due to neurodegenerative diseases such as Alzheimer disease (AD) is expected to double in the United States to nearly 14 million over the next 40 years. AD and related dementias (ADRD) are a leading cause of morbidity and mortality and among the costliest to society. Although emerging biomedical interventions for ADRD focus on early stages and are currently limited to AD, care management can benefit patients with ADRD across the disease course. ⋯ In this report, we present key points and gaps in knowledge about methods for detecting cognitive impairment in primary care clinics. These were developed via an interdisciplinary Geriatrics Summit hosted by the National Academy of Neuropsychology in 2022, attended by representatives of national organizations engaged in work to improve care of older adults. We propose a novel workflow to facilitate detecting cognitive impairment during routine primary care, focusing on opportunities provided by the annual wellness visit, a preventive visit available to Medicare beneficiaries, along with additional recommendations and opportunities for clinical practice and research.
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Annals of family medicine · Nov 2024
Are Direct Primary Care Practices Located in Health Professional Shortage Areas?
Direct primary care (DPC) is a model of health care delivery that relies on membership fees for service; however, it has been criticized as potentially worsening the shortage of primary care physicians. We sought to compare the distribution of DPC practices in the United States to that of non-DPC primary care and assess the overlap with Health Resources and Services Administration designated health professional shortage areas (HPSAs). ⋯ We found that DPC practices were less likely to be in HPSAs overall and less likely to be in a high-priority-need HPSA but more likely to be in a rural or partially rural HPSA compared to primary care physicians. There is ample opportunity to grow DPC presence in many HPSAs that remain underserved, especially high-priority HPSAs in urban areas.