J Am Board Fam Med
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Randomized Controlled Trial Multicenter Study
The Relationship Between Social Determinants of Health and Functional Capacity in Adult Primary Care Patients With Multiple Chronic Conditions.
Social determinants of health (SDoH) including insecure access to food, housing, and financial resources are critical threats to overall health. We sought to examine this relationship among adult primary care patients with multiple chronic conditions. ⋯ Among primary care patients with chronic conditions, SDoH are associated with poorer functional capacity, independent of other social and demographic factors. Primary care offers a promising, if underused, opportunity to intervene in SDoH. There is a need for future studies to explore the role of screening and intervention by primary care providers to mitigate or prevent SDoH.
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Hypermobility spectrum disorders (HSDs) encompass an array of connective tissue disorders characterized by joint instability and chronic pain. Fatigue and other systemic symptoms that affect daily functioning may occur, as well. Accurate data on incidence and prevalence of HSDs is hampered by lack of awareness of these conditions and the wide heterogeneity of their clinical presentation. ⋯ Diagnostic criteria for hEDS include measures of joint hypermobility, skin and other connective tissue findings, and lack of evidence of a different type of Ehlers-Danlos syndrome. Beyond accurate diagnosis, HSDs pose many challenges for primary care providers, as ongoing patient education, patient empowerment, and coordination of a multidisciplinary treatment team are integral to proper care. This article describes the incidence and prevalence, pathophysiology, diagnosis, and management of HSDs, including clinical cases exemplifying how joint hypermobility might present within a primary care setting.
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Oropharyngeal squamous cell carcinoma (OPSCC) has historically been attributable to tobacco and alcohol exposure and saw a decline in incidence after societal norms shifted away from smoking. In recent decades, this disease has had a re-emergence due to human papillomavirus (HPV) infection, now surpassing cervical cancer as the number 1 cause of HPV-related cancer in the United States. ⋯ This, coupled with low vaccination rates, puts primary care providers in a unique position to play a vital role in prevention and early diagnosis. In this review, we highlight the epidemiology, screening, patient presentation, diagnosis, prognosis, and prevention of HPV-positive OPSCC, with a focus on the primary care provider's role.
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We conducted a systematic scoping review of providers' KABB related to health care-based socioeconomic risk screening and referral interventions using several search engines. Included studies assessed health care providers' KABB about screening and interventions conducted in clinical settings. ⋯ Participation in screening and referral programs seems to influence providers' perception of implementation barriers. Future research should explore providers' concerns about addressing identified risks.
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Structuring patient and practice data into episodes formed the foundation of the earliest evidence base of family medicine. We aim to make patients' narratives part of the evidence base for family medicine by incorporating coded and structured information on the patient's reason to visit the family physician (FP) and adding the patient's personal and contextual characteristics to routine registration data. This documentation allows studies of relations between morbidity and elements of the patient story, providing more insight into the range of problems presented to primary care and in the patient-centeredness applied by FPs. ⋯ The Dutch PBRN FaMe-Net has started to add elements of patients' narratives and context to decades of morbidity registration, creating options for a scientific approach to primary care's core values. Assumptions of 'pre/post chances' of the final diagnosis, already existing implicitly in FPs minds, can be elaborated and quantified by investigating the associations between multiple registered variables, including parts of patients' 'stories.' This way, we aim to make visible what is intuitively already known by FPs.