Annals of family medicine
-
Annals of family medicine · Sep 2022
Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary Care.
Improving patients' self-care for chronic disease is often elusive in the context of social deprivation. We evaluated whether a practice-integrated community health worker (CHW) intervention could encourage effective long-term self-management of type 2 diabetes mellitus (T2DM). ⋯ Practice-linked CHWs can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.
-
Annals of family medicine · Sep 2022
Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia.
Primary care is the foundation of the health care workforce and the only part that extends life and improves health equity. Previous research on the geographic and specialty distribution of physicians has relied on the American Medical Association's Masterfile, but these data have limitations that overestimate the workforce. ⋯ Our novel method of identifying active physicians with a primary care scope provides a realistic size of the primary care workforce in Virginia, smaller than some previous estimates. Although the method should be expanded to include advanced practice clinicians and to further delineate the scope of practice, this simple approach can be used by policy makers, payers, and planners to ensure adequate primary care capacity.
-
I grew up on food stamps, unlike many of my medical school classmates. Prostitution and drug deals were regular occurrences in my neighborhood. A man was shot to death in front of my childhood home. ⋯ I had to accept that while I experienced survivor's guilt, people are agents of change in their own lives. To serve others, I owe it to myself to be safe and heal my own wounds first. Ultimately, I decided I want to partake in the story of humanity's inexorable will to survive in the face of structural barriers.
-
Part 1 of this essay argued that the root causes of primary care's problems lie in (1) the low percent of national health expenditures dedicated to primary care and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access. Part 2 explores policies and practice changes that could solve or mitigate these primary care problems. Initiatives attempting to improve primary care are discussed. ⋯ To truly revitalize primary care, 2 fundamental changes are needed: (1) a substantially greater percent of health expenditures dedicated to primary care, and (2) the building of powerful teams that add capacity to care for large panels while reducing burnout. Part 2 of the essay reviews 3 approaches to increasing primary care spending: state-level legislation, eliminating Medicare's disparity between primary care and procedural specialty reimbursement, and efforts by health systems. The final section of Part 2 addresses the building of powerful core and interprofessional teams.