J Am Board Fam Med
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To analyze transportation screening and assessment questions used in social risk screening tools to understand how these tools assess patients' mobility and transportation needs. ⋯ Development of a brief screening question that broadly captures transportation insecurity followed by a more comprehensive assessment triggered by positive response could enable policy makers and health systems to better identify individuals facing transportation insecurity and to develop transportation solutions that address patients' transportation needs.
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Our ability to smell and taste is dictated by 3 chemosensory systems with distinct physiologic mechanisms - olfaction, gustation, and chemesthesis. Although often overlooked, dysfunction of these special senses may have broad implications on multiple facets of patients' lives -including safety, nutritional status, quality of life, mental health, and even cognitive function. As "loss of smell or taste" emerged as a common symptom of coronavirus disease 2019 (COVID-19), the importance of intact chemosensory function has been thrust into the spotlight. Despite the growing recognition of chemosensory dysfunction, this already highly prevalent condition will increasingly impact a larger and more diverse population, highlighting the need for improved awareness and care of these patients. ⋯ Although patient-reported chemosensory function measures highlight the ease of screening of chemosensory dysfunction, self-reported measures underestimate both the prevalence and degree of chemosensory dysfunction and do not adequately distinguish between olfaction, gustation, and chemesthesis. Meanwhile, psychophysical assessment tools provide opportunities for more accurate, thorough assessment of the chemosenses when appropriate. Primary care providers are uniquely situated to identify patients burdened by chemosensory dysfunction and raise patient and provider awareness about the importance of chemosensory dysfunction. Identification of chemosensory dysfunction, particularly olfactory dysfunction, may raise suspicion for many underlying medical conditions, including early detection of neurodegenerative conditions. Furthermore, identification and awareness of patients with chemosensory dysfunction may help primary care providers to identify those who may benefit from additional therapeutic and safety interventions, or consultations with specialists for more detailed evaluations and management.
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This study describes medical malpractice claims from a large academic family medicine department over 20 years. The intent of this investigation is to analyze trends within the department, seeking to better understand how to improve the quality of patient care. ⋯ Most claims involved adult patients, occurred in the outpatient setting, and involved diagnosis related allegations. Although representing a minority of the claims, obstetric claims made up most of the total settlement amount. Missed or delayed diagnoses of cancer were a common cause for claims, reinforcing the important role that primary care physicians have in supervising and administering preventative health care to patients. This study also emphasizes the value of peer review committees to help inform medical-legal consultants as evidenced by the high correlation between standard of care determination and final claims outcomes.
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Adults with type 2 diabetes diagnosed at a younger age are at increased risk for poor outcomes. We examined life stage-related facilitators and barriers to early self-management among younger adults with newly diagnosed type 2 diabetes. ⋯ Our results highlight how the life position of younger-onset individuals with type 2 diabetes influences their early experiences. Proactively addressing perceived barriers to and facilitators of self-management in the context of family history and parenthood may aid in efforts to support these high-risk, younger patients.
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Medical mistrust can be a barrier to health care utilization. While the Group-Based Medical Mistrust Scale (GBMMS) has been validated among diverse populations, we know little about its psychometric performance among English-Speaking (ES) and Spanish-Speaking (SS) Latinos. We aim to examine the factor structure of GBMMS among Latino parents and explore whether scale latent factor structures would be different across preferred languages. ⋯ Our results suggest that the factor structures of the medical mistrust construct, measured by the GBMMS, are similar across ES and SS Latinos and that the GBMMS is valid for both populations. High factor pattern loading reflects a shared mistrust of how health care systems view and treat people of their racial/ethnic background, independent of their preferred languages. Measurement of medical mistrust and identifying its underlying causes are needed within diverse populations to fully address structural- and community-level influences on health inequities.