Annals of family medicine
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Annals of family medicine · Jan 2023
Building a Data Bridge: Policies, Structures, and Governance Integrating Primary Care Into the Public Health Response to COVID-19.
The effective integration of primary care into public health responses to the COVID-19 pandemic, particularly through data sharing, has received some attention in the literature. However, the specific policies and structures that facilitate this integration are understudied. This paper describes the experiences of clinicians and administrators in Alberta, Canada as they built a data bridge between primary care and public health to improve the province's community-based response to the pandemic. ⋯ Primary care systems looking to draw lessons from the data bridge's construction may consider ways to: leverage care model commitments to integration and adjust or create organization and governance structures which actively draw together primary care and non-primary care stakeholders to work on common projects. Such policies and structures develop trusting relationships, open the possibility for champions to emerge, and create the spaces in which integrative improvisation can take place.
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Annals of family medicine · Jan 2023
COVID-19 Impacts on Primary Care Clinic Care Management Processes.
To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota. ⋯ Although quite disrupted by the pandemic, care management processes for chronic disease care in these resilient primary care clinics actually increased from 2019 to 2021, at least in clinics that were part of large organizations. However, that was not true for clinics from smaller groups and perhaps for other areas of care.
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Annals of family medicine · Jan 2023
The Diagnostic Value of the Patient's Reason for Encounter in Primary Care: A Retrospective Cohort Study.
Context Knowledge of incidence, prevalence and trends in morbidity support the diagnostic process of general practitioners (GPs). GPs use estimated probabilities of probable diagnoses to guide their policy on testing and referral. However, GPs estimations often are implicit and imprecise. ⋯ Other patient factors might also have relevant predictive value. Artificial intelligence can be beneficial to add more variables to build a diagnostic prediction model. This model can support GPs in the diagnostic process and can help students and residents in training.
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Annals of family medicine · Jan 2023
Observational StudyImpact of the Affordable Care Act Medicaid Expansion on Weight Loss among Community Health Center Patients with Obesity.
Context: Obesity affects over 40% of the US population and is linked to multiple preventable health conditions which can cause premature morbidity and mortality. Weight loss of at least 5% in patients with obesity reduces their risk of comorbid conditions and leads to improvement in some conditions, such as diabetes. Patients with obesity from underserved populations are less likely to access primary and preventive care services. ⋯ Among newly insured patients, Hispanic (22%) and Black (29%) patients residing in expansion states, had larger proportion of patients with WL5+ than those in non-expansion states (20% and 18%, respectively). No differences were observed among non-Hispanic White patients (expansion 28% vs non-expansion 27%). Conclusions: The findings suggest greater improvement in weight management among patients residing in expansion states than those in non-expansion states, especially among racial and ethnic minorities receiving care in CHCs.
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Annals of family medicine · Jan 2023
Bodyweight Changes During COVID-19 for Patients Diagnosed with Depression: A Retrospective Cohort Study.
Context: The COVID-19 pandemic led to an unprecedented lockdown of millions of Americans from the spring of 2020 to the fall of 2020. Studies done on the impact of COVID-19 on mental health and body weight have been important to our understanding of the effects of the pandemic. However, these studies on depression and BMI change have not identified a possible direction of the causality of the relationship between depression and body weight as affected by lockdown measures during a pandemic. ⋯ Conclusion: Individuals with depression had significant changes in BMI during the COVID-19 pandemic, and age predicted these changes in middle-aged adults (30-50 years old). These findings highlight the importance of identifying and following up with individuals with a diagnosis of depression to alleviate effects on their BMI during extended isolation. Identifying patients who might be susceptible to these changes could lead to patient health outcomes.