Family physicians are well-positioned to support both persons living with dementia (PLWD) and their caregivers. However, current electronic medical record (EMR) systems do not capture the relational and interdependent nature of dementia care. Dyadic data, linking the records of persons living with dementia (PLWD) and their caregivers, could support more integrated, proactive, and personalized care. While there is growing interest in leveraging EMRs for this purpose, few systems enable routine dyadic linkage, limiting clinical utility and research capacity.This report describes the current state of dyadic EMR data linkage in Canada, drawing on a pilot study using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). We examined methods for identifying PLWD-caregiver dyads in primary care settings, including manual identification and algorithmic approaches using shared contact information. Both methods were feasible, but each faced challenges related to EMR compatibility, privacy regulations, and consent processes. The study highlights how CPCSSN infrastructure can be used to create de-identified, longitudinal data sets for research and surveillance, while also identifying critical gaps that limit clinical application.Our findings demonstrate that while EMRs offer a promising platform for linking dyadic data, system-level changes are needed to fully integrate caregiver information into routine care. This includes standardized fields, clearer privacy guidelines, and cross-sector data harmonization. Dyadic EMR linkage has the potential to inform research, improve quality of care, and guide policy development. Future efforts must balance innovation with feasibility and privacy, ensuring caregiver roles are visible and valued within primary care systems.Abstract also available in: عربي (Arabic); Deutsch (German); Español (Spanish); Francais (French); हिन्दी (Hindi); Indonesia (Indonesian); (Chinese); (Japanese); Portugues (Portuguese).
PURPOSE:Continuity of care has been associated with lower health care use and costs. When general practitioners (GPs) serve as gatekeepers to hospital care, having an ongoing relationship with a GP may promote more efficient care and reduce urgent referrals, thereby lowering costs. We examined the association of 2 conceptually distinct measures of continuity in general practice with both urgent hospital admissions and hospital costs. METHODS:We conducted a retrospective cohort study using routinely collected health care data from 100,450 adults in 48 Dutch general practices (2013-2018) who were linked to national hospital admission and cost records (2019). Continuity was separately measured by duration of GP-patient relationship (time registered with the practice) and by density of GP contacts (Herfindahl-Hirschman index). We assessed associations with urgent admissions and log-transformed hospital costs using multilevel logistic and linear models, adjusting for sex, age, comorbidity, migration background, and income. RESULTS:Compared with individuals registered with their practice for 0 to 5 years, those registered longer had 9% to 21% lower odds of urgent hospital admission, with the lowest odds seen in the group registered 15 to 20 years (adjusted odds ratio = 0.79; 95% CI, 0.70-0.88). No significant association was found between higher density of GP contacts and urgent admissions. All groups registered longer than 5 years had significantly lower hospital costs, with the largest model-based reduction (-39.7%) in the group registered 10 to 15 years. Higher density of GP contacts was also associated with lower costs, with an adjusted relative reduction of 6% to 7% in total hospital costs. CONCLUSIONS:Long-standing continuity of care in general practice among adult patients is associated with reduced urgent hospital admissions and health care costs in the Netherlands. These findings highlight the potential value of sustained GP-patient relationships in improving hospital outcomes.
Racially and ethnically minoritized patients are underscreened for colorectal cancer (CRC), resulting in racial/ethnic disparities. This secondary analysis of a pragmatic patient-randomized clinical trial compared effects of a CRC intervention across race/ethnicity. The multi-component intervention included a mailed fecal immunochemical test (FIT) for patients in Federally Qualified Health Centers due for screening, plus patient navigation for positive FITs. Among 3,734 patients, 9.7% identified as Hispanic, 29.0% as non-Hispanic Black, and 61.3% as non-Hispanic White, similar across intervention and control arms (P = .73). The adjusted risk difference (RD) for CRC screening uptake between arms was 18.3% (95% CI, 15.6%-20.9%). In stratified analysis, adjusted RDs were 16.7% (95% CI, 7.5%-25.9%) for Hispanic patients, 13.9% (95% CI, 8.6%-19.0%) for non-Hispanic Black patients, and 20.7% (95% CI, 17.2%-24.1%) for non-Hispanic White patients, which did not differ significantly (interaction P = .79). Because the intervention effect did not differ by race/ethnicity, broad implementation among minoritized populations could improve CRC screening disparities.
PURPOSE:Timely access to primary care remains a major challenge. Advanced access, an organizational model for appointment management, aims to improve accessibility by allowing patients to consult their health care professional in a timely manner. This systematic review evaluated its association with several key dimensions of primary care performance. METHODS:We conducted a comprehensive search in MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to May 10, 2025. Randomized intervention studies, nonrandomized intervention studies, and observational studies comparing advanced access with traditional scheduling systems among patients in primary care were eligible. Outcomes were the wait time to an appointment, continuity of care, emergency department (ED) use, and patient satisfaction. Two independent reviewers selected studies, extracted data, and assessed risk of bias. We performed a narrative synthesis, separately analyzing universal and non-universal health care systems. RESULTS:Among 7,595 unique records identified, 29 studies were included. Of these, 23 evaluated appointment wait time, 13 examined continuity of care, 3 assessed ED use, and 13 evaluated patient satisfaction. Appointment wait time decreased in all 23 studies assessing this outcome, with 13 reporting statistically significant reductions. Continuity of care improved in 11 of 13 studies, of which 7 reported statistically significant improvements. All 3 studies evaluating ED use reported reductions in ED visits, although none demonstrated statistical significance. Patient satisfaction improved in 8 studies, with 3 reporting statistically significant improvements. Overall, findings were consistent across universal and non-universal health care systems. CONCLUSIONS:Advanced access appears to improve appointment timeliness, continuity of care, and patient satisfaction, and may help reduce avoidable ED use across diverse health care systems.
PURPOSE:Studies of distant intercessory prayer as complementary medicine yield mixed results. We investigated commonly utilized proximal intercessory prayer (PIP) practices (ie, in-person prayer for another) used to treat pain and anxiety. METHODS:We recruited 180 participants from patients waiting for family medicine appointments. Enrollment for pain required scores of 4 or greater (in the past 7 days) on an 11 point (0 to 10) pain intensity numerical rating scale. Enrollment for anxiety required a score of 10 or greater on the Generalized Anxiety Disorder 7-item (GAD-7) scale, regardless of diagnoses. After their appointments, participants received 5 minutes of either Christian PIP (90 individuals) from a trained volunteer prayer practitioner or music (control, 90 individuals). Questionnaires reassessed pain or anxiety immediately, and 2 and 6 weeks later. RESULTS:Proximal intercessory prayer vs control group participants reported significantly larger (1 to 2 point) reductions in pain immediately and 2 weeks later, and larger (roughly 2 point) reductions in Likert anxiety immediately and GAD-7 at 2 and 6 weeks. Participants in both groups were well-matched, and predominantly Black, female, low-income, and Christian. Outcomes did not vary significantly by most demographic, baseline symptom, religious affiliation, healing prayer belief, or religious intensity measures. The main exception was that Black participants reported larger symptom reductions for pain and anxiety. Participants reported no adverse events. Most participants reported wanting future PIP opportunities along with medical visits. CONCLUSION:Proximal intercessory prayer was safe, effective, and well-received as complementary treatment for pain and anxiety. Further studies are warranted. Proximal intercessory prayer may be a low-cost, non-pharmacologic, effective adjunct to standard care with particular relevance for underserved populations.
Although older adults (>65 years of age) are considered the highest-risk population for fall-related injuries, adults with intellectual and/or developmental disability (IDD) or cerebral palsy (CP) are also at increased fall risk. We aimed to compare the incidence of fall-related emergency department (ED) visits with injury and age-related trends among adults aged 18-80 years with IDD or CP and a non-IDD/CP comparison group using the 2019 Healthcare Cost and Utilization Project State Emergency Department Databases. Fall-related ED visits with injury represented a greater proportion of ED visits among adults with IDD or CP compared with adults without. Among adults aged 62-65 years with no IDD/CP, 7.3% of ED visits were for falls with injury. Similar incidences of fall with injury were found at earlier ages among adults with IDD (aged 42-45 years) or CP (aged 34-41 years). Clinicians should consider screening for fall risk at younger ages among patients with IDD or CP.
PURPOSE Understanding and addressing increased administrative workload among family physicians is receiving attention, but data describing administrative tasks are limited. We used electronic health record (EHR) data to describe trends in orders made by family physicians, capturing changes in total workload per physician and the volume of per-patient contact over time. METHODS We used national Canadian Primary Care Sentinel Surveillance Network EHR data to measure annual counts of patient contacts, laboratory tests, referrals made, and prescriptions per physician from 2011 to 2021. We evaluated trends in the annual rates of these orders per patient contact by fitting multivariable Poisson regression within a generalized estimating equation framework. RESULTS Family physicians reporting EHR data saw more unique patients, had more total contacts, and had more days with patient contact in 2021 than 2011. In 2021, the average numbers of laboratory tests, referrals, and prescriptions per physician were greater than in 2011 (68.5%, 80.2%, and 43.1% increases, respectively). Rates of referrals and laboratory tests increased by 57% (incident rate ratio [IRR]2021; 95% CI = 1.57; 1.36-1.80) and 29% (IRR2021; 95% CI = 1.29; 1.18-1.41), respectively. The number of prescriptions per patient contact remained constant (IRR2021; 95% CI = 0.96; 0.90-1.03). CONCLUSIONS Our results suggest a significant increase in family physician administrative workload per patient contact over a period of 11 years. Whereas further research is needed to better understand drivers of increased referrals and laboratory tests, strategies to streamline administrative tasks in primary care could help inform the development of effective policy.
In this essay, the author highlights her difficult journey to breastfeed her son, discussing the physical, mental, monetary, and temporal difficulties faced by those who desire to breastfeed and offering recommendations for clinicians and society to make breastfeeding more attainable. Despite knowing breastfeeding can improve outcomes, even the author, a privileged and highly informed obstetrician and gynecologist, nearly could not afford the multiple, varied costs to breastfeed. Breastfeeding should not be a privilege, but an option accessible to all our patients.
PURPOSE We aimed to evaluate the multicomponent School of Caring program supporting caregivers of patients with dementia with respect to caregiver burden, quality of life, emotional well-being, self-efficacy, and social support. METHODS We conducted a quasi-experimental pre-/postintervention study with a 6-month follow-up conducted in primary care in Spain. Participants were caregivers of dependent people with dementia. Sociodemographic characteristics and information regarding care tasks were collected using an ad hoc questionnaire. We evaluated the program's effectiveness using the Zarit Burden Interview, EuroQol 5 dimensions 3 levels scale, General Self-Efficacy Scale, Warwik-Edinburgh Mental Wellbeing Scale, and Oslo Social Support Scale, validated questionnaires to assess caregiver burden, quality of life, self-efficacy, emotional well-being, and social support. The analysis compared the results of the outcomes at 3 time points (baseline, postintervention, and follow-up). We used multivariate regression to identify characteristics related to improvements produced by the program. RESULTS The School of Caring program was delivered to 8 groups, comprising 14-19 participants/group, from 2019 to 2023. A total of 132 caregivers completed the program and were evaluated pre-/postintervention, 33 (25%) of whom were lost to follow-up. The program produced significant improvements in all outcomes, which was maintained up to 6 months postintervention. At this stage, inexperienced caregivers showed the greatest improvement compared with former caregivers relative to burden levels. Overall, the amount of time dedicated to caregiving each day and experiencing a health issue were the elements that most significantly affected caregiver burden and quality of life. CONCLUSIONS The School of Caring program produced notable improvements in the burden and well-being of informal caregivers of dependent people with dementia. The findings provide evidence of the effectiveness of group-based, community primary care programs that support caregivers of people with high care demands such as dependent people with dementia.
PURPOSE:While point-of-care ultrasound (POCUS) has been integrated into daily practice by general practitioners (GPs) in some countries, there is a paucity of literature documenting its use by Chinese GPs. Additionally, artificial intelligence (AI)-assisted diagnosis is increasingly applied to imaging equipment. This study aims to explore the diagnostic performance of GPs in carotid plaque detection using AI-enhanced POCUS after systematic training. METHODS:This diagnostic accuracy trial was conducted in Shanghai, where 7 GPs received systematic training then recruited patients with high atherosclerotic cardiovascular disease risk during outpatient visits for free carotid plaque screening. We comprehensively evaluated their diagnostic performance using 2 approaches: per-patient (ie, assessed whether patients had any carotid plaque) and per-vessel (ie, determined plaque presence in any carotid vessel). Evaluation metrics included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for agreement. RESULTS:A total of 169 patients (mean age 69.6 years [SD 5.76]; 37.9% male) were included in this study. At the per-patient level, sensitivity was 0.87 (95% CI, 0.80-0.95); specificity was 0.91 (95% CI, 0.86-0.97); PPV was 0.89 (95% CI, 0.82-0.96); NPV was 0.89 (95% CI, 0.83-0.96); and the κ value was 0.78 (95% CI, 0.69-0.88), indicating high agreement with the gold standard. The diagnostic performance evaluated at the per-vessel level was comparable to that at the per-patient level. CONCLUSION:Our findings indicate that, after systematic training, GPs can effectively perform carotid plaque screening using AI-enhanced POCUS within a clinical workflow in high-risk elderly populations.
PURPOSE:Medicare Annual Wellness Visits (AWVs) offer many potential benefits to older adults, but patients in racial and ethnic minority groups have lower rates of AWV completion. Our objective was to understand older minority patients' attitudes and preferences related to preventive care and AWVs. METHODS:From June 2024 through October 2024, we conducted 4 focus groups at 2 urban primary care settings (ie, an academic health system and a Federally Qualified Health Center) among Medicare enrollees aged 66 years or more with 1 or more primary care encounter at a participating organization during the prior year. We recruited patients with Black race or Hispanic ethnicity documented in the electronic health record. Domains of interest were communication preferences, attitudes about preventive care and AWVs, and barriers to care. Focus groups were audio recorded, and transcripts were coded into key themes using a template analysis approach. RESULTS:There were 45 participants, who had a mean age of 71 years (SD = 4); most were female and identified as Black. Participants reported various forms of preferred communication, including patient portal, phone calls, and mailed letters. Five themes emerged: (1) the value participants placed on their health and preventive care; (2) the value placed on relationships with trusted primary care physicians; (3) barriers to scheduling and attending medical visits; (4) confusion or uncertainty about terminology describing preventive visits in office- and home-based settings, and; (5) lack of trust due to historical discrimination. CONCLUSIONS:Interventions to increase Medicare AWV uptake in Black and Hispanic patients must address and overcome barriers such as those identified in this study.
