J Am Board Fam Med
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Editorial
Implementing Practice Changes in Family Medicine to Enhance Care and Prevent Disease Progression.
This issue epitomizes family medicine with a heavy emphasis on research to prevent illness and illness progression. Which patients will experience significant symptomatic knee osteoarthritis? Do the elderly use retail clinics, and what is the impact on care for chronic conditions? Does capitation payment enhance or decrease same-day access? How do primary care practices risk stratify to provide integrated care? Can risk screening and on-site providers enhance psychiatric care? What screening questions should we ask adolescents, to identify problematic drug use? A report on a practice intervention to improve opioid prescribing practices, and another on the significant level of depression in many patients taking opioid medications. ⋯ Interdisciplinary care with pharmacists in the office does not help just the patients. We have several articles on diabetes-early diagnosis, and consideration of screening for prediabetes as a quality standard-with added commentaries about this possibility.
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Accommodating walk-in psychiatry visits in primary care can improve access to psychiatric care for patients from historically underserved groups. We sought to determine whether a walk-in psychiatry model embedded within an integrated care practice could be sustained over time, and to characterize the patients who accessed care through it. ⋯ Providing psychiatric care on a walk-in basis in integrated care is sustainable. Patients from historically underserved groups may access psychiatric care disproportionately through a walk-in option when it is available.
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Housing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care. ⋯ Housing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.
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Increased drug overdose deaths have become a serious public health problem. Primary care providers prescribe about 50% all opioid medications. This study examined opioids prescribing during primary visits to patients with a pain-depression dyad and patient demographic characteristics associated with opioids prescribing. ⋯ Pain-depression dyad is associated with higher odds of opioids prescribing during primary care visits. Future studies are needed to understand the complexity of these factors and identify effective strategies to prevent opioids addiction and overdose among patients with pain and depression.
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Children of adults eligible for the National Diabetes Prevention Program (DPP) lifestyle intervention may themselves be high risk for type 2 diabetes development, and high-risk children may be reached through programs that target high-risk adults. To understand the potential multigenerational impact of family-oriented diabetes prevention programming, we explored the correlation between parental eligibility for the National DPP program and child weight status by using nationally representative data. ⋯ In this nationally representative sample, parental BMI and child BMI categories were positively correlated, as was parental eligibility for diabetes prevention programming and child BMI. This highlights the potential of leveraging the national platform for adult diabetes prevention to reach high-risk children through family-oriented programming.