Original Research
Produce Prescriptions Improve Nutrition for Medicaid Patients With Diabetes
Background: To improve access to fresh fruits and vegetables for Medicaid patients with type 2 diabetes or prediabetes, the Los Angeles County Department of Public Health partnered with three Federally Qualified Health Centers to implement a produce prescription program. Participants received $40 per month for six months on a debit card that could only be used to buy eligible fresh fruits and vegetables at participating grocery stores. This before-and-after study examined changes in the ability for patients to access foods that promote health. Participants completed questionnaires at the start and end of the program that measured nutrition security and household food security.
What They Found: Among 1,309 participants who completed both surveys, nutrition security increased from 23.2% at baseline to 38.7% at follow-up, and food security increased from 25.2% to 42.9%. Improvements in nutrition security remained statistically significant after adjusting for sociodemographics, baseline food security, and fruit and vegetable consumption. Most participants still reported that healthy foods were too expensive, although more reported they were able to find stores with healthy food options after the program.
Implications: The authors describe the program as an early, short-term success and conclude that produce prescription programs can be integrated into health care settings to help high-risk patients access healthier foods.
Julia I. Caldwell, PhD, MPH, et al
Nutrition and Physical Activity Program, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
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Original Research
Linking Financial Incentives to Improved Blood Sugar Levels May Support Type 2 Diabetes Management
Background: In this randomized controlled trial in Israel, researchers examined whether a contingent discount as a financial incentive on medication expenses could help people with poorly controlled type 2 diabetes better manage their blood sugar. The study included 186 adults from neighborhoods with low socioeconomic status and followed them for six months. Intervention participants received discounts on their diabetes medications if their blood sugar levels improved, while participants in the control group paid for their medications as usual. Researchers then compared changes in blood sugar levels between the two groups.
What They Found: After six months, patients who received medication discounts when their blood sugar improved had greater improvements in long-term blood sugar levels than those who paid for medications. On average, HbA1c levels fell by about 1.4 percentage points in the intervention group, compared with about 0.7 percentage points in the usual-payment control group.
Implications: Providing a contingent discount on medication expenses to socioeconomically disadvantaged patients with uncontrolled type 2 diabetes may lead to improved glycemic control and encourage engagement with ongoing monitoring.
Matan J. Cohen, MD, PhD, et al
Clalit Health Services, Jerusalem district, affiliated with the Hebrew University Faculty of Medicine, Jerusalem, Israel
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Original Research
How Patients Value Visit Type, Speed of Care, and Continuity in Primary Care
Background: Many patients use patient portals to message their primary care clinician, but demand for in-person appointments remains high. Researchers from the University of Michigan examined how patients value trade-offs between quick portal messaging, getting a visit sooner with any available physician, or waiting longer to see their own primary care physician. The study analyzed 2,268 survey responses from adult patients in an academic family medicine clinic. Researchers asked patients to imagine common health situations, such as a new symptom, a medication question, or a mental health concern. Patients then chose between care options that varied by type and timing.
What They Found: Across all six scenarios, patients most often preferred a portal message from their own primary care physician within three days over waiting for video or in-person visits. When patients did not choose portal messaging, they generally preferred a faster video visit with another physician rather than waiting longer to see their own physician.
Implications: Patients’ strong preference for rapid portal messaging highlights growing pressure on primary care clinics, as responding to messages takes time and adds to clinician workload.
Katherine J. Gold, MD, MSW, MS, et al
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Original Research
Care Continuity Linked to Fewer Hospital Visits for Older Adults Receiving Home-Based Care
Background: This study examined whether continuity of care (how often patients see their assigned physician and nurse) was associated with urgent care use and hospital admissions among older adults receiving permanent home-based primary care.
What They Found: Researchers analyzed electronic health record data from three primary care centers in Barcelona, Spain, including 1,207 patients receiving permanent home-based care. The average patient age was 88.5 years, and most had multiple chronic conditions. Over one year, mean continuity of care was 73.3% with assigned general practitioners and 83.1% with assigned primary care nurses. Patients who saw their assigned clinician more often were less likely to use home ambulance services. Those patients were also less likely to visit the emergency department, or be admitted to the hospital. Seeing the same general practitioner for at least three out of four visits was associated with about a 39% lower likelihood of emergency department visits over one year, fewer ambulance calls, and fewer hospital admissions. Higher continuity with assigned nurses was also associated with fewer ambulance calls and fewer hospital admissions.
Implications: These findings support efforts to keep care relationships stable, particularly aiming for at least 75% of general practitioner visits with the assigned general practitioner.
Luis González-de Paz, MSc, PhD, et al
Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
Primary Health Care Transversal Research Group, Institut d’Investigacions Biomèdiques
August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Nursing Department of Public Health, Mental Health and Mother and Child Health, Univer-
sity of Barcelona, Barcelona, Spain
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Original Research
Systems-Level Approach in Primary Care Improves Alcohol Screening, Counseling, and Pregnancy-Intention Records
Background: The United States Preventive Services Task Force recommends screening adults, including pregnant women, for unhealthy alcohol use and providing brief behavioral counseling when risky drinking is identified. This study examined whether implementing the American Academy of Family Physicians’ Office Champions Quality Improvement Model, a framework that empowers local staff to lead care improvement efforts, could improve alcohol screening and brief intervention. Researchers reviewed 2,725 patient records from 17 family medicine practices at baseline (November 2019–February 2020), after implementation (August–November 2021), and at a sustainability follow-up (April–May 2022). Fourteen practices completed the final follow-up.
What They found: Alcohol screening increased from 61% at baseline to 81% at follow-up, and intervention among patients who screened positive increased from 22% to 67%. Documentation of pregnancy intention improved substantially, with fewer records marked as unknown and more patients identified as trying to become pregnant. Practices also increased use of the validated AUDIT-C screening tool. When patients screened positive, clinicians most often provided brief counseling and goal setting.
Implications: The authors conclude that primary care practices can substantially improve alcohol screening and counseling and prevention of alcohol-exposed pregnancies and fetal alcohol spectrum disorders by embedding team-based workflows, staff training, validated screening tools, and EHR supports into routine care.
Julie Wood, MD, MPH, et al
American Academy of Family Physicians, Leawood, Kansas
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Original Research
Study Compares Ways to Support Opioid Deprescribing in Primary Care
Background: This study examined how different types of support for 32 primary care clinics affected opioid prescribing and overall costs using a 2 x 2 design. Clinics were divided into four groups: education about opioid prescribing and regular feedback on their prescribing patterns only; education and feedback plus help changing clinic workflows; education and feedback plus coaching for prescribers; or education and feedback plus both clinic workflow support and prescriber coaching. The researchers compared changes in average opioid dose, testing and screening practices, and total costs, including costs related to changes in health care use.
What They Found: Clinics that received both clinic workflow support and prescriber coaching had the largest reduction in average opioid dose. Clinics that received clinic workflow support (with or without prescriber coaching) increased screening for pain and daily functioning more than other clinics. Clinics that received education alone showed the largest increases in urine drug testing, treatment agreements, and depression screening. Education alone cost less upfront, but was associated with more expensive urine drug testing, making it the most costly approach overall.
Implications: Among the four approaches, education plus clinic workflow support had the lowest overall cost, largely because it limited increases in urine drug testing and treatment agreements, which were major cost drivers. Education plus clinic workflow support and prescriber coaching led to the largest reductions in average opioid dose.
Andrew Quanbeck, PhD, et al
Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Original Research
Primary Care Home Visits for Older Adults Declined After Payment Policy Changes and COVID-19 in Ontario, Canada
Background: In Ontario, primary care home visits, which help older adults who are homebound or have difficulty getting to a clinic, increased during the 2010s but declined after a 2019 policy change reduced payment incentives and the COVID-19 pandemic began. This study examined how primary care home visits for adults aged 65 years and older changed from 2014 to 2024.
What They Found: Researchers used population-level health administrative data and an interrupted time series analysis of monthly home visit rates for Ontario residents aged 65 years and older. Home visits increased slightly before 2019 but dropped sharply by nearly 30 percent during the period from October 2019 through June 2020, which included the incentive change and early COVID-19 disruptions. Visit rates did not recover through 2024 and remained about one-third lower than expected. Nonpalliative home visits (routine primary care not focused on end-of-life care) declined more than palliative home visits, which were the only type to show growth after 2020.
Implications: Primary care home visits for older adults declined substantially and did not rebound after policy changes and COVID-19, suggesting a lasting shift in how care is delivered. Impact of Incentive Reform and COVID-19 on Primary Care Home Visits in Ontario: A Population-Based Interrupted Time Series Analysis
Aaron Jones, PhD, et al
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
ICES, Toronto, Ontario, Canada
Centre for Integrated Care, St Joseph’s Health System, Hamilton, Ontario, Canada
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Original Research
Why Family Physicians Are Leaving Comprehensive Care
Background: Many people in Canada cannot find a regular family physician, partially due to some family physicians leaving comprehensive primary care earlier than planned. This study explored why family physicians in Ontario left comprehensive care and what policy changes they believed could help retain physicians. Researchers conducted a qualitative study using semistructured virtual interviews with 12 family physicians in Ontario who left comprehensive care within the past eight years.
What They Found: Family physicians described leaving comprehensive care because it had become financially unsustainable and increasingly difficult to manage. Key pressures included inadequate compensation, rising costs, heavy administrative workload, inefficient referral processes, limited access to team-based care, and feeling undervalued and unsupported by the health system.
Implications: The findings suggest that improving access to primary care requires urgent attention to retaining practicing family physicians, not just training new ones. Policies that improve financial stability, reduce administrative burden, and better support comprehensive family medicine may help physicians stay in practice longer.
Why Are Family Physicians Leaving Comprehensive Care? A Qualitative Study on Retention in Ontario
Colleen Grady, DBA, et al
Centre for Studies in Primary Care, Queen’s University, Kingston, Ontario, Canada
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Editorial
Why Narrative Writing Complements Science in Family Medicine
Drawing on the five essays published in this issue of Annals of Family Medicine, this editorial explains why stories and reflective writing complement scientific research. The authors touch on how narrative and science together offer a fuller way of understanding health and lived experience.
Robin S. Gotler, MA
Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio
Melanie Steiner, PhD
Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Methodology
CRISP Translation Guide Enables Translating Research-Reporting Guidelines Across Languages
Background: Consensus Reporting Items for Studies in Primary Care (CRISP) is a research-reporting guideline developed for primary care. Because no widely accepted procedure exists for translating research-reporting guidelines, the authors developed the CRISP Translation Guide to facilitate the translation of research-reporting guidelines and related documents to support worldwide dissemination and application of primary care research results.
What They Developed and How: The authors developed and tested the CRISP Translation Guide, using the CRISP reporting guidelines as the case example. The guide outlines a five-step process: translating the document into the target language; reviewing it for clarity and usability by an intended user; back-translating it into English; having the original authors review the back-translation for accuracy and fidelity; and resolving any issues using a team of content experts and bilingual translators, with each step involving discussion and revision.
Implications: The CRISP Translation Guide can facilitate the translation of research-reporting guidelines to support the worldwide dissemination and application of primary care study results. .
The CRISP Translation Guide for Research-Reporting Guidelines
William R. Phillips, MD, MPH
University of Washington, Seattle, Washington
Elizabeth Sturgiss, BMed, MPH, PhD
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Innovations in Primary Care
Team-Based Primary Care Strategy Cuts Hepatitis C Virus Treatment Delays by Four Months
Background: Hepatitis C virus treatment is increasingly being offered in primary care because medications now require less frequent monitoring and have fewer adverse effects. However, many primary care clinicians still defer treatment to specialists due to administrative burdens, including laboratory workup, insurance prior authorizations, and pharmacy coordination, which can delay care.
The Innovation: At an urban family medicine residency clinic in Columbus, Ohio, many eligible patients were not successfully receiving and completing hepatitis C virus treatment. In July 2022, the clinic formed an interdisciplinary team consisting of a physician champion, a pharmacist, and an office staff member to streamline medication access, including prior authorization support. Physicians prescribed treatment, and the pharmacist coordinated medication access and conducted routine follow-up appointments to support adherence. The clinic retrospectively compared outcomes from July 2022 to June 2024 with July 2020 to June 2022 as a quality improvement evaluation.
Implications: Implementation of an interdisciplinary team resulted in more patients receiving hepatitis C virus treatment, while substantially reducing the average time to start treatment from over 6 months to under 2 months. Sharing administrative and follow-up tasks across a team was associated with improved access to treatment.
Hepatitis C Virus Treatment Outcomes Using a Family Medicine Interdisciplinary Team
Megan Hull, PharmD
Department of Family Medicine, OhioHealth Grant Medical Center, Columbus, Ohio
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Innovations in Primary Care
Primary Care Team Testing AI-Assisted Patient Messaging Offers Lessons Learned
Background: Primary care clinicians spend a growing amount of time responding to patient messages through electronic portals, a task that contributes to burnout. Some health systems are piloting using large language models (LLMs) to generate draft responses to patient messages.
The Innovation: At West Virginia University, the authors tested an artificial intelligence tool called Augmented Response Technology (ART) that generates a draft reply as soon as a patient message arrives. Nurses review each draft and decide whether to send, edit, or forward it to a physician. Early versions of ART produced responses that were not very useful, often focusing on triage rather than directly answering patients. The team improved the tool by overhauling the prompt input to enforce tone, safety, and content delivery by grouping messages into categories by type (results review, medication refills, paperwork, general symptoms) and adding a symptom severity library to best help tailor responses.
Implications: The authors conclude that tools like ART may support patient messaging, but only with careful, adaptable prompt design. Different specialties, message types, and patient populations require different approaches.
Lessons Learned From the Front Line of AI-Augmented Patient Messaging
Joseph E. Capito, MD, et al
Department of Family Medicine, West Virginia University, Morgantown, West Virginia
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Essay
A Black Physician Reflects on Navigating Race-Based Expectations About His Appearance and Identity
In this essay, a Black physician describes how, during medical training, he was repeatedly encouraged to change how he dressed and how he introduced himself in order to make patients feel more comfortable. These requests were tied to assumptions about his race, body, and name rather than his skills as a doctor. The author reflects on the emotional toll of being asked to adjust his identity to meet unspoken expectations of “professionalism.” Ultimately, he chooses to present himself authentically and finds that patients respond positively. The essay highlights how medical training can pressure clinicians from marginalized backgrounds to change who they are and calls for environments that support physicians in being themselves.
John E. Ukadike, DO, MPH
Emergency Medicine Residency Program, University of Nebraska Medical Center, Omaha, Nebraska
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Essay
What a Rural Family Medicine Rotation Taught Me About Community, Responsibility, and Care
This essay describes a third-year medical student’s month-long family medicine rotation in a small rural town in Texas and how that experience reshaped his understanding of being a physician. Through caring for multigenerational families, practicing with limited access to specialists, and becoming embedded in the local community, he reflects on the rewards and challenges of rural medicine and how close community ties deepened his sense of responsibility, professional identity, and leadership.
Lessons From the Town of Crazy Water
Benjamin Popokh, BS, BSA
University of Texas Southwestern Medical School, Dallas, Texas
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Essay
Pressure to Treat Symptoms Quickly Can Lead to Missed Diagnoses in Primary Care
In this essay, a medical intern describes working in a busy urban clinic in India where large patient volumes often push doctors to treat symptoms quickly rather than look for an underlying diagnosis. The author tells the story of a woman who had dizziness for over a year and was given medicines without a clear diagnosis. The medical intern took extra time to perform a bedside exam and diagnostic maneuvers, diagnosed benign paroxysmal positional vertigo, and the patient’s dizziness improved right away. The essay highlights the author’s emotional response to being able to identify and treat a real underlying condition after days of providing mostly symptom-based care. He describes feeling ecstatic and notes that he was almost sure he was happier than the patient herself. This experience leads him to reflect on how easily diagnosable conditions can be missed in busy clinics where care prioritizes quantity over quality, and how paying closer attention to patients’ symptoms, even within system constraints, could help more people receive appropriate diagnosis and care.
How Many Diagnosable Diseases Did I Miss Today?
Maanas Jain, MBBS
All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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Essay
Clear and Empathetic Documentation Can Strengthen Clinician-Patient Relationships and Improve Care
Because patients can now read their visit notes, medical documentation has become a form of communication with patients in addition to a clinical record. This essay argues that medical trainees should be taught to write notes that are patient-centered, respectful, and mindful of bias. The authors explain that traditional documentation language can unintentionally harm trust when patients read their records and advocate for teaching trainees to write with empathy and clarity to support stronger patient-clinician relationships and improve care.
Educating Medical Trainees About Patient-Centered Documentation in the Time of Open Notes
Elizabeth A. Fleming, MD, et al
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Essay
How Clinicians Leave a Visit Matters
This essay explores how physicians end patient visits and why those moments matter. The author recalls a moment when a hospitalized patient accidentally said “I love you” as she was leaving the room, prompting her to reflect on how clinicians are trained to begin visits but rarely taught how to leave them. The essay argues that how a physician physically and emotionally exits a patient encounter—whether rushed or deliberate—can communicate presence or abandonment. The author adopted a practice of pausing after difficult visits to signal continued care and non-abandonment, even when medicine cannot fix everything.
Rebecca E. MacDonell-Yilmaz, MD, MPH
The Warren Alpert Medical School of Brown University, Providence, Rhode Island
HopeHealth, Providence, Rhode Island
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Family Medicine Updates
American Academy of Family Physicians
AAFP’s New Type 1 Diabetes Framework Provides Step-By-Step Guidance for Diabetes Events
Early screening for type 1 diabetes can identify people at higher risk before symptoms start, giving families and physicians time to monitor and plan care. Type 1 diabetes can appear suddenly at any age, and some people are first diagnosed during a life-threatening emergency called diabetic ketoacidosis (DKA). A simple blood test can detect type 1 diabetes-related autoantibodies, and if they’re found, follow-up testing and a monitoring plan can help catch progression earlier and reduce the risk of DKA at diagnosis. People can get screened through a research program like TrialNet, through a community screening program like ASK, or through their doctor’s office. To help family medicine practices bring this information to their communities, the American Academy of Family Physicians (AAFP) has released a new framework designed to support type 1 diabetes screening and care in family medicine. Key to the framework is the Community Awareness and Screening Facilitator Guide, a step-by-step guide for running a type 1 diabetes–focused community event, with ready-to-use slides and handouts.
Society of Teachers of Family Medicine
Quick Consult Expands Access and Strengthens Support for Faculty Promotion and Research Mentoring
The Society of Teachers of Family Medicine (STFM) expanded access to Quick Consult, its online mentoring platform, to all Council of Academic Family Medicine (CAFM) organizations (STFM, NAPCRG, ADFM, and AFMRD). Quick Consult connects members with experienced peers for short, targeted consultations across academic, scholarly, and leadership topics, including research methods, survey design, statistical analysis, grant writing, medical education research, and dissemination strategies. New additions include a dedicated topic area supporting external letters for academic promotion.
Journal
The Annals of Family Medicine
Article Title
Jan/Feb Tip Sheet Summaries The Annals of Family Medicine
Article Publication Date
26-Jan-2026