J Am Board Fam Med
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With the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration. ⋯ CPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.
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Advance care planning (ACP) is critical for older adults with heart failure; however, patient-level and clinician-level barriers exist. Although a group visit (GV) approach to engage patients in ACP has proven effective among general geriatric populations, little is known about clinician perceptions/likelihood of referral. ⋯ This is the first study to gain clinician insights into ACP GVs specific to patients and caregivers affected by heart failure. Results shed light on an important topic and suggest key considerations for conducting GVs for ACP.
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The history of cancer screening has demonstrated that the case for cancer screening is not straightforward. In contemporary practice, sharing decision-making with patients has become expected of family physicians. ⋯ Improving cancer outcomes should be a priority for family medicine, but the importance of this goal should not undermine doctors' commitment to helping patients make informed decisions that are consistent with their values and priorities. If we are serious about empowering patients, we need to be more open about the limitations of cancer screening, to help patients make up their minds.
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Health care chaplains intervene on unmet religious/spiritual (R/S) needs in health care settings that are associated with poor outcomes. Little is known about demand for their services. The purpose of this study was to describe population-level awareness and perceptions of health care chaplains and preferences for their services. ⋯ The majority of the US population say they are aware of chaplains and desire their services, yet few report previous experience with them in health care. More behavioral interventions are needed to better connect patients to chaplains.
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Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans. ⋯ Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.