Past Is Prologue: The Essential Role of Advocacy in Shaping the Future of Family Medicine Research
Diversity in Family Medicine Research
In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, "Grow the family medicine research workforce by expanding pathways and strengthening mentorship," the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, "Increase funding for family medicine research and advocate for enhanced health policy and support," the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, "Build a national infrastructure for organizing and optimizing family medicine research opportunities," the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.
Osteopathic Research in Family Medicine
Osteopathic physicians (DOs) comprise a growing portion of family physicians. In 2023, more DO seniors matched into family medicine than MD seniors, and nearly a quarter of US DO seniors matched into family medicine. Family medicine benefits from the osteopathic philosophy of whole-person care, though this provides challenges regarding research in family medicine. Notably, among students entering family medicine, MD students report an average of 2.4 research activities compared with 1.7 for DO students, marking the lowest values across specialties. There are multifarious reasons for the limited research exposure of osteopathic medical students, and 2 may be amenable to change. First, osteopathic trainees have relatively limited research exposure. Second, osteopathic manipulation training emphasizes techniques that are not compatible with current theories of anatomy and pathology. The reduced research emphasis among osteopathic trainees can be addressed by strategies that focus on enhanced research exposure and a cultural shift toward fearless reevaluation of these inconsistent beliefs. Improvements in research training and culture among osteopathic trainees (including medical students and residents) will directly benefit osteopathic medicine, family medicine, and patients.
Team Science in Family Medicine Research
Collaboration, particularly interdisciplinary collaboration, is very common in family medicine research. Interdisciplinary collaboration and team science are encouraged and have significant advantages but they also have challenges to implementation. Addressing those challenges, even with changes to how promotion and tenure are conceptualized to reward team science is necessary for family medicine research to continue to grow and prosper.
Answering the "100 Most Important Family Medicine Research Questions" from the 1985 Hames Consortium
The 1985 Hames Consortium convened family medicine researchers to identify outstanding questions in their practice.
Current and Future Challenges to Publishing Family Medicine Research
Leveraging the All of Us Database for Primary Care Research with Large Datasets
The National Institutes of Health (NIH) are supporting the research program, a large multicenter initiative to accelerate precision medicine. The database contains information on greater than 400,000 individuals spanning thousands of medical conditions, drug exposure types, and laboratory test types. These data can be correlated with genomic information and with survey data on social and environmental factors which influence health. A core principle of the program is that participants should reflect the diversity present in the United States population.The database has advanced many areas of medicine but is currently underutilized by primary care and public health researchers. In this Special Communication article, I seek to reduce the "barrier to entry" for primary care researchers to develop new projects within the Researcher Workbench. This Special Communication discusses (1) obtaining access to the database, (2) using the database securely and responsibly, (3) the key design concepts of the Researcher Workbench, and (4) details of data set extraction and analysis in the cloud computing environment. Fully documented, tutorial R statistical programming language and Python programs are provided alongside this article, which researchers may freely adapt under the open-source MIT license. The primary care research community should use the database to accelerate innovation in primary care research, make epidemiologic discoveries, promote community health, and further the infrastructure-building strategic priority of the family medicine 2024 to 2030 National Research Strategy.
Practice-Based Research Networks: Asphalt on the Blue Highways of Primary Care Research
Measuring Research Capacity: Development of the PACER Tool
Evaluating research activity in research departments and education programs is conventionally accomplished through measurement of research funding or bibliometrics. This limited perspective of research activity restricts a more comprehensive evaluation of a program's actual research capacity, ultimately hindering efforts to enhance and expand it. The objective of this study was to conduct a scoping review of the existing literature pertaining to the measurement of research productivity in research institutions. Using these findings, the study aimed to create a standardized research measurement tool, the Productivity And Capacity Evaluation in Research (PACER) Tool. The evidence review identified 726 relevant articles in a literature search of PubMed, Web of Science, Embase, ERIC, CINAHL, and Google Scholar with the keywords "research capacity" and "research productivity." Thirty-nine English-language studies applicable to research measurement were assessed in full and 20 were included in the data extraction. Capacity/productivity metrics were identified, and the relevance of each metric was data-charted according to 3 criteria: the metric was objective, organizational in scale, and applicable to varied research domains. This produced 42 research capacity/productivity metrics that fell into 7 relevant categories: bibliometrics, impact, ongoing research, collaboration activities, funding, personnel, and education/academics. With the expertise of a Delphi panel of researchers, research leaders, and organizational leadership, 31 of these 42 metrics were included in the final PACER Tool. This multifaceted tool enables research departments to benchmark research capacity and research productivity against other programs, monitor capacity development over time, and provide valuable strategic insights for decisions such as resource allocation.
A Comprehensive Guide to Long-Acting Injectable Antipsychotics for Primary Care Clinicians
We propose a paper that provides education on commonly used long-acting injectable antipsychotics (LAIs) to improve primary care based mental health interventions in patients with severe mental illnesses (SMIs) such as schizophrenia, schizoaffective disorder, and bipolar disorders. With the expanding interface of primary care and psychiatry across all healthcare settings, it has become increasingly important for primary care clinicians to have a broader understanding of common psychiatric treatments, including LAIs. Long-acting injectable antipsychotics have been shown to be helpful in significantly improving treatment adherence, preventing disease progression, improving treatment response, decreasing readmission rates, and reducing social impairment. We discuss evidence-based indications and guidelines for use of long-acting injectable antipsychotics. We provide an overview of the treatment of SMI with LAIs, mainly focusing on the most commonly used long-acting injectable antipsychotics, advantages and disadvantages of each, along with outlining important clinical pearls for ease of practical application. Equipped with increased familiarity and understanding of these essential therapies, primary care clinicians can better facilitate early engagement with psychiatric care, promote more widespread use, and thus significantly improve the wellbeing and quality of life of patients with severe mental illness.
Artificial Intelligence and Family Medicine
Artificial intelligence (AI) is certainly going to have a large, potentially huge, impact on the practice of family medicine. The specialty is fortunate to have leading experts in the field to guide us along the way. One such team of forward thinkers provides insights into where AI can take the specialty. Another article reports on how well AI performed on the American Board of Family Medicine In-Training Examination. In addition to AI, we have 3 articles that investigate the intersection of social needs and the practice of medicine. Four clinical review articles cover nonalcoholic fatty liver disease, headache treatments, single maintenance and reliever therapy for asthma, and the use of cannabis in the setting of chronic pain. The clinical research articles cover point-of-care hemoglobin A1c testing, continuous glucose monitoring, and screening for HIV. Another group of articles examines the profession of family medicine, covering topics ranging from how women family physicians negotiate their first jobs to the words we use to define primary care.
Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management
Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge.
Clinician-Reported Barriers and Needs for Implementation of Continuous Glucose Monitoring
Continuous glucose monitoring (CGM) for patients with type 1 and type 2 diabetes is associated with improved clinical, behavioral, and psychosocial patient health outcomes and is part of the American Diabetes Association's Standards of Medical Care. CGM prescription often takes place in endocrinology practices, yet 50% of adults with type 1 diabetes and 90% of all people with type 2 diabetes receive their diabetes care in primary care settings. This study examined primary care clinicians' perceptions of barriers and resources needed to support CGM use in primary care.
Only One Quarter of Family Physicians Are Very Satisfied with Their Electronic Health Records Platform
Two decades into the era of Electronic Health Records (EHRs), the promise of streamlining clinical care, reducing burden, and improving patient outcomes has yet to be realized. A cross-sectional family physician census conducted by the American Board of Family Medicine in 2022 and 2023 included self-reported physician EHR satisfaction. Of the nearly 10,000 responding family physicians, only one-in-four (26.2%) report being very satisfied and one-in-three (33.8%) were not satisfied. These low levels of satisfaction point to the need for greater transparency in the marketplace and pressure to increase user-centric EHR design.
Wonca Europe 2023 Definition of General Practice/Family Medicine: New Needs New Content
Headache Treatment Options
Family medicine physicians often see headache as the chief complaint when meeting patients within their practice. The goal is to try different treatment modalities without having to send the patient to a specialist. Headaches affect different individuals during their lifetime. Before any treatment begins, it is best that one rules out possible causes of the headache, for example, drug interactions or structural cerebrum conditions. Nonpharmacological treatment is recommended first before attempting a stepwise approach to cost-effective pharmacological treatment options. Pharmacological treatment options should include preventive and on-demand options. A family physician has all the resources to assist patients with different types of headaches.
Primary Care Clinicians' Interest In, and Barriers To, Medication Abortion
Providing medication abortion in the primary care setting is a promising way to increase access to abortion, a threatened service in many States. This study aimed to characterize primary care clinicians' interest in prescribing medication abortion, what barriers they face in adding this service, and what support they need.
Potential Drawbacks of Noninvasive Diagnostic Methods for Nonalcoholic Fatty Liver Disease
The rising obesity epidemic is a phenomenon that has gained increasing attention from health providers and health policy makers. This led to recognition of nonalcoholic fatty liver disease (MASLD). The standard for its assessment has been histologic, which is neither practical nor acceptable by patients. Subsequently, a number of noninvasive assessment methods have been developed. However, despite ease of implementation, their confounding variables do hinder their accuracy. Nonetheless, the development of the liver stiffness measurement (LSM) and incorporation of other biological parameters has minimized but not eliminated the need for liver biopsy. Imaging methods are useful in evaluation, estimation, and following the progression of steatosis and fibrosis with particular attention to controlled attenuation parameter (CAP) and MRI-Proton Density Fat Fraction (MRI-PDFF). The choices for the family physician are broad and rely on tests' availability, cost, and patient acceptance. Great efforts have been undertaken to produce more robust and novel noninvasive markers that indicate fibrinogenesis directly in an implementable and cost-effective way.
Family Medicine Must Prepare for Artificial Intelligence
Artificial Intelligence (AI) is poised to revolutionize family medicine, offering a transformative approach to achieving the Quintuple Aim. This article examines the imperative for family medicine to adapt to the rapidly evolving field of AI, with an emphasis on its integration in clinical practice. AI's recent advancements have the potential to significantly transform health care. We argue for the proactive engagement of family medicine in directing AI technologies toward enhancing the "Quintuple Aim."The article highlights potential benefits of AI, such as improved patient outcomes through enhanced diagnostic tools, clinician well-being through reduced administrative burdens, and the promotion of health equity by analyzing diverse data sets. However, we also acknowledge the risks associated with AI, including the potential for automation to diverge from patient-centered care and exacerbate health care disparities. Our recommendations stress the need for family medicine education to incorporate AI literacy, the development of a collaborative for AI integration, and the establishment of guidelines and standards through interdisciplinary cooperation. We conclude that although AI poses challenges, its responsible and ethical implementation can revolutionize family medicine, optimizing patient care and enhancing the role of clinicians in a technology-driven future.