Family Medicine Commons^™

Feasibility Study Of An Artificial Intelligence Chatbot-Powered Cognitive-Behavioral Lifestyle Modification Program, Evans Forman, Charlotte Hagerman, Asher Hong, Zhuoran Huang, Hannah Mccausland, Jasmine Sun, Lauren Taylor, Meghan Butryn, Preetha Chatterjee, Ramtin Ehsani, Nawal Syed

Department of Family & Community Medicine Faculty Papers

Background: Approximately 2 billion adults seek lifestyle modification to improve their health and well-being. However, because of cost and access barriers, only a tiny fraction receive gold-standard lifestyle modification programs led by trained coaches. Digital programs without human coaches are more disseminable but have limited efficacy. Recent advances in large language model (LLM) AI chatbots have the potential to revolutionize digital programs by emulating human coaches, offering a safe, low-cost, and scalable lifestyle modification intervention. Yet, no studies have developed and tested such a program. Purpose: This study aims to evaluate the feasibility, safety, and user engagement of a new …

Continuous Glucose Monitoring Use In The Management Of Type 2 Diabetes In Primary Care: Cross-Sectional Survey Of Provider Comfort, Ryley Harris, Catherine Guariglia, Amy Cunningham

Department of Family & Community Medicine Faculty Papers

This study assessed primary care providers’ comfort with prescribing and using continuous glucose monitoring technology for type 2 diabetes management, identifying key barriers and educational needs.

Disease Burden Of Asthma Patients Utilizing Short-Acting Beta-2 Agonist-Only Inhalers As Rescue In The United States, Njira Lugogo, Rena C. Moon, Yen Chung, Joy David, Omar Motawakel, Ning A. Rosenthal, Neil Skolnik

Department of Family & Community Medicine Faculty Papers

Purpose: We aimed to describe the disease burden of asthma and examine relationships between short-acting beta-2 agonist (SABA) use and asthma exacerbations. Patients and Methods: This retrospective cohort study used geographically diverse Premier Healthcare Database (PHD) and linked insurance claims (10/01/2021-09/30/2022) for US patients aged ≥18 years with a SABA-only prescription and a history of asthma exacerbation within 12 months before index date (the earliest SABA prescription date). Three asthma control groups were defined based on SABA usage: well controlled-low (0–1 prescriptions), not well controlled-medium (2–3 prescriptions), very poorly controlled-high (≥4 prescriptions). Four asthma severity groups were defined using asthma …

A House Divided: A Mixed Method Investigation Of Primary Care Interprofessional Teams Using The Core Principles And Values Of Teamwork Framework, Erin L. Kelly, Catherine Guariglia, Jeanne Felter, Dhruvi Shah, Brooke Mauriello, Amy Cunningham, Chris Arenson, Randa Sifri

Department of Family & Community Medicine Faculty Papers

Context

Primary care teams are facing increased demands, turnover, and escalating rates of burnout. A primary care team aligned in its core values and organized according to common teamwork principles is essential for delivering patient-centered, coordinated, and effective healthcare.

Methods

As part of a series of studies on workplace factors and burnout among primary care practice team members, we selected an urban practice with high rates of burnout to assess their teamwork via a practice-wide survey and six focus groups divided by role. The interview guide focused on identifying areas for potential intervention around teamwork. Transcripts were open-coded using a …

The Impact Of Gender, Training Year, Medical Specialty And The Covid-19 Pandemic On Resident Wellness, Sara Beachy, Jessica Luzier, Chantel Weisenmuller, Kathleen Bors, Mary Ann Maurer, Amna Anees, Tiffany Lasky, Lisa Calderwood

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Data are limited as to which factors most strongly impact medical trainees' well-being, and few studies have assessed trainee's wellness at multiple time points during the COVID-19 pandemic. Additionally, much research has not taken an intersectional approach to understanding the ways in which different facets of a resident's identity impact their wellness. Thus, more person-centred, probability-driven statistical approaches that can produce distinct heterogenous groups of individuals are warranted to understand the way in which different identities are associated with resident wellness scores.

METHODS: A latent profile analysis was conducted using institutional data from resident surveys administered from 2019 to …

Best Practices For Creating An Addiction Curriculum Within Family Medicine Residency Programs: A Qualitative Analysis Of Expert Opinion, Gregory A. Jaffe, Barisue Brodsky, Jacob Buckley, Brooke Mauriello, Corey Pasakarnis, Paul Rizzo, Madison Smith, Randi Sokol

Department of Family & Community Medicine Faculty Papers

Background and Objectives: Primary care physicians are well-positioned to be at the forefront of screening for and treating substance use disorders (SUDs). In addition, the Accreditation Council for Graduate Medical Education has deemed addiction training a common program requirement for all residency programs. With less than one-third of family medicine residency programs providing addiction training, understanding best practices for addiction training is important.

Methods: We interviewed 12 faculty at family medicine residency programs across the country who have a strong reputation for addiction training. We analyzed interview transcripts thematically to identify best practices for creating and providing addiction curricula.

Results: …

Cervical, Breast, And Colorectal Cancer Screening Outcomes Among Refugees In Philadelphia, Pennsylvania, Colleen Payton, Nina Kvaratskhelia, Melanie Chalfin, Jessica Deffler, Marc Altshuler

Department of Family & Community Medicine Faculty Papers

Cancer screening can detect cancer at an early stage and decrease cancer morbidity and mortality. Refugee populations may have had limited access to cancer screening before arrival in the United States. A cross-sectional analysis of cervical, breast, and colorectal cancer screening was conducted among refugees with primary care visits between 2018 and 2022 at a refugee health clinic in Philadelphia, Pennsylvania. Cancer screening outcomes included the number and type of screenings; the number of normal, inconclusive, and abnormal screening results; completion of follow-up tests for inconclusive and abnormal results; and the number of cancer diagnoses. Among 149 refugee women aged …

Evaluation Of A Multistage Implementation Of Medication For Opioid Use Disorder Services In Primary Care, Sarah Lawson, Allie Hamilton, Jordan Lazarus, Gregory A. Jaffe, Erica Li, Lara Weinstein, Susan Fidler, Erin Kelly

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Despite effective treatment for opioid use disorder, access to care is limited. Increased availability of evidence-based medication for opioid use disorder (MOUD) treatment within primary care is urgently needed. This study describes efforts to increase MOUD services within a large urban primary care practice.

METHODS: After an internal assessment of barriers to MOUD services, a two-phase approach was used to educate providers and to implement MOUD services within a primary care practice over 2.5 years. Physicians became X-waiver certified in the education phase and completed four internal training sessions. Physicians completed pre-post surveys to assess their intention to prescribe …

Multi-Cancer Early Detection Tests: Attributes For Clinical Implementation, Jon O. Ebbert, Ernest T. Hawk, Christopher V. Chambers, Margaret A. Tempero, Elliot K. Fishman, Jospeh E. Ravenell, Tomasz M. Beer, Seema P. Rego

Department of Family & Community Medicine Faculty Papers

Guideline-recommended screening programs exist for only a few single-cancer types, and these cancers represent less than one-half of all new cancer cases diagnosed each year in the U.S. In addition, these "single-cancer" standard of care (SoC) screening tests vary in accuracy, adherence, and effectiveness, though all are generally understood to lead to reductions in cancer-related mortality. Recent advances in high-throughput technologies and machine learning have facilitated the development of blood-based multi-cancer early detection (MCED) tests. The opportunity for early detection of multiple cancers with a single blood test holds promise in addressing the current unmet need in cancer screening. By …

Moud 2.0: A Clinical Algorithm And Implementation Evaluation Protocol For Sublingual And Injectable Buprenorphine Treatment Of Opioid Use Disorder, Brandon Joa, Eric Fung, Michael Weinstein, Lara Weinstein

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Primary care is the initial contact point for most patients with opioid use disorder (OUD) but lacks tools for guiding treatment. Only a small fraction of patients access evidence-based care. Long-acting injectable buprenorphine has potential to improve medication adherence and program retention in low-barrier primary care treatment settings. We present the first clinical decision support algorithm incorporating long-acting buprenorphine (LAIB) in primary care. We include a protocol for a future evaluation of the algorithm's implementation process, "Medication for Opioid Use Disorder (MOUD) 2.0," at a housing and integrated care clinic at a Federally Qualified Health Center.

METHODS: Literature review …

Author Correction: Best Practice Advice For Asthma Exacerbation Prevention And Management In Primary Care: An International Expert Consensus, Neil Skolnik, Barbara P. Yawn, Jaime Correia De Sousa, María Mar Martínez Vázquez, Amanda Barnard, Wendy L. Wright, Austin Ulrich, Tonya Winders, Stephen Brunton

Department of Family & Community Medicine Faculty Papers

No abstract provided.

An Evaluation Of The Decline In Primary Care Physician Visits, 2010 To 2021, Anuradha Jetty, Marie Ezran, Alison Huffstetler, Yalda Jabbarpour

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.

METHODS: The Medical Expenditure Panel Survey data (2010-2021) …

Partnerships To Improve Access To Healthcare For Refugees And Immigrants In Philadelphia, Jessica Deffler, Chelsea Salas-Tam, Jenna Gosnay, Marc Altshuler

Department of Family & Community Medicine Faculty Papers

The United States has welcomed refugees since World War II. Currently, the world is experiencing an unparalleled refugee crisis that calls for action by nations across the globe. There are over 82 million people who are forcibly displaced from their homes today (UNHCR Global Trends, Forced displacement in 2020. [cited 2021 Sep 28]. Available from: https://www.unhcr.org/flagship-reports/globaltrends/). Over the last decade, Philadelphia has become home to hundreds of refugees from countries in Southeast and Central Asia, Africa, the Middle East, as well as many others. For newly arrived refugees, finding stable housing, medical care, and employment is difficult due to cultural, …

Guidelines For Returning To Dance Following Concussion: Adaptations From Sport Concussion Literature, Sheyi Ojofeitimi, Lauren Mcintyre, Elizabeth Barchi, Sarah S. Rae, Brittney Winnitoy, Jeffrey A. Russell

Department of Family & Community Medicine Faculty Papers

Sport concussion receives substantial attention as a public health concern. Conversely, performing artists, including dancers, sustain concussions, but these aesthetic athletes do not receive the same level of consideration nor care for this injury as that offered to traditional athletes. The concussion literature pertaining to dance is sparse, and, to our knowledge, no recommendations exist for the crucial aspect of care related to returning to dance following a concussion. The purpose of this article is to assimilate the current knowledge about post-concussion return to activity management in sport—the closest analog of the physical demands required in dance—as a means to …

Virtual Primary Care In A Large Delaware-Based Independent Academic Medical Center: Impact And Opportunity, Darrell C. Dow, Sarah E. Schenck, Tracy L. Bell, Stephanie C. Roth, Omar Khan

Department of Family & Community Medicine Faculty Papers

COVID-19 and related challenges to patient access necessitated the development of new models of care to ensure a healthy patient population. This paper describes the outcomes of a pilot virtual primary care program at a large independent academic health center in Delaware. The preliminary results are encouraging from the perspective of provider and patient satisfaction, as well as the utility of the operational model. A complete cost-benefit analysis was beyond the scope of the paper; thus, future operational research should focus on the metrics of cost and quality as key indicators of model sustainability.

Social Media As Health Educator: An Assessment Of The Understandability And Accuracy Of Tiktok Content About Contraception, Julianna Coleman, Maetal Haas-Kogan, Andrea Pelletier, Rachel Stoddard, Natasha Johnson, Julia Beatini, Nora Sun, Alex Keuroghlian, Deborah Bartz

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Contraception knowledge and attitudes are largely formed from conversations within one's social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy.

METHODS: This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability (ability to explain a key message) and actionability (identify what they can do to act on that message) using the Patient Education Materials Assessment …

Best Practice Advice For Asthma Exacerbation Prevention And Management In Primary Care: An International Expert Consensus, Neil Skolnik, Barbara P. Yawn, Jaime Correia De Sousa, María Mar Martínez Vázquez, Amanda Barnard, Wendy L. Wright, Austin Ulrich, Tonya Winders, Stephen Brunton

Department of Family & Community Medicine Faculty Papers

Primary care clinicians play a key role in asthma and asthma exacerbation management worldwide because most patients with asthma are treated in primary care settings. The high burden of asthma exacerbations persists and important practice gaps remain, despite continual advances in asthma care. Lack of primary care-specific guidance, uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, and reliance on systemic corticosteroids or short-acting beta2-agonist-only therapy are challenges clinicians face today with asthma care. Evidence supports the use of inhaled corticosteroids (ICS) + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and …

Understanding Faculty Perspectives On Health Equity Curriculum Implementation In Graduate Medical Education: A Qualitative Study, Krys Foster, Dhruvi Shah, Quinn Plunkett, Randa Sifri

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Despite increased awareness of persistent healthcare disparities, integrating health equity education into medical residency curricula needs urgent expansion. The Accreditation Council for Graduate Medical Education (ACGME) mandates addressing healthcare disparities and social determinants of health, but implementation remains insufficient due to pervasive barriers.

OBJECTIVE: To explore residency faculty perspectives at one institution surrounding implementing a health equity curriculum within their programs.

METHODS: Between November 2022 and April 2023, qualitative interviews and focus groups were conducted with residency faculty participants (n = 13) from a large academic medical institution. Participants were recruited via an internal email list directory of program …

Health Outcomes Reported By Healthcare Providers And Clients Of A Community-Based Medically Tailored Meal Program, Jessica M. Sautter, Jule Anne Henstenburg, Adrian Glass Crafford, Ian Rowe-Nicholls, Victor S. Diaz, Kaitlyn Ann Bartholomew, Julia S. Evans, Maria R. Johnson, Jeffrey Zhou, Deeksha Ajeya

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Medically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).

METHODS: Clients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients' …

"It Shouldn't Be Just Hush-Hush": A Qualitative Community-Based Study Of Menstrual Health Communication Among Women In Philadelphia, Allison R. Casola, Lynette Medley, Brianna C. Kunes, Nya Mcglone, Alexis Silverio

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.

METHODOLOGY: In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N …

Family Physicians And Menstrual Care: An Analysis Of Cera 2023, Allison Casola, Olivia Rea, Tiffany Ho

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations.

OBJECTIVES: We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care.

DESIGN/METHODS: This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included …

Relief In Gastrointestinal Symptoms With Medical Marijuana Over 1 Year, Matthew P. Wallingford, Erin L. Kelly, Allison Herens, Daniel Hanna, Emily Hajjar, Brooke Worster

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Subjective improvement in gastrointestinal (GI) symptoms was assessed among patients using medical marijuana (MMJ).

METHODS: Participants completed surveys at 0 days, 30 days, 6 months, and 12 months with questions about the severity of their GI symptoms on a scale from 1 (mild) to 3 (severe).

RESULTS: In each survey, participants reported a significant decrease in GI symptom severity when using MMJ versus when not using MMJ (p < 0.05). The most common self-reported side effects from using MMJ were increased appetite (12-21.4%), fatigue (6-16.7%), anxiety (4-11.9%), cough (4-11.9%), headache (6-7.9%), and dry mouth (4-7.1%).

CONCLUSION: In patients with chronic GI symptoms, MMJ may provide persistent symptom severity improvement. Limited product availability and mild to moderate side effects are factors to consider before trialing MMJ.

Discussing Menstrual Health In Family Medicine, Allison Casola, Alice Renaud, Ashwini Kamath Mulki

Department of Family & Community Medicine Faculty Papers

No abstract provided.

Examining Menstrual Health Experiences In Philadelphia, Pa: A Qualitative Investigation, Allison Casola, Oriana Pando, Lynette Medley, Brianna Kunes, Nya Mcglone, Olivia Rea

Department of Family & Community Medicine Faculty Papers

BACKGROUND: While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators.

OBJECTIVES: The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia.

DESIGN: This project was a qualitative research study.

METHODS: We used a collaborative, community-based participatory research approach with No More …

Primary Care Provider Receptivity To Multi-Cancer Early Detection Test Use In Cancer Screening, Christopher Chambers, William Leach, Kaitlyn V Davis, Ronald Myers

Department of Family & Community Medicine Faculty Papers

Multi-cancer early detection tests (MCEDs) are blood-based tests that detect biomarkers released or induced by cancer cells. If MCED tests are shown to be safe and effective in cancer screening, they are likely to be ordered and managed in primary care. To understand primary care providers’ support for and concerns about the implementation and management of MCED testing, the research team developed a cross-sectional survey that was sent to 939 primary care providers (physicians, residents/fellows, and advanced practice providers) in a large academic health system in the greater Philadelphia area. The survey included standard items used to assess provider background …

Designing For Community Engagement: User-Friendly Refugee Wellness Center Planning Process And Concept, A Health Design Case Study, Ellen Solomon, Brandon Joa, Shandon Coffman, Billie Faircloth, Marc Altshuler, Bon Ku

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Refugee and immigrant populations have diverse cultural factors that affect their access to health care and must be considered when building a new clinical space. Health design thinking can help a clinical team evaluate and consolidate these factors while maintaining close contact with architects, patients' community leaders, and hospital or institutional leadership. A diverse group of clinicians, medical students, community leaders and architects planned a clinic devoted to refugee and immigrant health, a first-of-its-kind for South Philadelphia.

METHODS: The planning process and concept design of this wellness center is presented as a design case study to demonstrate how principles …

Bricks And Mortar Of Well-Being: Exploring The Housing-Health Connection, Roshanak Mehdipanah, Lara Weinstein

Department of Family & Community Medicine Faculty Papers

Housing is a determinant of health. Increasing housing costs and worsening housing conditions have impacted populations worldwide. This Editorial aims to examine the dynamic connection between housing and health and the role of public health in addressing this relationship for a Collection launched at BMC Public Health on Housing as a determinant of health and well-being.

Dance/Movement Therapy As A Holistic Approach To Diminish Health Discrepancies And Promote Wellness For People With Schizophrenia: A Review Of The Literature, Jacelyn Biondo

Department of Family & Community Medicine Faculty Papers

Individuals with a diagnosis of schizophrenia face a myriad of obstacles to wellness, beginning with diagnostic discrepancies including over- and misdiagnoses on the schizophrenia spectrum. People with schizophrenia experience profound amounts of stigmatization from the general population, their healthcare providers, and even themselves. Such stigmatization creates a barrier for wellness, poorer prognoses, and often limits adherence to physical and mental healthcare. Moreover, it can exacerbate the already stifling symptomatology of their diagnoses, including specific bodily-related symptomatology. Oftentimes, a diagnosis of schizophrenia disrupts one's relationship with their body including a diminished mind-body connection, decreased interoceptive awareness, and thus unsuccessful intra- and …

Factors Likely To Affect The Uptake Of Genomic Approaches To Cancer Screening In Primary Care: A Scoping Review, Kaitlyn V Davis, Mie H Hallman, Melissa Dicarlo, Sophie M Wambua, Rachel L Jaffe, Allison W Welsh, Cameron Kerber, Hushan Yang, Christopher Chambers, Ronald E. Myers

Department of Family & Community Medicine Faculty Papers

Genomic tests are being developed for use in cancer screening. As most screening is offered in primary care settings, primary care provider and patient perceptions of such tests are likely to affect uptake. We conducted a scoping review to synthesize information on factors likely to affect patient and provider use of biospecimen collection and analysis for cancer screening, methods referred to as liquid biopsy or multi-cancer early detection (MCED) testing when used to detect multiple cancers. We ultimately identified 7 articles for review and analyzed them for major themes. None reported on primary care provider perspectives. Six articles focused on …

Towards A Common Lexicon For Equity, Diversity, And Inclusion Work In Academic Medicine, José E Rodríguez, Edgar Figueroa, Kendall M Campbell, Judy C Washington, Octavia Amaechi, Tanya Anim, Kari-Claudia Allen, Krys Foster, Maia Hightower, Yury Parra, Maria H Wusu, William A Smith, Mary Ann Villarreal, Linda H Pololi

Department of Family & Community Medicine Faculty Papers

Differential rewarding of work and experience has been a longtime feature of academic medicine, resulting in a series of academic disparities. These disparities have been collectively called a cultural or minority "tax," and, when considered beyond academic medicine, exist across all departments, colleges, and schools of institutions of higher learning-from health sciences to disciplines located on university campuses outside of medicine and health. A shared language can provide opportunities for those who champion this work to pool resources for larger impacts across the institution. This article aims to catalog the terms used across academic medicine disciplines to establish a common …