J Am Board Fam Med
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Practice facilitation is an effective approach to implementing quality improvement (QI) interventions in practice-based research networks (PBRNs). Regular facilitator-practice interactions are necessary for successful facilitation, and missed engagements may hinder the process of practice improvement. This study employs a mixed-methods approach to characterize the dynamics of practice facilitation and examine facilitation delays and barriers, as well as their association with the achievement of QI program goals in a PBRN initiative. ⋯ This study is the first to quantify irregular intervals between facilitation activities and demonstrate their negative association with project completion. The analytic method can be applied to identify at-risk practices and to accelerate timely interventions in future studies. Our delay detection algorithm could inform the design of a decision support system that notifies facilitators which practices may benefit from timely attention and resources.
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Many partners and children who are affected by intimate partner violence (IPV) are unable to leave abusive situations that put their health and safety at risk. Family physicians provide care for people who perpetrate IPV and are in a role that may allow them to recognize and counsel patients who are using violence. Appropriate referrals can potentially help these patients access effective interventions such as certified battering intervention programs in a manner that prevents violence for their families. ⋯ As with other patient populations, being labelled may not accurately describe their identity, behavior, nor experiences, and result in them avoiding care. In keeping with trauma-informed approaches, we provide possible examples of respectful nonjudgmental language and nonthreatening clinically appropriate questions for people who use violence. Additional research is needed to identify how best to discuss perpetration of IPV with patients to help initiate change in their behavior while maintaining victim safety.
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Cardiovascular disease is a leading cause of morbidity and mortality in the United States. Since their initial discovery, statins have become the first-line treatment for decreasing the risk of cardiovascular disease. Although they are typically well tolerated, side effects do occur and tend to affect the musculature. ⋯ This case report details the case of a 54-year-old woman who developed anti-HMGCR myopathy after several years of uncomplicated statin use. Differences between other reported cases and this 1 are discussed, including the patient's strong response to steroid therapy which resulted in the normalization of her serum creatinine kinase and alleviation of her muscle weakness. This case highlights the need for clinicians to be aware of anti-HMGCR myopathy and to consider it as a potential cause of proximal muscle weakness and persistent serum creatinine kinase elevations in patients exposed to statins even if they were previously well tolerated by the patient.
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The American Academy of Family Physicians has 72,600 active members and a robust continuing medical education platform. A foundational principle of their work is an assumption of an intrinsic motivation of physicians to learn in order to better take care of their patients and communities. This commentary presents their vision of individualized learning portfolio in which individual family physicians utilize data to identify their gaps of knowledge and performance over time and use a varirty of CME, including performance improvement, to address and lessen those gaps, with the Academy serving as a navigator and facilitator, all while supporting intrinsic motivation to learn and improve.
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The American Board of Family Medicine (ABFM) is exploring the development of an ABFM Journal Club as a part of its continuing certification portfolio. To benchmark this effort, we reviewed the journal article activities of 8 other American Board of Medical Specialties boards. ⋯ A National Journal Club Committee will choose the top 100 articles based on methodologic rigor, generalizability and relevance to family medicine, and potential to change practice. A postactivity assessment instrument will require mastery learning of new clinical findings and support deeper learning, with the goal of supporting personal physicians in keeping up to date and informing shared decision-making.