Annals of family medicine
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Annals of family medicine · Sep 2023
Reduced Accuracy of Intake Screening Questionnaires Tied to Quality Metrics.
Clinical workflows that prioritize repetitive patient intake screening to meet performance metrics may have unintended consequences. This retrospective analysis of electronic health record data from 24 Federally Qualified Health Centers assessed effectiveness and accuracy of the 2-item Patient Health Questionnaire (PHQ-2) for depression screening and Generalized Anxiety Disorder 2 (GAD-2) for anxiety screening from 2019 to 2021. Scores of over 91% of PHQ-2 and GAD-2 tests indicated low likelihood of depression or anxiety, which diverged markedly from published literature on screening outcomes. Visit-based screenings linked to performance metrics may not be delivering the intended value in a real-world setting and risk distracting clinical effort from other high value activities.
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Annals of family medicine · Sep 2023
Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics.
To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care. ⋯ Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources.
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Annals of family medicine · Sep 2023
Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study.
There are numerous supportive quality improvement (QI) projects to facilitate the implementation of evidence-based practices in primary care, but recruiting physician practices to join these projects is challenging, costly, and time consuming. We aimed to identify factors leading primary care practices to decline participation in QI projects, and strategies to improve the feasibility and attractiveness of QI projects in the future. ⋯ Staffing challenges and general time constraints, exacerbated by the pandemic, are compromising primary care practices' ability to engage in QI research projects. To encourage participation, policy makers should consider direct supports for primary care, which may also help to alleviate burnout.
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Gender-affirming hormone therapy (GAHT) is safe overall, with few adverse effects. One potential effect from using testosterone for GAHT is an increase in hemoglobin and/or hematocrit, known as secondary erythrocytosis. Current guidelines recommend monitoring hemoglobin or hematocrit routinely in the first year, some as frequently as every 3 months, which can create barriers to care. Our study explored the incidence of erythrocytosis in the first 20 months of testosterone therapy among people receiving gender-affirming care. ⋯ Severe erythrocytosis (hematocrit >54%) is a rare outcome of gender-affirming testosterone therapy. Clinical recommendations should reconsider the need for routine frequent erythrocytosis screening within the first year of testosterone therapy for patients who prefer to minimize laboratory draws.