J Am Board Fam Med
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Primary care practices can help patients address obesity through weight loss; however, there are many barriers to doing so. This study examined weight management services provided and factors associated with higher reported provision of services. ⋯ Practice-associated factors such as culture and implementation climate may be worth examining to understand how to implement weight management in primary care.
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Comprehensiveness is a defining principle of primary care and Family Medicine but is declining in some settings. This study explores the relationship between practice setting and comprehensiveness among family physicians (FPs). ⋯ Significant variation in FP comprehensiveness exists across different practice types. FPs in practice types commonly associated with large health systems had narrower breadth of practice, concerning amid increasing practice consolidation. Given associations between comprehensiveness and desirable health care outcomes, policy makers should encourage payment/accountability models that incentivize broader SOP.
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Continuity is a core component of primary care and known to differ by patient characteristics. It is unclear how primary care physician payment and organization are associated with continuity. ⋯ Our results suggest that continuity does not differ substantially by physician payment or organizational model among primary care patients who are formally enrolled with a physician in a setting with universal health insurance.
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Observational Study
Developing and Validating a Novel Tool to Enhance Functional Status Assessment: The Tennessee Functional Status Questionnaire (TFSQ).
Functional status is a major contributor to overall health and reflects both daily activity level (performance) and maximum attainable activity level (capacity). Existing assessment tools evaluate only 1 domain of function and do not provide insight into contributors to functional decline. We addressed these deficiencies by developing the Tennessee Functional Status Questionnaire (TFSQ), which reports activity levels in metabolic equivalents (METs) and evaluates 5 key areas: performance, capacity, activity, pain, and acute care. We validated the activity levels reported by the TFSQ against the Duke Activity Status Index (DASI). ⋯ The TFSQ is a brief and efficient assessment of patient function, standardized to METs and validated against the DASI. Our study suggests that many patients may have the functional reserve to increase daily physical activity and that factors such as changes in activity, pain, and recent acute care interaction may lower functional capacity.
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The COVID-19 pandemic has laid bare a problem that many people have managed behind the scenes for years: how to balance work and family caregiving responsibilities. For physicians, many of whom were already experiencing burnout prior to the pandemic, the extra burden of COVID-19-related work stress combined with fewer options for childcare and other support has made coping all but untenable. In early 2022, the Accreditation Council for Graduate Medical Education (ACGME) promulgated new paid family and medical leave policy for residents and fellows. This editorial considers the importance of this step by the ACGME as well as the remaining gaps in paid leave policy in medical education, graduate training, and practice.