J Am Board Fam Med
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People experiencing homelessness have significantly shorter life expectancies and higher rates of morbidity and mortality than the general population. Many barriers have been identified to providing palliative care to this population. This study examines health and social service providers' experiences providing end-of-life care to people experiencing homelessness, seeking recommendations to improve both patient and provider experience. ⋯ Focusing on harm reduction, and using the framework of Equity-Oriented Health Care to make systemic, cultural, and policy changes to develop a palliative-care system for persons experiencing homelessness may improve care experience for both patients and providers.
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Thirty-five thousand Canadians are homeless on any given night, and mortality rates are much higher than for the general population. Studies have identified barriers to accessing end-of-life care among the homeless, including logistic barriers and experiences of stigma. This study seeks to explore the experience, goals, fears, and hopes surrounding death in the setting of homelessness or vulnerable housing. ⋯ Participants with lived experience of homelessness were articulate in their desires and needs for end-of-life care. They have extensive exposure to mortality and feel that their needs are not met by the current palliative care system. Recommendations for system change that include harm reduction and equity-oriented health care, as well as a combination of outreach and inpatient services, are necessary before palliative care services will be accessible for this population.
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Family physicians (FPs) are specialty trained and certified and provide most primary care (PC) services in the United States. General practitioners (GPs), a separate group without specialty PC training, are commonly confused with FPs despite differences in demographic characteristics, professional qualifications, and clinical services. Our study documents how often research in major medical journals distinguishes between these 2 groups or combines GPs and FPs together. ⋯ Most PC research reports combine GPs and FPs into a single group, masking differences between these distinct groups. Most research reports fail to explain how they classify PC clinicians. Research reports need to improve classification of FPs and PC clinicians.
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Observational Study
Translating Team-Based Breastfeeding Support into Primary Care Practice.
Team-based care facilitates efficient, evidence-based, patient-centered practice. An outpatient, integrated lactation consultant (LC) and primary care provider (PCP) model improves breastfeeding support, yet practices need assistance with implementation. ⋯ Team-based LC and PCP health care is a promising approach for delivering efficient, patient-centered, face-to-face counseling and support. Practice assessment informs financial feasibility and confirms provider interest in change. An integrated LC/PCP model can be implemented in a FQHC while enhancing patient breastfeeding support and provider satisfaction.
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In this essay, the author analyzes contributions from the American Academy of Family Physician's (AAFP's) political action committee (FamMedPAC) during the 2018 election cycle. The author highlights discrepancies between explicit AAFP legislative priorities and the voting records and public positions of Congressional members who received FamMedPAC support during the election cycle. The analysis raises questions about FamMedPAC's decision-making process for allocating support to candidates. The author posits that consistency between AAFP positions and those of candidates receiving FamMedPAC contributions is essential to preserve both public trust in family physicians and family physicians' trust in the AAFP.