Annals of family medicine
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Annals of family medicine · Mar 2024
Small Independent Primary Care Practices Serving Socially Vulnerable Urban Populations.
This mixed methods study sought to describe the extent to which family physicians in urban communities serve socially vulnerable patients and to better understand their practices, their challenges, and the structural supports that could facilitate their patient care. ⋯ Small independent practices serving vulnerable patients in urban communities are surviving because deeply committed physicians are making personal sacrifices. Health equity-focused policies could decrease the burden on these physicians and bolster independent practices so that socially vulnerable patients continue to have options when seeking primary care.
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Building on previous efforts to transform primary care, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in 2015. This 3-year initiative provided external quality improvement support to small and medium-size primary care practices to implement evidence-based cardiovascular care. ⋯ EvidenceNOW taught us that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to a specific disease or initiative. We believe these lessons argue for a national primary care extension service that provides ongoing support for practice transformation.
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Annals of family medicine · Mar 2024
Genital Tucking Practices in Transgender and Gender Diverse Patients.
Genital tucking (tucking) is the practice of hiding or minimizing the appearance of one's genitals and gonads. We aimed to better understand the prevalence of tucking and its potential effect on behavior and health. ⋯ Health care providers should empathetically discuss tucking and its potential risks and benefits with transgender and gender diverse patients. Further research is needed to better quantify the potential risks involved with tucking and to assist in developing educational resources.
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Annals of family medicine · Mar 2024
"It Can't Hurt!": Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening.
Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS. ⋯ Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations.
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Annals of family medicine · Mar 2024
How to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box.
We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. ⋯ Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts.