image: The HEAL Protocol in Brazilian Health Care: An Innovative Approach to Primary Care for Human Trafficking Survivors
Credit: American Academy of Family Physicians
Editorial
Veterans Experiencing Homelessness Who Secure Housing More Likely to Get Cancer Health Screenings
Background: This editorial reviews Decker et al’s study of more than 100,000 veterans experiencing homelessness who were overdue for colorectal or breast cancer screening. About 57,000 secured housing during a 24-month window and were more than twice as likely to get screened after doing so.
Editorial Stance: The author calls the findings from Decker et al a “rare, measurable improvement” in care for people who have experienced homelessness. Although causality cannot be claimed from this observational work, the author praises the study as a needed answer to past evidence gaps flagged by the National Academies of Science, Engineering, and Medicine (NASEM). Vickery urges more research into what types of housing drives improvements in screening and warns that proposed federal cuts to health, housing, and research funding would undercut progress.
Why It Matters: The findings from Decker et al strengthen arguments for sustained investment in supportive housing and person-centered care models within and beyond the Veteran’s Administration.
Katherine Diaz Vickery, MD, MSc
The Health, Homelessness, & Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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Original Research
Study Finds Veterans Experiencing Homelessness Who Gain Housing Are More Likely to Get Colorectal and Breast Cancer Screenings
Background and Goal: This study examines if gaining housing increased rates of colorectal and breast cancer screening in a cohort of veterans who experience homelessness.
Study Approach: Researchers reviewed ten years of Veterans Health Administration (VA) records (2011-2021). They identified all veterans who were homeless and overdue for colorectal or breast cancer screening at their first VA clinic visit in the most recent year (the “index” visit). Housing status was then tracked for 24 months after that visit. Researchers compared screening rates between veterans who gained housing and those who remained homeless, adjusting the analysis for different factors, including age, health conditions, and the VA facility where care was received.
Main Results: 117,619 veterans experiencing homelessness aged 50-75 years who were eligible but not up-to-date for colorectal screening, and 6,517 women experiencing homelessness aged 50-75 years who were eligible but not up-to-date for breast cancer screening were included in the analysis.
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Nearly one-half the colorectal cohort (49.0%) and breast cohort (47.5%) gained housing in the subsequent 24 months.
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Veterans who gained housing were more likely to undergo colorectal screening and more likely to undergo breast cancer screening than veterans who continued to experience homelessness. Both of these differences were highly significant.
Why It Matters: Gaining housing may facilitate screening by promoting access to communication, reducing competing priorities, and decreasing vulnerability to external forces such as encampment clearing or theft.
Hannah Decker, MD, MAS, et al
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
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Original Research
Machine Learning Model Predicts Missed Appointments in Primary Care Clinics
Background and Goal: This study examined whether machine learning could predict the risk and contributing factors of no-shows and late cancellations in primary care practices.
Study Approach: Researchers at Pennsylvania State University integrated prior appointment history from 15 family medicine clinics, linking to corresponding U.S. Census statistics and national weather reporting databases. Four different machine learning modeling approaches, including gradient boost, random forest, neural network, and LASSO logistic regression were applied to predict appointment outcomes. The outcome of each appointment was attributed to one of the three classes: no-shows, late cancellations (canceled within 24 hours before appointments), and completed visits.
Main Results:
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The analysis consisted of 109,328 patients and 1,118,236 appointments, including 77,322 (6.9%) no-shows and 75,545 (6.8% late cancellations).
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The gradient boost model achieved the best performance in classifying patients as likely to be a no-show or to cancel an appointment late (AUROC of 85% for no-shows and 92% for late cancellations).
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No bias against patient characteristics (sex and race/ethnicity) was detected.
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The schedule lead time (the number of days from a patient’s appointment request to the appointment date) was the most important predictor of missed appointments.
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Patients who missed appointments tended to be female, younger, sicker, under/uninsured, less fluent in English, and in ethnic minority groups. They also experienced longer lead times, higher prior missed appointment rates, and more socioeconomic challenges.
Why It Matters: The findings of this study provide insights into the underlying barriers to missed appointments and suggest that health systems prioritize strategies to reduce lead time and enable care teams to design personalized interventions, such as text reminders or transportation assistance to potentially improve patient appointment adherence.
Predicting Missed Appointments in Primary Care: A Personalized Machine Learning Approach
Wen-Jan Tuan, DHA, MS, MPH, et al
Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
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Original Research
Irish Study Reveals Five Medication 'Prescribing Cascades' That May Put Older Adults at Risk
Background and Goal: “Prescribing cascades” occur when one medication is used to treat or prevent a side effect of another medication. An unintentional cascade can arise when a patient's symptoms are mistaken for a new illness. In that case, the patient not only experiences the original side effect but also faces added risks from the second medication.
Study Approach: Researchers at University College Cork in Cork, Ireland, analyzed national prescription data for 533,464 community-dwelling Irish adults aged 65 years and older, covering prescriptions dispensed from 2017 to 2020. A prescription sequence symmetry analysis was performed with a 365-day window to examine nine expert-defined prescribing cascades known as “ThinkCascades.” Researchers examined dispensed prescriptions data only for potential prescribing cascades.
Main Results:
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Out of the nine prescribing cascades examined, five had significant positive adjusted sequence ratios, indicating that the patient was more likely to receive the first medication before the second medication:
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Calcium channel blocker leading to diuretic prescribing
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Alpha-1-receptor blocker leading to vestibular sedative prescribing
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Selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) leading to sleep agent prescribing
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Benzodiazepine leading to antipsychotic prescribing
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Antipsychotic leading to antiParkinsonian agent prescribing
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Three other drug pairs showed significant negative associations, indicating that the patient was less likely to receive the first medication before the second medication:
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Diuretic to overactive bladder medication
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Benzodiazepine to antidementia agent
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Nonsteroidal anti-inflammatory drugs (NSAIDs) to antihypertensive medication
Why It Matters: For clinicians, including adverse drug reactions among the possible causes to confirm or exclude when patients present with new symptoms in primary care is an important step in identifying and mitigating medication-related harm.
Ann Sinéad Doherty, PhD, et al
Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
An accompanying episode of the Annals of Family Medicine Podcast, featuring study authors Ann Sinéad Doherty, PhD, and Emma Wallace, PhD, will be available at 9 a.m. ET on July 29, 2025 [here].
This study has been published as an early access article on the Annals of Family Medicine website. Please share the link associated with the title text of the study (this one: Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland)
Visual Abstract
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Original Research
Family Physicians Improve Rural Maternity Outcomes But Those in High-Need States Need Support
Background and Goal: This study explores the geographic distribution of family physicians providing maternity care and identifies opportunities for family physicians to expand access to maternity care.
Study Approach: The study merged county-level counts of OB-GYNs, certified nurse-midwives, and hospitals offering obstetric services from the 2021–2022 HRSA Area Health Resource File with 2013–2021 American Board of Family Medicine data on family physicians who reported delivering babies.
Researchers used a mapping approach to identify three types of vulnerable counties based on the following: family physicians as the only clinician provider of maternity care along with at least one hospital providing obstetric care (‘family physicians with hospitals’); family physicians as the only clinician provider of maternity care with no hospital providing obstetric care (‘family physicians only’); and no clinician providers of maternity care but county has at least one hospital providing obstetric services (‘only hospital’).
Main Results:
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The majority of the 325 vulnerable counties across the three types are rural and concentrated in the central U.S., the upper Midwest, and in Mississippi. More than one-third of these counties are found in just four states: Texas, Iowa, Nebraska, and Kansas.
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‘Only hospital’ counties are located primarily in a few states, including Mississippi, Missouri, Oklahoma, and Texas, have significantly higher percentages of Black populations, and have higher rates of social deprivation.
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‘Family physicians with hospital’ and ‘family physician only’ counties have significantly lower rates of preterm births, low birth weight, and infant mortality when compared to ‘only hospital’ counties.
Why It Matters: While family physicians are providing maternity care in rural areas across the U.S., opportunities exist to expand their reach. The study findings highlight the importance of supporting rural training tracks, obstetric fellowship programs, and obstetric-focused family medicine residency programs in filling high-need area deficits.
Michael Topmiller, PhD, et al
The Robert Graham Center for Policy Studios in Family Medicine, American Academy of Family Physicians, Washington, DC
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Original Research
Most Primary Care Patients With Opioid Use Disorder Who Start Treatment Stay Engaged
Background and Goal: Opioid use disorder (OUD) medication treatment saves lives, yet fewer than one-third of people with OUD receive evidence-based treatment with medication. Researchers examined how often adults who report opioid use and moderate or severe substance-use symptoms begin, and stay on, OUD medication.
Study Approach: Researchers reviewed electronic health record and insurance claims data from 33 primary care clinics in Washington from March 1, 2015, to Jan. 1, 2023. The study included 1,502 adults who, at or just before a primary care visit, completed a substance-use checklist, said they had used opioids in the past year, and had not received OUD medication in the prior 30 days. Treatment initiation was defined as receiving buprenorphine, methadone, or injectable naltrexone within 14 days of the checklist; engagement meant at least one additional dose in the next 34 days.
Main Results
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Of the 1,502 patients, 80 (5%) had moderate symptoms of substance use disorder and 542 (36%) patients had severe symptoms.
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Among patients with moderate symptoms, 10% (8 patients) initiated medication treatment, and 75% (6 patients) remained engaged in the following month.
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Among patients with severe symptoms, 26% (141 patients) initiated medication treatment, and 76% of those patients (108) remained engaged in the following month. These patients were significantly more likely to initiate and remain engaged compared to those with moderate symptoms.
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Overall, most primary care patients who reported opioid use and moderate or severe substance use disorder symptoms did not initiate opioid use disorder medication treatment. However, most patients who did initiate medication treatment remained engaged in the following month.
Why It Matters: Routine screening alone did not move most patients with clear OUD symptoms into lifesaving treatment. While patients were willing to report use of opioids and substance use symptoms on the checklist, use of the checklist will likely need to be paired with robust implementation strategies and other proactive, patient-centered, population-based systems to engage patients in medication treatment for OUD.
Claire B. Simon, MD, et al
Department of Family Medicine, University of Washington, Seattle, Washington
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Original Research
Body Fat Percentage Beats BMI in Predicting 15-Year Mortality Risk Among U.S. Adults Ages 20 to 49
Background and Goal: Although body mass index (BMI) is widely used in clinics as the standard measure of body composition, it can potentially misclassify muscular individuals as overweight and miss cases of "normal-weight obesity," masking serious metabolic and heart disease risks. This study examined BMI vs body fat percentage for 15-year mortality risk among adults aged 20-49 years.
Study Approach: Researchers from the University of Florida analyzed data from 4,252 participants in the 1999-2004 National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of non-institutionalized U.S. adults ages 20 to 49. All participants had complete technician measured body composition data, including height, weight and waist circumference. Body-fat percentage was assessed by bioelectrical impedance analysis. Records were linked to the National Death Index through 2019.
Main Results:
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Adults with a high body-fat percentage (27% or more in men; 44% or more in women) were 1.78 times more likely to die from any cause than individuals in the healthy body fat range (HR 1.78; 95% CI, 1.28 to 2.47). Adults with a high body-fat percentage were also 3.62 times more likely to die from heart disease (HR 3.62; 95% CI, 1.55 to 8.45).
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Overweight/obese BMI (25 kg/m² or higher) was not associated with a statistically significant higher risk of death from any cause, compared with adults in the healthy BMI range (HR 1.25, 95% CI 0.85 to 1.84).
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Adults with a high waist circumference (more than 40 inches in men; more than 35 inches in women) were 1.59 times more likely to die from any cause than individuals in the healthy range (HR 1.59; 95% CI, 1.12 to 2.26). Adults with a high waist circumference were also 4.01 times more likely to die from heart disease (HR 4.01; 95% CI, 1.94 to 8.27).
Why It Matters: The study findings support reexamining how body composition is measured in clinical settings. Historically, it has been difficult to measure body fat percentage in primary care outpatient settings. New bioelectrical impedance devices have the potential to change this.
Body Mass Index vs Body Fat Percentage as a Predictor of Mortality in Adults Aged 20-49 Years
Frank A. Orlando, MD, et al
Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
This study has been published as an early access article on the Annals of Family Medicine website. Please share the link associated with the title text of the study (this one: Body Mass Index vs Body Fat Percentage as a Predictor of Mortality in Adults Aged 20-49 Years)
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Original Research
Study Finds Uneven Progress Toward Diabetes Goals Across Patient Groups in the Enhanced Primary Care Diabetes Program
Background and Goal: The Enhanced Primary Care Diabetes (EPCD) model is a nurse-led care delivery model that leverages multidisciplinary support to improve diabetes care quality in primary care settings. This study assessed whether patients of different racial and ethnic groups benefited equally.
Study Approach: The authors reviewed health records for 1,749 adults aged 18 to 75 years from 13 family medicine and internal medicine practices in Mayo Clinic Rochester who joined the EPCD program from Jan. 1 to Dec. 31, 2020. They followed each patient’s progress through Aug. 1, 2022, to see how long it took to meet five publicly-reported diabetes care goals known as D5: a blood pressure reading lower than 140/90; taking a statin medicine to lower bad cholesterol; blood sugar or HbA1c reading of less than 8%; living tobacco-free; and taking a daily dose of aspirin as appropriate. They then compared those times across racial and ethnic groups, accounting for differences in age, sex, where patients live, type of diabetes, number of medications, insulin use, and any gaps in care at the start.
Main Results:
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60.7% (1,061 patients) met the D5 during the study period.
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Black patients with diabetes were less likely than White patients to reach the D5 (HR 0.68; 95% CI, 0.52-0.90; P = .007). There was no difference among Asian and Hispanic patients compared to White patients.
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Compared to White patients, Asian patients had fewer nurse touch points (median 0.8 per year) during the study period, while Black patients had more (median 2.2 per year). Hispanic patients had no significant difference.
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Factors tied to slower D5 attainment included younger age, insulin use, fewer baseline D5 components met, and a lower medication count at program entry.
Why It Matters: Black patients were significantly less likely to attain the D5 despite being engaged with the care team nurses more often than White patients. The findings of the study highlight the need to tailor chronic disease programs to socioeconomic and cultural context.
Joseph R. Herges, PharmD
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
Lauren R. Stonerock, PharmD
Department of Pharmacy, Trinity Health, Grand Rapids, Michigan
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Original Research
White Veteran High Users of Online Portal Generate and Exchange More Messages Than Certain Patient Minorities in the Veterans Health Administration
Background and Goal: Use of secure messaging, which lets patients communicate with clinicians or care teams through an online portal, has increased in recent years. While secure messaging can increase access to care, answering a high volume of messages can burden care teams. Researchers examined the percentage of all secure messages that were exchanged between primary care teams and high users and whether high users were also heavy users of other primary care or emergency department services.
Study approach: Researchers analyzed data from the VHA Corporate Data Warehouse, the Patient-Centered Management Module web application and the My HealtheVet portal. They included every veteran who sent or received at least one secure message with primary care during a one-year study period from October 1, 2022 to September 30, 2023. Veterans at or above the 95th percentile of annual message volume were classified as high users.
Main Results: Over 1.5 millions veterans were included in the analysis.
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High users exchanged 30.5% of all secure messages. High user exchanges featured a greater percentage of patient-generated messages.
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Veterans were more likely to be high users if they were aged 75 years or older, were more frail, had higher degrees of complexity, or lived with mental-health conditions. They were also more likely to be White individuals and to live in neighborhoods with higher socioeconomic status.
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Most secure-messaging high users did not use in-person, telephone, video, or emergency care services at the same high frequency as secure messages.
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Patients were less likely to be high users if they identified as Black, Hispanic, or Asian/Pacific Islander/Native Hawaiian, or were male.
Why It Matters: These findings can help family physicians and policy makers focus outreach and resources on patient subgroups that rely heavily on secure messaging. The results can also help practice leaders anticipate which veterans’ access might be most affected by policy changes.
High Users of Primary Care Secure Messaging in the Veterans Health Administration
Jonathan Staloff, MD, MSc, et al
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
Department of Family Medicine, University of Washington, Seattle, Washington
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Systematic Review
Umbrella Review Summarizes Family Physicians’ Experiences With Clinical Integration
Background and Goal: Clinical integration involves coordinating ongoing health care services across health professionals, facilities, and support systems to meet patient care needs. Researchers aimed to map out barriers and facilitators perceived by family physicians in clinical integration to guide future intervention development.
Study Approach: Researchers examined systematic review studies published from 2010 to 2022. Researchers adopted a “best-fit framework approach” to organize findings into themes and subthemes. They then validated the framework with another 21 reviews published between 2022 and 2024.
Main Results: 90 reviews covering over 1,200 studies were included in the analysis
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Researchers identified 9 themes related to operation units (system, organization, and practice); individuals (providers, family physicians, and patients); medicine and professional work (professional); beliefs, attitudes, stigma and culture (normative); and administrative management, finance, and communication (functional).
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The professional theme appeared in 86% of the reviews, including subthemes related to diseases, roles and identities, clinical guidelines, and teamwork.
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In contrast, system, organization, and practice-related themes were less frequently reported (48%, 22%, and 23%).
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Four subthemes stood out for their popularity: family physicians’ characteristics, knowledge, and experience (78%); patients’ characteristics, knowledge, and experience (70%); beliefs and attitudes (62%); and roles and identities (60%).
Why It Matters: The study findings highlight the complex interactions between factors, subthemes, and overarching themes.Clinical leaders and decision makers must bear these factors in mind when experimenting with interventions, targeting common elements shared across themes to strengthen care integration.
Olivia L. Tseng, MD, PhD, MSc, et al
University of British Columbia, Vancouver, British Columbia, Canada
Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada; Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Research Brief
U.S.-Born Latinos Have Higher Rates of Obesity Compared to Foreign-Born Latino and White Youth
Background and Goal: Childhood obesity rates differ by ethnicity, yet data on nativity for Latino youth in primary care are limited. Researchers used community health center electronic health records (EHR) from 2012-2020 to track obesity trends by ethnicity and nativity and to test whether nativity is linked to obesity prevalence among patients aged 9-17 years.
Study Approach: Researchers examined EHR data for 147,376 children who visited 1,311 community-based health centers in 21 states. They divided the 2012-2020 span into four snapshots and, at every visit, noted whether a child’s body mass index placed them in the obesity range for their age and sex. Children were grouped as foreign-born Latino, U.S.-born Latino, or non-Hispanic White. Researchers compared obesity rates across groups while accounting for age, sex, insurance, household income, clinic-visit frequency, pregnancy, neighborhood disadvantage and state.
Main Results: The final sample size included 147,376 children across all periods; cross-section counts rose from 38,697 (2012-13) to 72,747 (2018-20).
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U.S.-born Latino children had higher odds of obesity than non-Hispanic White peers in every period (aOR for U.S.-born Latino children across each period: 1.33 to 1.48).
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Foreign-born Latino children never differed significantly from non-Hispanic White children.
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Obesity prevalence increased over time in all three groups.
Why It Matters: The findings of this study reveal opportunities for primary care practices to further consider patients’ background and culture when addressing obesity and related disease prevention.
Jennifer A. Lucas, PhD, et al
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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Special Report
Report Proposes Considerations for Data Transformation to Advance AI Research and Implementation in Primary Care
Background and Goal: Large-scale, well organized, and open datasets are necessary for primary care–focused artificial intelligence and machine learning (AI/ML) research and development. This article proposes a set of high-level considerations around the data transformation needed to enable the growth of AI/ML applications in primary care.
Key Insights: The authors propose five key considerations for data transformation in primary care: automation of data collection, organization of fragmented data, identification of primary care–specific use cases, integration of AI/ML into human workflows, and surveillance for unintended consequences. The authors further emphasize three factors that will enable each of these efforts to be effective and work cohesively: increased collaboration of the industry and academia AI/ML communities with primary care, increased funding from the private and public sectors, and upgrades to human and data infrastructures.
Why It Matters: Data transformation to advance AI/ML research and implementation in primary care requires cross-sectoral collaborations between government, industry, professional organizations, academia, and frontline primary care.
Data Transformation to Advance AI/ML Research and Implementation in Primary Care
Timothy Tsai, DO, MMCI, et al
Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
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Innovations in Primary Care
Web-Based Tool Helps Michigan Physicians Navigate Diabetes Coverage and Prior Authorization
Michigan’s Collaborative for Type 2 Diabetes (MCT2D), a statewide population health collaborative quality initiative, analyzed nearly 1,000 physician-submitted patient case summaries and needs assessments, finding that physicians needed help managing the burden of prior authorization. The team first developed a PDF guide that was posted on their website in 2021. In 2024, they created an interactive web tool, Coverage Checker, co-designed with MCT2D clinicians. The tool shows care team members whether a patient’s insurance covers guideline-directed medical therapy or continuous glucose monitors and the prior authorization steps each plan requires. Coverage Checker encompasses about 75% of Michigan’s largest commercial, Medicare, and Medicaid insurance policies, autofills chart notes, and is reviewed quarterly. A mobile app is planned for release later in 2025.
Coverage Checker: A Web-Based Tool to Navigate Diabetes Coverage and Prior Authorization
Noa Kim, MSI, et al
Michigan Collaborative for Type 2 Diabetes, University of Michigan, Ann Arbor, Michigan
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Innovations in Primary Care
HEAL Protocol Addresses Human Trafficking in Brazilian Primary Care
Primary care is often the first or only contact point for human trafficking survivors. In the Brazilian state of Pernambuco, professionals from the health, social services, and justice sectors collaborated to adapt and translate the U.S.-based HEAL Trafficking Protocol Toolkit to the Brazilian context. The toolkit equips health care professionals with the knowledge and tools to identify, and respond to, potential victims of human trafficking in a trauma-informed and patient-centered manner. Since September 2023, the Brazilian Protocol Toolkit page on the HEAL website has received 535 views from 270 users across 17 Brazilian states and 53 different cities.
Marcella R. Cardoso, PhD, et al
Division of Gynecologic Oncology, MGH Global Disaster Response and Humanitarian Action, Strength & Serenity, MGH Global Initiative to End Gender-Based Violence, Boston, Massachusetts
Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
HEAL Trafficking, Long Beach, California
Visual Abstract
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Essay
Family Physician Offers Framework for Managing Patient Demand
Background: Primary care clinics face rising demand. Under a fee-for-service model, health systems add visits to meet demand, but value-based payment removes the volume incentive, forcing family physicians to ask which visits are actually necessary.
Key Argument: The author argues that as more organizations adopt value-based contracts, skillful demand management will become critical for delivering high-quality, sustainable primary care. A practical “3D” framework—Delegate, Defer, Direct— is introduced to help physicians manage demand. “Delegate” identifies opportunities for other health care team members or community resources to effectively deliver care. “Defer” lengthens or tailors follow-up intervals for stable chronic conditions, such as “graduating” well-controlled diabetes or hypertension patients from quarterly to annual physician visits while nurses handle labs and refills. “Direct” gives patients guidance and educational tools so they know when self-care is enough and what warrants a visit.
Why It Matters: Demand management continues to face significant hurdles: staffing constraints limit team-based care, patient engagement with community partnerships remains inconsistent, and social determinants create barriers and higher utilization. The “3D” framework provides clinicians with a path toward high-value care that respects patient preferences, using traditional or emerging tools.
Managing Patient Demand in a Value-Based System
Kumara Raja Sundar, MD
Kaiser Permanente Washington, Seattle, Washington
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Essay
Advance Notification Urged for Conscientious Refusals in Rural Primary Care
Background: U.S. clinicians have the right to refuse to provide treatment that conflicts with their core moral or religious values. The American Medical Association says physicians must warn patients about any limits before entering into a patient-physician relationship. Rural patients face long travel times, physician shortages, and higher distrust of the health system, making the timing of the warning especially important.
Key Argument: Advance notification should be essential for rural primary care physicians because it spares patients valuable time. However, in-person notice during the visit may be preferred when emphasizing willingness to care for other aspects of the patient’s health. Face-to-face discussion allows physicians to explain their stance yet reaffirm commitment to all other aspects of care.
Why It Matters: Setting advance notice as the norm and using in-person notice selectively could preserve trust in physician-patient relationships, reduce logistical and financial burdens, and promote the community’s trust in physicians’ practice for rural patients.
Advance Notification for Conscientious Refusal in Rural Health Care
Forrest Bohler, BS, et al
Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
This essay has been published as an early access article on the Annals of Family Medicine website. Please share the link associated with the title text of the study (this one: Advance Notification for Conscientious Refusal in Rural Health Care)
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Essay
High-Risk Obstetrics Patient’s Newborn Death Prompts Medical Student to Reflect on the Emotional Complexities of Entering Health Care
Background: A third-year medical student recounts her experience with a high-risk obstetric patient. After two weeks of bedside visits filled with optimism and fear, the patient delivered by emergency cesarean at 26 weeks. However, her son died in the neonatal intensive care unit (NICU) two days later.
Key Argument: The author now understands a universal truth about the practice of medicine: it is as much about embracing the joy of life as it is about navigating its inevitable sorrows. Whether one is an obstetrician, family physician, internist, or pediatrician, the role of a physician demands an unyielding commitment to patients during their brightest and darkest moments.
Why It Matters: This essay emphasizes the emotional challenges faced by physicians. Regardless of specialty, physicians must navigate deeply emotional issues with empathy and dedication.
Learning to Navigate the Dark With Grace
Katarina Forsthoefel, BS
Florida State University College of Medicine, Tallahassee, Florida
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Essay
Health Care, Politics, and Identity: A Family Physician’s View
Background: A family physician recounts the morning after the 2024 U.S. presidential election, when a Trump victory left his clinic steeped in “profound, overwhelming grief.” Marginalized patients, including women seeking preventive care, families reliant on Medicaid, and transgender adults, voice anxiety about losing coverage and essential services.
Key Argument: The author rejects the profession’s traditional stance of “institutional neutrality” and asserts that physicians cannot remain neutral when legislation threatens patients’ well-being.
Why It Matters: The experiences detailed in the essay highlight the tension between professional neutrality and physicians’ moral imperative to advocate for vulnerable populations.
The Day After: Primary Care in a Post-Election Landscape
Riley Smith, MD
University of North Carolina, Chapel Hill, North Carolina
This essay has been published as an early access article on the Annals of Family Medicine website. Please share the link associated with the title text of the study (this one: The Day After: Primary Care in a Post-Election Landscape)
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Family Medicine Updates
AAFP Pilot Program Shows Value of Lifestyle Medicine
American Academy of Family Physicians
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Association of Departments of Family Medicine
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More Than Metrics: A Meaningful Approach to DEI Milestones
Association of Family Medicine Residency Directors
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STFM Presents 2025 Society Awards
Society of Teachers of Family Medicine
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Charting the Future: Progress in the National Family Medicine Research Strategy
NAPCRG
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Journal
The Annals of Family Medicine