Annals of family medicine
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Annals of family medicine · Apr 2022
Randomized Controlled Trial Pragmatic Clinical TrialIntegrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit.
Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. ⋯ Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes.
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Annals of family medicine · Apr 2022
Multimorbidity and frailty in middle-aged adults with type 2 diabetes mellitus.
Context: Frailty and multimorbidity are common in type 2 diabetes, including in middle-aged people (<65 years). Clinical guidelines recommend adjustment of treatment targets in people with frailty or multimorbidity. However, guidelines do not specify how frailty/multimorbidity should be identified. ⋯ For the frailty phenotype, the relationship between HbA1c and mortality was steeper and more linear in frail compared with pre-frail or robust participants. Conclusion: Assessment of frailty/multimorbidity should be embedded within routine management of middle-aged and older people with type 2 diabetes. Method of identification as well as features such as age impact baseline risk and should influence clinical decisions (eg. glycaemic control).
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Annals of family medicine · Apr 2022
ReviewCommunity-based physical activity and/or nutrition interventions to promote mobility in older adults: An umbrella review.
Background: Physical activity and a healthy diet are important in helping to maintain mobility and quality of life with aging. Delivery of physical activity and nutrition interventions in a group setting adds the benefits of social participation. Several published systematic reviews have explored a broad range of PA and/or nutrition interventions for older adults, making it challenging to bring together the best scientific evidence to inform program design and to inform multicomponent intervention development. ⋯ There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions: Multicomponent group-based physical activity interventions can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.
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Annals of family medicine · Apr 2022
ReviewPresence for racial justice: disrupting racism through physician-patient communication.
Context: Anti-Black racism is firmly rooted in US healthcare, but many clinicians do not have the tools and language to question their biases and address racism in clinical practice, eg biased communication practices such as "non-compliance" in medical documentation. Objective: Presence 5 for Racial Justice (P5RJ) leverages the Presence 5 patient-provider communication framework to identify anti-racism communication practices that support trusting relationships between physicians and Black patients and empower Black individuals in clinical care. Study design: For this multi-phased community-based participatory research (CBPR) overseen by an advisory board of clinicians and patients at four community clinics, we conducted a literature review, interviews with Black patients, clinician small-group discussions, and design thinking interviews with non-medical professionals. ⋯ Outcomes: Strategies on how providers, through communication and connection in the clinical visit, can navigate and address structural, institutional, and personally mediated forms of racism faced by Black patients. Results: P5RJ practices included: 1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address emergent bias and social determinants of health; 2) Listen intently and completely by using focused interpersonal listening without interruption and deep listening for racism impacts; give patients time and space to tell their story; 3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort, consent, and referral planning; 4) Connect with the patient's story by acknowledging socio-political factors influencing patient health and focusing on positive efforts/events to encourage patient agency; 5) Explore emotional cues by noticing and naming patient emotions and considering how racial trauma might influence these emotions. Conclusion: P5RJ practices offer strategies to reflect on clinician biases, address racism and known gaps in care for Black patients and promote health equity in their clinical care.
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Annals of family medicine · Apr 2022
ReviewPolicy pathways to address American youth firearm injury and death.
Context: The burden of firearm violence and death are uniquely American problems. Over 90% of firearm deaths among children and adolescents in high income countries occur in the United States. Despite similar overall crime rates, the gun homicide rate is about 25 times higher in the U. ⋯ Conclusions: We aim to promote education, physical safety, and behavioral health so that children can achieve their highest potential. Decreasing firearm injury and death is achievable with education, collaboration, research, and policies. To protect children and youth from firearm injury and death, we must: strengthen federal laws building on evidence from state policies; protect current evidence-based state laws from dismantling efforts; invest in public health firearms research; overcome the inequities suffered by disproportionately affected populations.