Annals of family medicine
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Annals of family medicine · Apr 2022
Socializing the evidence for diabetes control to develop "Mindlines": A qualitative pilot study.
Context: Evidence on specific interventions to improve diabetes control in primary care is available, but this evidence is not always well-implemented. The concept of "mindlines" has been proposed to explain how clinicians integrate evidence using specifics of their practices and patients to produce knowledge-in-practice-in-context. Objective: We designed a pilot study to operationalize the "mindlines" concept by creating a venue for clinician-staff interaction concerning evidence. ⋯ Results: While most of the conversation concerned barriers to implementation of the simple diabetes intervention model, we noted examples of practices adopting and adapting the evidence to suit their own needs and context, consistent with the fundamentals of the "mindlines" model. Performance metrics regarding diabetes control for the four practices improved after the intervention. Conclusions: It appears that the type of conversations that "mindlines" research describes can be generated with facilitation around evidence, but further research is required to better understand the limitations and impact of this intervention.
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Annals of family medicine · Apr 2022
Outpatient antibiogram and predictors of ciprofloxacin and trimethoprim-sulfamethoxazole resistant urinary tract infections.
Context: Rising antibiotic resistance has transcended hospital boundaries and impacted individuals with community acquired urinary tract infections (UTI). Scant data on antibiotic resistance in outpatient settings exists and most studies in the United States (U. S.) have identified predictors of resistance in acute-care settings. ⋯ Conclusion: The Infectious Disease Society of America cautions against prescribing an antibiotic if regional resistance exceeds 20%. We constructed an antibiogram and found resistance surpassed this threshold for TMP-SMX and ciprofloxacin and identified factors associated with resistance to these agents. Assessing these characteristics during clinical decision making may improve antibiotic-organism susceptibility concordance in primary care.
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Annals of family medicine · Apr 2022
Assessing the application of continuity of care indices in the last year of life: a retrospective population-based study.
Context: Most people spend the majority of their last year of life at home or in a home-like setting, receiving outpatient healthcare. Increasing numbers of physicians and teams, including palliative care providers, may become involved in care in addition to a usual provider such as a family physician. Continuity of care (CoC) near the end of life, although considered a marker of quality of care, may be interrupted despite the provision of high-quality care. ⋯ Results were similar for other indices. Conclusions: Decedents experience low continuity of outpatient physician care in the last year of life, especially those with cancer, comorbidities, and frequent physician visits. Modifications to existing indices may be needed to serve as end-of-life care quality indicators.
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Annals of family medicine · Apr 2022
Older adults' willingness to take magnesium to treat depression.
Depression affects up to 15% of community-dwelling older adults. Late-life depression is frequently underdiagnosed and undertreated. When depression in older adults is identified, up to 80% of treatment occurs in primary care. Currently available treatments have significant limitations (e.g., modest effectiveness, high costs, adverse effects, poor adherence, and social stigma), therefore additional treatment options are essential. Over the counter magnesium chloride is inexpensive, widely available, generally safe, well-absorbed, and was efficacious in prior studies, often within 2 weeks. ⋯ A majority of older community-dwelling adults are willing to take magnesium for the treatment of depression. Many adults are already taking at least 1 over the counter supplement daily. Further research is needed to determine the efficacy of magnesium supplements as an alternative treatment option in this population.
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Annals of family medicine · Apr 2022
Racial and ethnic disparities in access to primary care during COVID-19.
Context: Early evidence suggests that many patients chose to forgo or delay necessary medical care during the COVID-19 pandemic. Existing and well-documented racial and ethnic disparities in access to care were exacerbated by the pandemic for many reasons, potentially including the additional barriers involved in a rapid shift to telehealth for certain groups of patients. Objectives: 1) Examine changes in primary care visit volume and telehealth during the COVID-19 pandemic. 2) Test for racial and ethnic differences in primary care in-person and telehealth visits during the pandemic relative to pre-pandemic levels. ⋯ Conclusion: Declines in primary care visits during the pandemic were partially offset by an increase in telehealth use. Utilization in our sample suggests less decline in Black and Hispanic patient primary care utilization during the pandemic than expected, in contrast to Asian patients, who demonstrated the largest declines. This metric and these results are novel and foundational for ongoing & further study using other data sources.