J Am Board Fam Med
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Understanding how physicians' practice patterns change over a career is important for workforce and medical education planning. This study examined trends in self-reported practice activity among early- and later-career stage family physicians (FPs). ⋯ Although early-career FPs more frequently reported providing both inpatient and outpatient care and serving as hospitalists compared with later-career FPs, both groups had a decline in frequency of providing mixed practice. This change after only 3 years in practice has significant implications for patient care and medical education.
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Clinical trials generally have not assessed efficacy of long-term opioid therapy (LTOT) beyond 6 months because of methodological barriers and ethical concerns. We aimed to measure the effectiveness of LTOT for up to 12 months. ⋯ Using LTOT for up to 12 months is not more effective in improving CLBP outcomes than treatment without opioids. Clinicians should consider tapering opioid dosage among LTOT users in accordance with clinical practice guidelines.
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Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed. ⋯ Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.
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Practice-based research networks (PBRNs) improve primary care by addressing issues that matter to clinicians. Building trust between researchers and care teams is essential to this process, which often requires visiting practices to cultivate relationships and perform research activities. However, in a recent study using practice facilitation to improve the delivery of a preventive service, the COVID-19 pandemic prompted us to convert all planned facilitation from an in-person to virtual format. This eliminated the need to commute by automobile to and from practices across the state, greatly reducing the carbon footprint of the study. ⋯ Climate change poses a significant threat to the health of people and communities. Given their commitment to improving population health, it may be time for PBRNs to routinely assess their environmental impact and minimize preventable environmental costs.
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The majority of climate change research and policy centers around the physical health effects of planetary degradation. The mental health impacts of climate change are just now starting to be elucidated and discussed more commonly among mental health providers and policymakers. There is a huge area of opportunity in primary care to discuss and address climate anxiety in patients, many of whom may not be forthcoming in discussing how climate anxiety is contributing to their mental health.