Family medicine (FAM MED )

Publisher: Society of Teachers of Family Medicine


Family Medicine publishes original clinical and educational research of interest to family medicine faculty, practicing clinicians, residents, and others involved in family medicine education. The journal also publishes special articles and commentaries about the fundamental concepts of medical education, as well as book reviews and international reports. All original research reports and commentaries are anonymously refereed.

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Publications in this journal

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    ABSTRACT: BACKGROUND AND OBJECTIVES: Family medicine residents increasingly work collaboratively with psychology trainees. One type of collaborative experience involves dual interviewing of clinic patients. The goal of this observational study was to provide an initial description of what occurs during dual interviews as it relates to behavioral health assessments and interventions. METHODS: Psychology trainees provided detailed descriptions of 550 collaborative patient encounters involving 348 patients from the Wayne State University/Crittenton Family Medicine Residency clinic. Psychology trainees coded the frequency of behavioral health assessments and interventions by the resident, psychology trainee, or both. RESULTS: Eighty percent of the encounters contained a behavioral health assessment, and 29% contained a behavioral health intervention. Most of these clinical activities were collaboratively done. Interestingly, residents and psychology trainees tended to provide different behavioral health interventions. Moreover, residents provided different behavioral health interventions in repeat dual interviews (n=202) as opposed to first-time visits (n=348), while psychology trainees did not. CONCLUSIONS: Little is known about the process of dual interviewing, and this study is an important first step in describing how residents and psychology trainees actually interact during these encounters. More research is needed about the impact of dual interviewing on residents’ behavior.
    Family medicine 06/2013; 45(6):424-427.
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    ABSTRACT: Context: Many patients with type-2 diabetes seek help with care from someone. Whether the specific source of help with diabetes care is associated with better diabetes control is unclear. Objective: To determine if the “source of most help” in diabetes care is associated with glycosylated hemoglobin (A1C). Design: Cross-sectional analysis of survey data using questions from the Michigan Diabetes Research & Training Center (MDRTC) Diabetes Care Profile. Setting: specialty endocrinology outpatient clinic. Patients: Inclusion criteria: age>21 years, English literate, type-2 diabetes diagnosis. 225 patients eligible, 206 patients completed (n=206, 91% response). Primary Outcome: Glycosylated hemoglobin (A1C). Results: Age 60.8±12.63, 44.2% male, 36.9% African-American, 61.7% married, 29.6% 4-year college graduate, body mass index 33.2±7.5, 49.0% diabetes duration>10 years, 30.0% A1C<7; 26% identified a spouse as their source of most help, 21% non-spouse family member or friend, 35% health care worker, and 18% self. After adjustment for age, gender, race, marital status, education, diabetes duration, and medication adherence, mean A1C level by source of most help: 7.6±0.34 spouse, 9.0±0.34 non-spouse family or friend, 7.5±0.25 healthcare worker, and 7.3±0.35 self. Those receiving help from non-spouse family or friend had significantly higher A1C levels than all other groups (p<0.05 for each comparison). Conclusions: Patients with diabetes who depend on their spouse, healthcare worker, or self for care have similar A1C levels; however, those who depend on non-spouse family or friend have higher A1C. A better understanding of sources of help with diabetes care may facilitate disease management and improve clinical outcomes.
    Family medicine 02/2013; 45(Sup. 2).
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    ABSTRACT: Background Research comparing cancer journeys between those living in rural and urban environments has found evidence that rural dwellers are diagnosed later and have poorer survival than urban counterparts. To date these findings have not been satisfactorily explained. One potential explanation is that rural doctors manage potential cancer symptoms differently to those in cities, perhaps because of access issues. To explore this further we studied the management of a retrospective cohort from Northeast Scotland diagnosed with melanoma between 1991 and 2007 with respect to place of residence. Method A database was constructed comprising pathology data from all melanomas diagnosed in Northeast Scotland between December 1991 and July 2007. Postcode was used to assign rurality and deprivation data prior to being anonymized. A single observer then scrutinized all reports and collected key clinical data. Univariate analysis explored the effect of rurality on location of excision, completeness of excision and Breslow thickness. Subsequent multivariate analysis adjusted for important potential confounders. Results Pathology reports from 1256 melanomas were scrutinized. On univariate analysis: The proportion of rural dwellers receiving their biopsy in primary care, contrary to current UK guidelines[2], was significantly higher than for urban dwellers (26.3% vs 17.7%, p<0.001). Rural dwellers, however, were no more likely to have an incomplete excision (70.9% vs 69.8%, p=0.771) and there was no significant difference between Rural and Urban dwellers in median Breslow thickness at diagnosis. The difference in location of excision remained significant after adjustment for age, sex, site of melanoma and deprivation (odds ration 1.42 (95% CI’s 1.01- 1.98) p=0.04). Conclusions People living in the country are more likely to have their melanoma excised by a GP than those living in the city. This does not appear to lead to an increased risk of an incomplete excision, but nor does it appear to result in earlier stage diagnosis.
    Family medicine 01/2013; 45(Supplement 2 2012 NAPCRG Abstracts):P7.
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    ABSTRACT: BACKGROUND Malignant melanoma incidence is increasing in all Caucasian populations. Incidence is highest in Australia where it has increased by 85% in men and 31% in women between 1983 and 2001. Scotland has fewer cases but, alarmingly, a relatively greater increase in incidence, 283% in men and 236% in women between 1985 and 2007. Little is known about the extent to which Scottish people have learned about melanoma and risk reducing behaviour compared to Australians, where public health efforts are long-standing and well resourced. AIM To compare personal risk; level of concern; knowledge and self-reported protective behaviour between the Scottish and Australian populations. METHOD A validated questionnaire was administered in Western Australia and Grampian. Questionnaires were coded and scored. Demographics were described and compared. Four summary scores were generated (personal risk score; level of concern score; melanoma knowledge score; protective behaviour score) by summing responses to questionnaire items. Median scores were analysed using the Mann-Whitney U test. Binary logistic regression was used to adjust for potential confounders and identify independent predictors of good performance. RESULTS 271 Scots and 265 Australians responded. Personal risk of melanoma was similar between Australians and Scots (mean 11.6 vs mean 11.4, p<0.517). Australians were more concerned about melanoma (5.5 vs 3.1, p<0.005), practiced more sun protection (13.6 vs 11.9, p<0.005), and knew more about melanoma (13.9 vs 11.9). Following adjustment for potential confounders, Australian nationality remained predictive of a high concern, practicing sun protection and melanoma knowledge. Younger age, high educational attaintment, personal history of skin cancer, and knowing someone with skin cancer were independently predictive of high concern, practicing sun protection and melanoma knowledge. CONCLUSIONS Australian people are better prepared to protect themselves against skin cancer than Scots. This behoves Scottish health policy makers to study and implement the Australian model here.
    Family medicine 01/2011; 43(Supplement 1 2010 NAPCRG Abstracts):P8.
  • Family medicine 10/2009; 41(8):540-1.
  • Family medicine 07/2009; 41(6):448.
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    Family medicine 07/2009; 41(6):395-7.
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    ABSTRACT: Family medicine does not have a defined scope of procedures or universal standards for procedural training. This contributes to wide variation in family physician training and difficulties obtaining hospital privileges for advanced procedures. The Society of Teachers of Family Medicine (STFM) Group on Hospital Medicine and Procedural Training previously developed a list of core procedures to be taught in all family medicine residencies. The group reconvened to develop a consensus list of advanced procedures within the scope of family medicine. Working from a master list of procedures, the group, which consisted of 21 family medicine educators, used a multi-voting process to identify advanced procedures within the scope of family medicine. The group generated a list of 36 advanced procedures and added nine procedures to the previously created list of core procedures. The STFM Group on Hospital Medicine and Procedural Training proposes a list of advanced procedures within the scope of family medicine and urges family medicine governing bodies to use this list to define and standardize the scope of procedural training and practice in family medicine.
    Family medicine 07/2009; 41(6):398-404.
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    ABSTRACT: Colorectal cancer (CRC) screening is widely recommended but underused. A physician's recommendation for CRC screening has been consistently associated with patients undergoing CRC screening, but a better understanding of factors influencing a physician's recommendation for CRC screening is needed. This study's purpose was to describe patient and physician factors associated with a physician's recommendation for CRC screening. A cross-sectional survey was conducted in a primary care clinic population during 2004-2005 to determine the association between self-reported physician recommendation for CRC testing and patients' sociodemographic factors, health characteristics, other health behaviors, and physician and patient-physician factors including patient-physician gender and racial/ethnic congruence. Bivariate and multivariate logistic regressions were performed. A total of 560 patients ages 50-80 were recruited. Their mean age was 63 years, 47.5% were male, 36% were non-Hispanic whites, 35% were African Americans, and 29% were Hispanics. Sixty-one percent reported receiving a physician's recommendation for CRC testing. In multivariate testing, a physician's recommendation for CRC testing was associated with having a female physician, being a male patient, having gastrointestinal disease, and having better health status. Female physicians are more likely to recommend CRC. Patients are more likely to receive a CRC recommendation if they are male, have gastrointestinal disease, and have better health status. Further studies should explore cultural influences on physician recommendation for screening.
    Family medicine 07/2009; 41(6):427-33.
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    Family medicine 07/2009; 41(6):393-4.