Annals of family medicine
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Annals of family medicine · Nov 2021
Improving Suicide Risk Screening to Identify the Highest Risk Patients: Results From the PRImary Care Screening Methods (PRISM) Study.
Over 95% of patients who screen positive on the Patient Health Questionnaire-9 (PHQ-9) suicide risk item do not attempt or die by suicide, which could lead to unnecessary treatment and/or misallocation of limited resources. The present study seeks to determine if suicide risk screening can be meaningfully improved to identify the highest-risk patients. ⋯ Among primary care patients who screen positive for suicide risk on the PHQ-9, SCS items improved screening efficiency by identifying those patients who are most likely to engage in suicidal behavior within the next 30 days.
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Annals of family medicine · Nov 2021
Case Study With a Participatory Approach: Rethinking Pragmatics of Stakeholder Engagement for Implementation Research.
The case study design is particularly useful for implementation analysis of complex health care innovations in primary care that can be influenced by the context of dynamic environments. Case studies may be combined with participatory approaches where academics conduct joint research with nonacademic stakeholders, to foster translation of findings results into practice. The aim of this article is to clarify epistemological and methodological considerations of case studies with a participatory approach. ⋯ We then compare the epistemological posture of 3 prominent case study methodologists, Yin, Stake, and Merriam, to present the epistemological posture of case studies with a participatory approach. The relevance, applications, and procedures of a case study with a participatory approach methodology are illustrated through a concrete example of a primary care research program (PriCARE). We propose 12 steps for designing and conducting a case study with a participatory approach that may help guide researchers in the implementation analysis of complex health care innovations in primary care.
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Annals of family medicine · Nov 2021
Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices.
We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. ⋯ Improvements in clinic-level performance on BP control may be attributed to implementation of 7 evidence-based strategies to build quality improvement capacity. These strategies were feasible to implement in small practices over 15 months.
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Annals of family medicine · Nov 2021
Clinician Response to Patient Emotion: Impact on Subsequent Communication and Visit Length.
It is widely cited-based on limited evidence-that attending to a patient's emotions results in shorter visits because patients are less likely to repeat themselves if they feel understood. We evaluated the association of clinician responses to patient emotions with subsequent communication and visit length. ⋯ If saving time is a goal, clinicians should consider responses that explicitly address a patient's emotion. Arguments for providing space for patients to discuss emotional issues should focus on other benefits, including patients' well-being.
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Continuity of care has long held a hallowed place in the halls of family medicine. Indeed, it is one of the 4 pillars of an ideal family practice, along with first contact, comprehensive, and coordinated care. But what does it mean to the patient, the doctor, and our sense of identity and purpose? And why, in recent years, has it receded from the discourse of family medicine values? This author suggests that continuity is an expression of the value we place on human relationships, a contract of sorts with the people we care for both inside and outside the office. Such relationships are not lightly discarded, for they serve us best in the long haul when our own sense of identity and purpose is tested and worn.