Annals of family medicine
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Annals of family medicine · Jan 2023
Recruiting Indigenous Patients Into Clinical Trials: A Circle of Trust.
The Circle of Trust is a new conceptual model that can help investigators and the American Indian/Alaska Natives (AI/AN) community work together to promote inclusion of AI/AN populations in clinical trials to improve health outcomes. Racial/ethnic minority groups remain underrepresented in clinical trials and this creates the need and opportunity for novel approaches. Indigenous populations are particularly underrepresented in clinical trials. ⋯ The authors, experts in AI/AN health and recruitment of minorities into research, collaborated to modify the currently existing and published "trust triangle" model that focuses on minority recruitment to include participants, researcher, and trusted entity. We advocate for expanding the trust triangle into a circle of trust inclusive of community. The "circle of trust" is a new conceptual model that can help investigators and the AI/AN community work together to promote inclusion of AI/AN populations in clinical trials to improve health outcomes.
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Annals of family medicine · Jan 2023
Exploring the Association Between Physician Continuity of Care and Diagnosing Hypertension.
Context. The American Board of Family Medicine was funded by the Gordon Betty Moore Foundation to study the association between physician continuity of care, a clinical quality measure, and its impact on accurate, timely, efficient, and cost-effective diagnosis of target conditions that contribute to cardiovascular disease. In this exploratory analysis, we used electronic health records data from the PRIME registry to examine the association of continuity with factors leading to a hypertension diagnosis. ⋯ We found no significant association between physician continuity of care and the rate or timeliness of the hypertension diagnosis. Conclusions. Factors leading to a hypertension diagnosis may be influenced more by other unobserved variables than by physician continuity of care.
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Annals of family medicine · Jan 2023
Assessing Representativeness of Randomised Controlled Trials using Serious Adverse Events.
Context: The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. Objectives: We explore an approach assessing trial representativeness by comparing rates of trial Serious Adverse Events (SAEs: most of which reflect hospitalisations/deaths) to rates of hospitalisation/death in routine care (which, in a trial setting, would be SAEs be definition). ⋯ Conclusion: Trial participants experience fewer SAEs than expected based on age/sex/condition hospitalisation and death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess applicability of trial findings to older populations in whom multimorbidity and frailty are common.
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Annals of family medicine · Jan 2023
Patients' Experiences With Therapeutic Approaches for Post-COVID Syndrome: Results of a Crowdsourced Research Survey.
Some patients develop multiple protracted sequelae after infection with SARS-CoV-2, collectively known as post-COVID syndrome or long COVID. To date, there is no evidence showing benefit of specific therapies for this condition, and patients likely resort to self-initiated therapies. ⋯ Responses of 499 participants suggested few approaches (eg, mind-body medicine, respiratory therapy) had positive effects and showed a great need for patient-centered communication (eg, more recognition of this syndrome). Our findings can help design clinical studies and underscore the importance of the holistic approach to care provided by family medicine.
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Annals of family medicine · Jan 2023
Association of Family Financial Stress During the COVID-19 Pandemic and Child Social and Emotional Difficulties.
Context: The COVID-19 pandemic and associated public health measures have substantially increased stress on families, including financial stress. Objective: To explore the association between familial financial stress and child socioemotional and behavioural difficulties during the COVID-19 pandemic and examine parenting behaviour as a potential mediator to this relationship. Study Design and Analysis: Cross-sectional cohort study using online survey data. ⋯ Conclusion: Financial stress during the COVID-19 pandemic was associated with poorer child social and emotional health. Unproductive parenting behaviours, including overreactivity and laxness, significantly mediated these effects. This work supports the importance of policies aimed to alleviate family financial stresses and highlights the potential impact such policies have on child health.