Annals of family medicine
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Annals of family medicine · Jul 2023
Observational StudyPersonal Continuity and Appropriate Prescribing in Primary Care.
Personal continuity between patient and physician is a core value of primary care. Although previous studies suggest that personal continuity is associated with fewer potentially inappropriate prescriptions, evidence on continuity and prescribing in primary care is scarce. We aimed to determine the association between personal continuity and potentially inappropriate prescriptions, which encompasses potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), by family physicians among older patients. ⋯ A higher level of personal continuity is associated with more appropriate prescribing. Increasing personal continuity may improve the quality of prescriptions and reduce harmful consequences.
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Annals of family medicine · Jul 2023
Reducing Acute Hospitalizations at High-Performing CPC+ Primary Care Practice Sites: Strategies, Activities, and Facilitators.
Despite evidence suggesting that high-quality primary care can prevent unnecessary hospitalizations, many primary care practices face challenges in achieving this goal, and there is little guidance identifying effective strategies for reducing hospitalization rates. We aimed to understand how practices in the Comprehensive Primary Care Plus (CPC+) program substantially reduced their acute hospitalization rate (AHR) over 2 years. ⋯ The AHR high performers observed that strengthening the local primary care infrastructure through practice-driven, targeted changes in access, care management, and comprehensiveness of care can meaningfully reduce acute hospitalizations. Other primary care practices taking on the challenging work of reducing hospitalizations can learn from CPC+ practices and may consider similar strategies, selecting activities that fit their context, personnel, patient population, and available resources.
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Annals of family medicine · Jul 2023
Concerns Regarding Gynecological Aspects of Brazilian Girls and Women With Down Syndrome: A Cross-Sectional Study of Caregivers' Opinions.
Girls and women with Down syndrome (DS) and their caregivers may have more difficulties in dealing with puberty, menstruation, and sexuality than those without DS. Our aim was to understand the concerns of these caregivers about gynecological aspects, including menstruation, contraception, and sexual practice. ⋯ In our sample, females with DS had sexual development comparable to those without the syndrome. As these females become increasingly independent, it is necessary to guide caregivers and primary care physicians, especially gynecologists, about the difficulties related to the menstrual period.
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Annals of family medicine · Jul 2023
The Warmest of Handoffs: A Neighborhood Physician's Transfer of Care.
Transitioning care of a patient from an outgoing to an incoming physician provides a precious opportunity to transfer knowledge and trust. We explore this process from the perspectives of 2 practitioners, an incoming physician who recently completed training and a retiring physician leaving a practice of 40 years. The method we arrived at for this transfer provided the space for collaboration on what the essence of caring for a unique individual will entail. ⋯ It involves worrying and watching and relaxing into hopefulness. It is both witnessing and launching a life's work. It is reliving and inheriting and reinventing relationship.