Annals of family medicine
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEffect of a Medical-Legal Partnership on Mental Health and Utilization: A Randomized Controlled Trial in Primary Care.
Context: Family physicians lack resources to effectively intervene on health-harming legal needs (HHLNs), despite growing calls to address social determinants of health. One promising model is the medical-legal partnership (MLP), which embeds legal screening and referral in clinics, but more evidence is needed prior to broader implementation. Objective: To examine whether an MLP reduces stress, depression, and medical overutilization. ⋯ Being in the intervention group was associated with lower PSS scores (18.8 vs. 19.9; PP = 75%) but higher hospitalizations (0.4 vs. 0.3; PP = 78%) and GAD-7 scores (10.3 vs. 6.7; PP=90%). Conclusion: Findings in this trial of an MLP referral were mixed. At 6 months, participants who received an MLP referral appeared to be less stressed but also reported higher anxiety and more hospitalizations.
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Annals of family medicine · Jan 2023
Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan.
During a pandemic, when there are many barriers to providing preventive care, chronic disease management, and early response to acute common diseases for primary care providers, it is unclear whether primary care attributes contribute to reducing hospitalization. We aimed to examine the association between core primary care attributes and total hospitalizations during the COVID-19 pandemic. ⋯ Our study revealed that the provision of primary care, particularly high-quality primary care, was associated with decreased total hospitalization, even during a pandemic when there are many barriers to providing usual medical care. These findings support policies that seek to strengthen primary care systems during and after the COVID-19 pandemic.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEvaluating the Feasibility of Enhanced Care Planning and Clinical-Community Linkages for Primary Care Teams to Better Address.
Context: Patients with MCC have a range of needs that extend beyond traditional medical care including behavioral, mental health, and social needs. While primary care does its best to address these needs, few practices can undertake a systematic approach without broader health system and coordinated community support. We are conducting a randomized controlled trial to compare a package of four tools (an online health risk assessment called My Own Health Report (MOHR), patient navigator, community health worker, and linkage to community programs) versus usual care to better address these root causes of poor health. ⋯ Conclusions: Helping patients create care plans and connecting them with a patient navigator for the short-term may have long-term benefits for patients and care teams. Yet, this model of team-based care is not currently feasible for many practices. Primary care will benefit from increased health system and community support to make this model more viable to better support the complex needs of patients with MCCs.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEvaluation of a Virtual Pre-Consultation Tool for Older Adults in Primary Care: Results from a Randomized Trial.
Context: Virtual pre-consultation screening of patient needs may offer opportunities to improve the care and health outcomes of older patients in primary care, especially those with multiple care needs. Objective: We sought to implement and evaluate the effectiveness of a multidimensional virtual pre-consultation tool in the primary care setting to support rapid and standardized needs assessment for older persons. Study Design and Analysis: Pragmatic, multi-center, 1:1 individually randomized trial design. ⋯ Final results of the intention-to-treat analysis will be presented overall and stratified by urban and rural sites. Conclusions: Intended consequences of this intervention include an increased responsiveness of consultations for providers resulting in improved care of older patients. Overall, we hope results will support the implementation of evidence-based, multidimensional and virtual pre-consultation tools for older persons in the primary care setting.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialComparative Effectiveness RCT of Two Weight Loss Strategies in Primary Care Patients: MyPlate.gov vs Calorie Counting.
Context: Since 2011, the U. S. government has supported two approaches to achieve healthier body fat composition: the Diabetes Prevention Program calorie counting (CC) approach, and adherence to federal nutrition guidelines at www.choosemyplate.gov (MyPlate). Objective: Compare the effect of the CC versus MyPlate approach on satiety/satiation and on achieving healthier body fat composition in the primary care setting. ⋯ Conclusions: A MyPlate-based intervention may be a practical alternative to the more traditional CC approach to promoting satiety and facilitating reduction in central adiposity among low-income mostly Latina overweight primary care patients. Our results align with recommendations favoring a diet rich in diverse, fiber-rich foods. More research is warranted to investigate satiety-enhancing approaches to desirable weight control in diverse populations and the use of community health workers as change agents.