Articles: primary-care.
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Integrated behavioral health (IBH) delivered in primary care is critical to addressing the growing behavioral health crisis in the United States. COVID-19 prompted changes to the core components of IBH, causing the model to shift. The specifics of how IBH teams adapted and what these adaptations mean for the future of IBH teams in primary care are uncertain. ⋯ COVID-19 interrupted the originally designed IBH model of team-based care. Changes to the physical proximity of team members disrupted all other components of IBH, requiring adapted workflows, communication via digital channels, virtual team building, asynchronous care coordination, and remote service delivery. Long-term evaluation of these innovations is needed to examine whether shifts in core components impact model efficacy. Training family medicine, primary care, and behavioral health clinicians for these adapted models of IBH will be needed.
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Generative artificial intelligence and large language models are the continuation of a technological revolution in information processing that began with the invention of the transistor in 1947. These technologies, driven by transformer architectures for artificial neural networks, are poised to broadly influence society. ⋯ In this article, I discuss the principal limitations to the use of generative artificial intelligence in medical education-hallucination, bias, cost, and security-and suggest some approaches to confronting these problems. Additionally, I identify the potential applications of generative artificial intelligence to medical education, including personalized instruction, simulation, feedback, evaluation, augmentation of qualitative research, and performance of critical assessment of the existing scientific literature.
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Incident benzodiazepine prescriptions in primary care for anxiety decreased between 2003 and 2018. However, from 2008, incident prescribing of benzodiazepines for anxiety increased among those aged 18-34 years. There are increasing concerns around prescribing of benzodiazepines. Further, although guidelines state benzodiazepines should only be prescribed short term, in 2017, 44% of incident prescriptions were prescribed for longer than the recommended duration of 2-4 weeks. ⋯ Patient-driven factors for prescribing benzodiazepines suggest there are current unmet treatment needs among young adults with anxiety. Given increases in prescribing in this age group, it may be timely to revisit the role of benzodiazepines in the management of people with anxiety in primary care.
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Background Relapse contributes to the clinical and societal burden associated with depression. It is not well understood how relapse risk and prevention are managed and discussed between patients and general practitioners in primary care. Aim To understand the extent to which relapse risk and prevention are discussed and managed in general practice. ⋯ Longer-term follow-up and monitoring of depression could be improved in primary care. Conclusion We provide an evidence-informed framework to improve practice systems and GP consultations to improve longer-term care and support for people with depression. Going forwards, brief scalable relapse prevention interventions are needed to improve the ongoing care of people with depression in primary care; implementing these would require additional primary care resources.