Original Research
Family-Based Lifestyle Intervention Improves Weight Management and Cardiovascular Health Among High-Risk Patients
Background and Goal: The PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC) Study, conducted in India, aimed to assess whether a family-based approach to lifestyle interventions could improve weight management and obesity-related health outcomes among individuals with a family history of premature coronary heart disease.
Study Approach: In this cluster randomized controlled trial, families were randomly assigned to a family-based intervention group or a usual care group. The intervention group received structured lifestyle counseling from nonphysician health workers, who provided regular home visits, goal-setting, and peer group sessions focused on diet, physical activity, and cardiovascular health. The usual care group received one-time counseling and annual cardiovascular risk screenings but no ongoing interventions.
Main Results: 1,671 participants (1,111 women) from 750 families participated. After adjusting for family clustering and socio-economic factors, intervention participants experienced, on average, these improvements compared to the usual care group after two years:
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2.61 kg greater reduction in weight (P < .001)
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1.06 kg/m² greater reduction in BMI (P < .001)
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4.17 cm greater reduction in waist circumference (P < .001)
Why It Matters: The findings demonstrate that a family-based approach to lifestyle interventions can significantly improve weight management and cardiovascular health among high-risk individuals. These interventions could have a substantial public health impact in preventing future diabetes and other noncommunicable disease conditions.
Family-Based Interventions to Promote Weight Management in Adults: Results From a Cluster Randomized Controlled Trial in India
Jeemon Panniyammakal, PhD, et al
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
Visual Abstract
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Original Research
Over Half of Patients Prefer Their Own Doctor and Will Wait Longer for an Appointment
Background and Goal: This study focuses on how primary care patients balance the trade-off between continuity of care and access to timely appointments. It examines whether patients prefer to wait longer to see their own primary care physician (PCP) or prefer to see another clinician for faster care.
Study Approach: Researchers analyzed data from a cross-sectional online survey of adult primary care patients in Michigan. Patients were presented with scenarios in the survey for different visit types—annual checkups, chronic and mental health follow-ups, new symptoms, and urgent concerns—and asked to choose among three options: see only their PCP, prefer their PCP but willing to see another clinician, or see the first available clinician.
Results: 2,319 questionnaires were included in the analysis.
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Over one-half of patients preferred their PCP for annual checkups, chronic condition follow-up, and mental health follow-ups. Patients were willing to wait 3-4 weeks to see their PCP for sensitive exams (68.2%), new mental health concerns (58.9%), and new concerns about chronic conditions (61.1%).
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Only 7.2% of patients were willing to wait for their PCP for urgent concerns while most preferred the soonest available clinician.
Why It Matters: As urgent care rises and health systems prioritize rapid access over continuity, this study suggests these shifts may not align with patient preferences, which emphasize trust and continuity over convenience.
Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?
Gregory Shumer, MD, MHSA, et al
University of Michigan, Michigan Medicine, Ann Arbor, Michigan
Visual Abstract
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Original Research
Long-Term Inhaled Corticosteroid Use for COPD Linked to Serious Long-Term Health Risks
Background and Goal: Inhaled corticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease (COPD), but not recommended as first-line treatment unless patients have asthma/COPD overlap or frequent exacerbations. This study examined whether long-term ICS use (more than two years) increases the risk of serious health conditions compared with short-term use (less than 4 months).
Study Approach: Researchers analyzed electronic health records from over 20 million patients, focusing on individuals aged 45 and older with a COPD diagnosis. They created two groups: a prevalent cohort (patients diagnosed with COPD at any time) and an inception cohort (patients newly diagnosed with COPD). Using propensity score matching, they compared long-term ICS users with those with short-term use. Researchers examined the risk of developing both a composite outcome (any of five major conditions) and individual health outcomes for over 500,000 people.
Main Results:
Overall Risk (Composite Outcome)
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Compared with those using ICS for a short time, long-term ICS users were more than twice as likely to develop at least one of the following conditions:
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Type 2 diabetes
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Cataracts
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Pneumonia
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Osteoporosis
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Nontraumatic fractures
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Prevalent cohort (all COPD patients): risk was 165% higher Inception cohort (newly diagnosed COPD patients): risk was 160% higher Among newly diagnosed COPD patients, 1 in 5 long-term ICS users developed at least one of these conditions.
Recurrent Cases
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Some conditions were also analyzed for recurrent cases (meaning patients who developed them more than once):
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People on long-term ICS were nearly three times as likely to have repeated cases of pneumonia Fractures were also more likely to happen again
Individual Outcomes
Diabetes, cataracts, pneumonia, osteoporosis, and fractures were also more common in long-term ICS users before being combined into the composite outcome.
Why It Matters: Many patients with COPD are prescribed ICS even when not medically necessary, exposing them to serious long-term risks.
Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease
Wilson D. Pace, MD, et al
DARTNet Institute, Aurora, Colorado
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Original Research
Many Patients With Chlamydia and Gonorrhea Are Not Receiving CDC-Recommended Treatment in Primary Care
Background and Goal: Prompt treatment of chlamydia and gonorrhea following a confirmed diagnosis is essential to prevent complications and reduce transmission. Adherence to the Centers for Disease Control (CDC) treatment guidelines in primary care settings remains a concern. This study aimed to quantify the overall treatment rate for chlamydia and gonorrhea and identify factors associated with treatment delays and disparities.
Study Approach: Researchers analyzed electronic health record data from the PRIME registry, which includes information from over 2,000 primary care clinicians across the United States. The study included patients diagnosed with chlamydia or gonorrhea between 2018 and 2022 and assessed whether they received appropriate antibiotic treatment within 30 days of diagnosis.
Main Results: 6,678 cases of chlamydia and 2,206 cases of gonorrhea confirmed by a positive test were identified.
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75.3% of chlamydia cases and 69.6% of gonorrhea cases were treated within 30 days.
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More than 80% of treated patients received antibiotics within 7 days of diagnosis.
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Only 14% of chlamydia cases were treated with the recommended doxycycline and only 38.7% of gonorrhea cases were treated with the recommended ceftriaxone.
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Women, young adults (ages 10-29), and suburban residents were more likely to receive treatment.
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Time to treatment of chlamydia was longer for patients aged 50-59 years and for non-Hispanic Black patients.
Why It Matters: Many patients with chlamydia and gonorrhea in primary care settings do not receive the recommended treatment. This gap in care may contribute to ongoing STI transmission and adverse health outcomes, particularly among marginalized populations.
Treatment of Chlamydia and Gonorrhea in Primary Care and Its Patient-Level Variation: An American Family Cohort Study
Shiying Hao, PhD, et al
Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, California
An accompanying episode of the Annals of Family Medicine Podcast, featuring study authors Shiying Hao, PhD, and Neil Kamdar, MA, will be available here beginning 9am EDT March 25.
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Original Research
Shared Decision Making Among Primary Care Clinic Staff and Family Involvement Improves Follow-Up for Chronic Patients
Background and Goal: Regular follow-up visits are critical for managing chronic conditions, yet some primary care clinics achieve higher visit regularity than others. This study aimed to identify specific strategies used by high-performing clinics to promote consistent follow-up visits for adults with chronic conditions.
Study Approach: This qualitative study used semi-structured interviews with 15 primary care physicians, 12 nurses, 15 administrative staff, and 4 pharmacists from 12 clinics—half with high temporal regularity (patients attending follow-ups consistently) and half with low temporal regularity, identifying strategies that helped high–temporal regularity clinics maintain regular chronic care visits.
Main Results: Clinics with high temporal regularity shared key teamwork strategies that distinguished them from low–temporal regularity clinics:
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Close working relationships with less hierarchical staff structures where every team member is part of the decision-making process
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Staff members described a clear system to ensure follow-up for “no show” patients, beginning with administrative staff reaching out to patients and ending with recruiting the help of patients’ family members
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Additional innovative strategies, including routine staff meetings, adaptive workflows, assisting patients with bureaucracy, informal communication channels, and consulting social workers
Why It Matters: This study highlights how team-based strategies—including structured follow-up systems, proactive patient outreach, and interdisciplinary collaboration—can improve regular follow-up for patients with chronic conditions.
Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients
Maram Khazen, PhD, et al
Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Department of Health Systems Management, the Max Stern Yezreel Valley College, Jezreel Valley, Israel
Visual Abstract
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Original Research
“About Me” Care Card Tool Can Improve Care Planning and Cognitive Health Management
Background and Goal: Existing tools for cognitive impairment focus primarily on clinical diagnosis but do not support discussions that address patients’ personal fears, goals, and social needs. The goal of this study was to develop and test the “About Me” Care Card, a tool designed to promote dialog between patients, caregivers, families, and clinicians on care related to dementia, cognitive impairment, and aging.
Study Approach: Researchers conducted a feasibility study using a community and user-centered design approach to develop and test the “About Me” Care Card, a tool developed based on shared decision-making principles. An environmental scan identified gaps in existing cognitive care tools, and a global steering committee made up of health care professionals, patient advocacy groups, caregivers/family members, and individuals with dementia provided feedback.
Main Results Fourteen clinicians consisting of 7 clinician types across 7 institutions piloted the card during in-person visits or by telephone. Observations showed the card (1) allowed time to elicit what matters most to patients, (2) created space for personalized care conversations, (3) opened an examination of social care needs, and (4) moderated emotional relationships between families and individuals. Findings from 44 completed post-use surveys showed that most patients found the card beneficial, with 65% recommending it for those over age 65. However, while 41% found it easy to use, some patients with advanced cognitive challenges required assistance and only 32% felt it helped in creating a concrete plan to address their priorities.
Why It Matters: Findings from this study suggest that integrating tools like the “About Me” Care Card into primary care workflows could help clinicians identify patient concerns earlier.
Feasibility and Acceptability of the “About Me” Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment
Stuart W. Grande, PhD, MPA, et al
University of Minnesota School of Public Health, Minneapolis, Minnesota
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Research Brief (Early Access, already uploaded to eurekalert!)
Survey Finds Many Americans Greatly Overestimate Primary Care Spending
Background and Goal: This study, based on an online survey of 1,135 adults demographically representative of the U.S. population, aimed to measure public perceptions of primary care spending.
Key Insights: Respondents believed that 51.8% of overall health care spending goes to primary care—more than 10 times the documented share of 4.7%. Additionally, respondents believed that primary care addresses 58.7% of health care needs, very close to actual primary care utilization as a percentage of all ambulatory physician visits in the United States (50.3%).
Why It Matters: Chronic underinvestment in primary care has resulted in workforce shortages, physician burnout, reduced access, and suboptimal care. Access to high-quality primary care has been associated with better population health and more equitable outcomes.
The General Public Vastly Overestimates Primary Care Spending in the United States
Melissa Ma, BS, et al
School of Medicine, University of California, San Francisco, San Francisco, California
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Research Brief
Ambulatory Antibiotic Use in France Showed Significant Decline During the COVID-19 Pandemic
Background and Goal: The COVID-19 pandemic and lockdown measures in France affected health care access and prescribing patterns, leading to significant changes in outpatient (ambulatory) antibiotic use. This study examined how systemic antibiotic use in France changed from 2020 to 2022 compared to expected trends.
Study Approach: Researchers used nationwide health insurance data covering 67 million people to track monthly antibiotic prescriptions from January 2010 to March 2022. They applied interrupted time-series analysis to measure changes in antibiotic use following the first national lockdown on March 17, 2020. Main Results:
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Use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared with expected levels.
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Amoxicillin (−27.5% at 3 months; −55.5% at 12 months)
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Amoxicillin-clavulanic acid (−10.9% at 3 months; −24.9% at 12 months)
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Cefepime (−22% at 3 months; −8.3% at 12 months)
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Fosfomycin (−10.4% at 3 months; −8.6% at 12 months)
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Some antibiotics (e.g., colistin, phenoxymethylpenicillin, trimethoprim-sulfamethoxazole) with chronic indications temporarily increased
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Azithromycin use did not decrease after the first lockdown (−6.3% at 3 months, which was not statistically significant) and actually increased over 12 months (+2.7%)
Why It Matters: The pandemic significantly reduced antibiotic use, particularly for those with indications for the treatment of respiratory and urinary tract infections, which may indicate that some antibiotics were overprescribed before COVID-19.
Changes in the Ambulatory Use of Antibiotics in France Due to the COVID-19 Pandemic in 2020- 2022: A Nationwide Time-Series Analysis
Nicolas Rousselot, MD, MSc, et al
Department of General Practice, University of Bordeaux, Bordeaux, France
Inserm U1219, Bordeaux Population Health Research Center, Bordeaux, France
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Research Brief
Newer Hepatitis B Vaccine Shows Promise as Booster for Health Care Workers
Background and Goal: Health care workers are at higher risk of hepatitis B infection due to occupational exposure to blood and body fluids. They are considered protected if they have a hepatitis B surface antigen antibody (anti-HBs) titer of ≥10 mIU/mL after completing a full vaccination series.This study compared the effectiveness of Heplisav-B, a new hepatitis vaccine, vs. standard hepatitis B vaccines as a booster in previously vaccinated individuals.
Study Approach: Researchers conducted a retrospective cohort study at the Uniformed Services University of the Health Sciences, analyzing medical records from 2019 to 2022. The study included medical students who had completed a full hepatitis B vaccine series but had low antibody levels. Participants received either a standard hepatitis B booster or a Heplisav-B booster. Their antibody levels were measured at least 30 days later to determine if they had achieved protective immunity.
Main Results:
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99.4% of individuals receiving Heplisav-B reached protective antibody levels.
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92.7% of individuals receiving a standard booster reached protective levels.
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The 6.7% higher response rate with Heplisav-B was statistically significant (95% CI, 1.9%-14.5%; P = .003).
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All seven individuals who remained below protective levels after one booster reached immunity after receiving additional vaccinations.
Why It Matters:The study findings suggest that a single booster dose is sufficient to confirm hepatitis B immunity in most young, healthy health care workers who previously completed a full vaccination series. Heplisav-B was more effective than standard hepatitis B vaccines.
Heplisav-B vs Standard Hepatitis B Vaccine Booster for Health Care Workers
Alan L. Williams, MD, MPH
Department of Family Medicine, Uniformed Services University, Bethesda, Maryland
Raquelle S. Newman, MD
Spangdahlem Air Base, 54529 Spangdahlem, AE, Germany
Visual Abstract
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Original Research
Shared Decision Making Improves Health Care Access and Outcomes for Racially and Ethnically Diverse Primary Care Patients
Background and Goal: Racial and ethnic minority patients often face barriers to quality shared decision making with clinicians, contributing to disparities in health care access and outcomes. This study reviewed existing research to identify barriers and facilitators that influence shared decision making for diverse patient populations in primary care settings.
Study Approach: Researchers conducted a scoping review of 39 studies that examined shared decision making among racially and ethnically diverse adults in U.S. and Canadian primary care settings. They used thematic analysis to identify key factors affecting shared decision making before, during, and after clinical visits.
Main Results:
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Facilitators of shared decision making included:
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Empathetic, clear, and honest communication from clinicians
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Encouraging patient participation by allowing time and space for questions and discussion
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Cultural and language alignment between clinicians and patients, improving trust
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Incorporating family in decision making
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Barriers to shared decision making included:
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Mistrust of clinicians and the health care system, often due to past discrimination and prejudice
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Language and cultural barriers that limited meaningful communication
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Clinician time constraints, reducing opportunities for shared decision making
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Implicit bias and stereotyping, leading patients to feel dismissed or unheard
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Why It Matters: Primary care teams and health systems can improve shared decision making for diverse populations by strengthening cultural language and cultural competence, addressing discrimination, ensuring adequate time for shared decision-making discussions, and incorporating family input when appropriate.
Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators
Yohualli Anaya, MD, MPH, et al
Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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Original Research
Performance-Based Reimbursement Increases Administrative Burden and Moral Distress, Lowers Perceived Quality of Care
Background and Goal: Performance-based reimbursement (PBR) is a payment system in which clinics receive compensation based on the quality and outcomes of care they deliver, rather than the volume of services provided. Although designed to improve efficiency and effectiveness, the growth of PBR systems has been linked to increased administrative work for physicians. This study examined how PBR affects doctors' perceived ability to provide quality care at both the individual and organizational levels.
Study Approach: Researchers conducted a longitudinal study using a three-wave survey of primary care physicians, drawing data from the Longitudinal Occupational Health Survey in Health Care Sweden. The first wave, conducted from March to May 2021, involved a survey sent to a nationally representative sample of physicians (N=6,699), asking respondents to rate the impact of the PBR system on a scale ranging from very negative to very positive. The second wave, conducted from March to May 2022, measured illegitimate tasks (tasks that fall beyond the scope of an employee's primary responsibilities and professional role or tasks not anticipated for a particular position) using the Bern Illegitimate Tasks Scale. Moral distress was assessed using an instrument originally developed for Norwegian physicians and later translated into Swedish. The third wave, conducted from October to December 2023, evaluated perceived quality of care at both the individual and organizational levels using the English National Health Staff Survey.
Main Results: A total of 433 primary care physicians responded to the survey at all three time points. Overall, 70.2% of respondents reported that PBR negatively impacted their work (58.9% negative, 12.3% very negative).
Quality of Individual Care
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PBR was associated with increased illegitimate work tasks and greater moral distress
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Illegitimate work tasks and moral distress were both associated with lower perceived individual quality of care
Quality of Organizational Care
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PBR was associated with an increase in illegitimate work tasks and lower perceived organizational quality of care
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Moral distress did not have a significant association with perceived organizational quality of care
Why It Matters: The identification of illegitimate tasks and moral distress as factors associated with perceived care quality suggests that reducing tasks which are seen as irrelevant could support physician well-being and health care delivery.
Emma Brulin, RD, PhD
Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Kevin Teoh, PhD
Birkbeck Business School, Birkbeck, University of London, London, United Kingdom
Visual Abstract
An editorial, titled All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful, accompanies this original research study.
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Editorial
Pay-for-Performance Metrics Must Be More Impactful and Physician-Controlled (early access, already shared to eurekalert!)
Background: This editorial builds on a study by Brulin and Teoh, released ahead of the March/April 2025 issue of Annals of Family Medicine, which found that performance-based reimbursement is associated with lower perceived quality of care by increasing illegitimate tasks and moral distress for primary care physicians.
Editorial Stance: Quality metrics and pay-for-performance initiatives are far more expensive than many patients, clinicians, or administrators realize. The authors call for more rigorous review through cluster randomized controlled trials both before and after implementation—and recommend against implementing metrics with little impact or those that detract from care. They recommend refocusing incentives on targets that are impactful, time-limited, low-cost, and physician-controlled.
Why It Matters: While no single metric is perfect, some can support better care if applied thoughtfully and tested in real-world settings.
All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful
Michael E. Johansen, MD, MS, et al
Grant Family Medicine, OhioHealth, Columbus, Ohio
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Essay
Physician’s Self-Disclosure Helps Patient Overcome Mental Health Care Stigma
Background: Physician self-disclosure is frequently employed intentionally to establish rapport, cultivate trust, convey empathy, or strengthen the credibility of clinical recommendations. In this essay, a primary care physician shares a personal experience of disclosing their own mental health history to help a patient struggling with anxiety and depression.
Key Argument: The author reflects on a case where sharing their own experience with anxiety and antidepressant use helped a longtime patient overcome resistance to treatment. The author argues that carefully chosen personal disclosures—when used with clear boundaries—can be a valuable tool in primary care.
Why It Matters: Physicians' willingness to share their own experiences—within appropriate boundaries—can help break down the isolation that patients often feel. Thoughtful, authentic connections between physicians and patients can strengthen trust and ultimately support both mental and physical well-being.
Let’s Dare to Be Vulnerable: Crossing the Self-Disclosure Rubicon
Ohad Avny, MD
Clalit Health Services, Department of Family Medicine, Hebrew University, Jerusalem, Israel
Aya Alon
Department of Counseling and Human Development, Haifa University, Haifa, Israel
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Essay
Compassion in Post-Mortem Authorship is Needed
Background: When an academic researcher passes away before their work is published, their colleagues may face difficult legal and ethical challenges in maintaining their authorship. There is little clear guidance on handling post-mortem authorship, forcing corresponding authors to navigate these policies alone.
Key Argument: Many journals’ requirement for a deceased author’s family to sign copyright and disclosure publishing forms is both emotionally distressing and impractical. Instead, journals should allow a corresponding author or supervisor to sign on the deceased’s behalf. This approach would respect the author’s contributions while sparing families from unnecessary hardship.
Why It Matters: More thoughtful policies could help preserve the legacy of deceased authors while reducing stress for colleagues handling post-mortem authorship.
When the Death of a Colleague Meets Academic Publishing: A Call for Compassion
Catherine G. Derington, PharmD, MS
Intermountain Healthcare Department of Population Health Sciences, University of Utah Spencer Fox-Eccles School of Medicine, Salt Lake City, Utah
Journal
The Annals of Family Medicine
Article Title
March/April Annals of Family Medicine Tip Sheet
Article Publication Date
24-Mar-2025