Why Are Family Physicians' Panels Shrinking?

The average panel for family physicians dropped from about 2400 to about 1800 patients from 2013 to 2022. Likely reasons for this decline: 1) fewer people seeking primary care, and 2) fewer people receiving their care through a long-term continuity relationship with a primary care clinician.

Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: Results From a Pragmatic Cluster Randomized Controlled Trial.

Objective: This cluster (clinic-level) randomized controlled trial (RCT) compared medical assistant (MA) health coaching (MAC) with usual care (UC) among at-risk adults with type 2 diabetes in two diverse real-world primary care environments: a federally qualified health center (FQHC; Neighborhood Healthcare) and a large nonprofit private insurance-based health system (Scripps Health).

Research Design And Methods: A total of 600 adults with type 2 diabetes who met one or more of the following criteria in the last 90 days were enrolled: HbA1c ≥8% and/or LDL cholesterol ≥100 mg/dL and/or systolic blood pressure (SBP) ≥140 mmHg. Participants at MAC clinics received in-person and telephone self-management support from a specially trained MA health coach for 12 months.

Storylines of family medicine XII: family medicine and the healthcare system.

is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'XII: Family medicine and the future of the healthcare system', authors address the following themes: 'Leadership in family medicine', 'Becoming an academic family physician', 'our call to act', 'The paradox of primary care and three simple rules', 'The quadruple aim-melding the patient and the health system', 'Fit-for-purpose medical workforce', 'Universal healthcare-coverage for all', 'The futures of family medicine' and 'The 100 essay.' May readers of these essays feel empowered to be part of family medicine's exciting future.

High-Performing Teamlets in Primary Care: A Qualitative Comparative Analysis.

Purpose: In efforts to improve patient care, collaborative approaches to care have been highlighted. The teamlet model is one such approach, in which a primary care clinician works consistently with the same clinical staff member. The purpose of this study is to identify the characteristics of high-performing primary care teamlets, defined as teamlets with low rates of ambulatory care sensitive emergency department (ACSED) visits and ambulatory care sensitive hospital admissions (ACSAs).

Revitalizing Primary Care, Part 1: Root Causes of Primary Care's Problems.

This 2-part essay offers a discussion of the health of primary care in the United States. Part 1 argues that the root causes of primary care's problems are (1) the low percent of national health expenditures dedicated to primary care (primary care spending) and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access.Information used in this essay comes from my personal clinical and policy experience bolstered by summaries of evidence.

Revitalizing Primary Care, Part 2: Hopes for the Future.

Part 1 of this essay argued that the root causes of primary care's problems lie in (1) the low percent of national health expenditures dedicated to primary care and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access. Part 2 explores policies and practice changes that could solve or mitigate these primary care problems.Initiatives attempting to improve primary care are discussed.

Care Management For Patients With Type 2 Diabetes: The Roles Of Nurses, Pharmacists, And Social Workers.

Managing patients with type 2 diabetes takes time. Clinicians in primary care, where most diabetes visits take place, lack that time. Planned visits by diabetes care managers-nurses, pharmacists, social workers, and other team members-assist clinicians and are associated with improved glycemic control.

Process evaluation of a medical assistant health coaching intervention for type 2 diabetes in diverse primary care settings.

Team-based models that use medical assistants (MAs) to provide self-management support for adults with type 2 diabetes (T2D) have not been pragmatically tested in diverse samples. This cluster-randomized controlled trial compares MA health coaching with usual care in adults with T2D and poor clinical control ("MAC Trial"). The purpose was to conduct a multi-method process evaluation of the MAC Trial using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

Integrating Physical Therapists Into Primary Care Within A Large Health Care System.

Background: Bellin Health in Wisconsin has pioneered the colocation and integration of physical therapists into primary care pods.

Methods: This is an observational study based on one in-person visit and several interviews.

Results: For patients with musculoskeletal complaints, providers make warm handoffs to the physical therapist, who is a few steps away.

Medical assistant health coaching ("MAC") for type 2 diabetes in diverse primary care settings: A pragmatic, cluster-randomized controlled trial protocol.

In the US, nearly 11% of adults were living with diagnosed diabetes in 2017, and significant type 2 diabetes (T2D) disparities are experienced by socioeconomically disadvantaged, racial/ethnic minority populations, including Hispanics. The standard 15-min primary care visit does not allow for the ongoing self-management support that is needed to meet the complex needs of individuals with diabetes. "Team-based" chronic care delivery is an alternative approach that supplements physician care with contact from allied health personnel in the primary care setting (e.

Coaching patients to be active, informed partners in their health.

In this issue, the article "A Physician Communication Coaching Program," by McDaniel and colleagues (see record 2020-40858-007), addresses this untenable situation through the coaching of physicians as part of continuing medical education. The coaching program hopes to explode the traditional paradigm of physician-patient interaction. An alternative paradigm is the philosophy of health coaching.

The Outpatient Training Gap: A Pilot Study.

Background And Objectives: Most family medicine residency training takes place in hospitals, which is not reflective of the outpatient care practiced by most primary care clinicians. This pilot study is an initial exploration of family medicine residency directors' opinions regarding this outpatient training gap.

Methods: The authors surveyed 11 California family medicine residency program directors in 2017-2018 about factors that influence decisions regarding allocation of residents' inpatient and outpatient time.

Models of Faculty Involvement in Primary Care Residency Teaching Clinics.

Through site visits to 42 teaching clinics associated with family and internal medicine residency programs during 2013-2018, the authors observed a spectrum of faculty involvement. In this Perspective, they describe and share examples of the 3 faculty models they identified. Some programs have a small, focused faculty whose members spend at least 5 half-day sessions per week seeing patients or precepting residents in the clinic.

Powering-Up Primary Care Teams: Advanced Team Care With In-Room Support.

Primary care teams are underpowered. Teams do not maximally redistribute team functions when clinicians are diverted from activities where they add the most value. This commentary describes "advanced team care with in-room support" as a way to "power-up" primary care teams.

Clinical Training Innovation for Prelicensure Graduate Nursing Students to Expand Roles in Primary Care.

Background: With the aging population, the prevalence of chronic disease is increasing, requiring a team-based approach to care with registered nurses (RNs) playing a vital role.

Problem: Nursing education generally prioritizes acute care rather than ambulatory care; however, nursing students should also be prepared to adequately respond to the population needs for longitudinal chronic care management.

Approach: To address the need for RNs to assume a role in chronic care management, a School of Nursing and Health Professions piloted a clinical option in which second-degree master of science in nursing students are prepared to function as health coaches on primary care teams at a local community health center.

Continuity of Care in Residency Teaching Practices: Lessons from "Bright Spots".

Continuity of care is a challenge in primary care residency teaching clinics. Resident physicians have competing inpatient and outpatient responsibilities and often spend only 1 to 2 half-days per week in the clinic. Their clinic schedules are often pieced together after the needs of inpatient and specialty rotations are met.