The American Academy of Family Physicians (AAFP) was founded in 1947 to promote and maintain high-quality standards for family medicine, an offshoot of the classical general practitioner. It is headquartered in Leawood, Kansas.AAFP is one of the largest medical organizations in the United States, with 136,700 members in 50 U.S. states and territories, in addition to international members. The AAFP was instrumental in establishing family medicine as medicine's 20th primary specialty. The AMA's Council on Medical Education and the independent American Board of Medical Specialties granted approval to a certifying board in family medicine on February 8, 1969.
Background:Depression is pervasive, and rates are rising in the United States. Most people with depression receive care from primary care clinicians, but gaps in the quality of care exist. Team-based approaches to depression care have been shown to aid in treatment and management; yet, challenges exist in implementation. Digital health apps have been shown to be effective in improving depression symptoms and enhancing patient engagement in some populations. Many, however, do not share data with clinical care teams. Objective:This study aimed to understand the barriers to and facilitators for implementation of a digital health program that supports coordinated use by clinical care teams and patients, via a mobile app and care team-facing web interface, for depression in primary care. Methods:This study was part of a larger intervention study that included 4 primary care practices: 2 intervention and 2 control sites. The intervention sites used a patient-facing mobile app and a care team-facing web interface, and the control sites continued usual care. The study team conducted interviews from May to October 2021. Patient and care team participants were recruited toward the end of their study involvement. Separate semistructured interview guides were developed for patient and care team participants. Interviews were recorded and transcribed. Data were coded using Atlas.ti.9, and data analysis was completed using a grounded theory approach. Results:Interviews with patient (n=8) and care team (n=8) participants revealed 3 main topics for program implementation: app/interface usability, tracking, and program recommendations. For app/interface usability, overall, navigation for both patient and care team participants was simple and straightforward. Although app content was relevant, patient participants desired additional educational resources and information to aid in their depression treatment and management. In terms of tracking, care team participants indicated that data obtained via the interface enabled them to monitor patients in between visits; and in some circumstances, these data facilitated conversations with patients about treatment plans. Tracking medication adherence differed among patient participants due to established routines of taking medications consistently, lack of motivation to track, or lack of interest in tracking. Care team participants reported the ability to respond more quickly to side effects. Patients commented on tracking difficulties: confusing response options, insufficient goal attainment response options, not being able to provide details or write notes, and no ability to change goals. Some patient and care team participants perceived that tracking encouraged communication with one another; others perceived tracking as having no impact on shared decision-making. Conclusions:Results suggest implementation of a digital health program for depression treatment and management in primary care practices could impact patient medication adherence, produce faster turnaround time for medication optimization, encourage goal setting, and foster communication between patients and care team members. Program enhancements could optimize patient and care team member engagement.
BACKGROUND AND OBJECTIVES:Although buprenorphine is effective and approved for treating opioid use disorder (OUD), it remains underutilized in primary care settings. This study's objective was to explore what primary care teams need to overcome barriers in treating OUD, and to assess whether those needs change after receiving education on OUD treatment. METHODS:The American Academy of Family Physicians hosted a 12-month Project ECHO® educational series on OUD for primary care teams. Thematic analysis was conducted on participant responses pre- and post-series to the survey item "Please list your most pressing needs related to OUD" (N = 92). RESULTS:Ninety-two participants from 25 primary care practices from the US and Canada responded to the pressing needs item across both surveys. The most prevalent need reported at baseline was Education and Training, which became second to Health System Resources at endpoint. Respondents cited organizational protocols for OUD treatment as a pressing need among other Health System Resources such as support for reimbursement. Needs relating to transportation and housing; engaging patients to start and continue in OUD treatment; and addressing stigma within the community and health system were indicative of overlapping barriers. DISCUSSION AND CONCLUSIONS:Responses from primary care teams echo previous studies on barriers to OUD treatment and provide specific, actionable insight to addressing these barriers. SCIENTIFIC SIGNIFICANCE:Actionable insights, for example, implementing health system-level OUD protocols and guidelines and promoting availability of OUD treatment and education, are ways that primary care teams could increase treatment of patients with OUD.
Chronic foot pain is a common clinical issue that can greatly affect an individual's quality of life. This document defines best practices for ordering imaging studies based on specific clinical scenarios, which are categorized into different variants. Each variant includes a brief description of the usefulness, advantages, and limitations of various imaging modalities. This document is the result of a comprehensive analysis of the available literature and a thorough review of best imaging practices for each clinical scenario. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Despite advances in disease-modifying treatments, significant barriers in the evaluation and clinical management of people with early Alzheimer's disease (AD) remain. These barriers have been documented in scientific literature and increasingly call for primary care to play a larger role in the detection, diagnosis, treatment, and monitoring of AD. Drawing upon the work of a multistakeholder consortium, this article identifies systemic and structural barriers that hinder primary care professionals in the United States from playing a larger role. We propose solutions to these barriers and call for evolution of the U.S. healthcare system to ensure it is prepared to adapt to the rapidly progressing scientific and societal landscape and meet the growing needs of people affected by the early stages of AD.
Establishing partnerships with trusted community organizations is a well-established strategy to reach communities underrepresented in medical research. Community organizations are trusted sources of information and services, with the potential to improve research readiness within communities. Literature suggests that research participation is facilitated by initial practices such as relationship- building, inclusive design, and accessibility, which ultimately lead to a sense of openness and trust among community members. However, the value of collaborative efforts between partnering organizations can be difficult to measure and evaluate. Following a community-engaged research recruitment project, MyAlliance for Brain Health, we evaluated how organizational stakeholders perceived community-academic research partnerships established during the grant period using a mixed-methods approach. Qualitative data was obtained through semi-structured interviews with six different organizational and program leaders, and quantitative data was collected through a short community-partner survey aimed at measuring actual vs. preferred engagement. Interview findings indicated that in general, organizational and program leaders appeared to place more emphasis on the value of partnering relationships than they did on perceived challenges. Survey data supported this finding, revealing that the actual level of engagement across different grant activities was similar to what community partners would like to see going forward. Interview data also revealed that organizations shared more common successes than they shared common challenges, suggesting that challenges were mostly unique to specific community organizations. Our findings support community engagement models that value sustained relationships as a path towards readiness to engage with dementia research.
