Correction to "Hepatitis C for Primary Care Physicians"
In the above-mentioned article,1 the sustained virological response (SVR) is defined as "no detectable hepatitis C viral RNA 24 months after treatment." The time frame should read "24 weeks" and not months. The electronic version on the Journal of the American Board of Family Medicine website has been corrected. We apologize for the error, and we regret any confusion or inconvenience it may have caused. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Tags: Erratum Source Type: research

The Evolution of Maintenance of Certification for Family Physicians (MC-FP) Part IV, Performance in Practice
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Lainhart, N., Hagen, M. D. Tags: Board News Source Type: research

Poetry in a Pill
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Goldstein, A. O. Tags: Reflections in Family Medicine Source Type: research

Atrial Fibrillation Diagnosed through Sensory Complaints
We describe a patient in whom atrial fibrillation and subsequent embolic stroke was discovered because of complaints of decreased smell and taste. These deficits ultimately improved after treatment of the atrial fibrillation along with anticoagulation medication for stroke prevention. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Thomassin, S. S., Zinn, S. Tags: Brief Reports Source Type: research

Renal Failure in a Soldier Taking N.O.-Xplode
Conclusions: This case demonstrates the need for improved patient–physician communication about dietary supplements. The patient had not consulted a physician before initiating use; the amount of each ingredient contained in the dietary supplement is unavailable; and there are no available data regarding safety or efficacy. It is critical that physicians are able and open to counseling patients on the inherent risks associated with dietary supplements, including their lack of regulation by the Food and Drug Administration, unknown efficacy, and possible serious adverse outcomes. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Siano, K. A. Tags: Brief Reports Source Type: research

Identification and Basic Management of Bleeding Disorders in Adults
This article reviews the diagnostic approach to hematologic laboratory abnormalities and abnormal bleeding in adults, as well as basic preventive care and hemostatic management of adults with bleeding disorders. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Kruse-Jarres, R., Singleton, T. C., Leissinger, C. A. Tags: Clinical Reviews Source Type: research

Asthma in Preschool Children: A Review of the Diagnostic Challenges
Family physicians face many challenges when diagnosing asthma in preschool children. These diagnostic challenges are compounded by variations in the natural history of early stage asthma, which are not fully understood, since early childhood wheezing and asthma are heterogeneous disorders with many phenotypic and variable expressions. Since no standard definition for the type, severity, or frequency of symptoms exist for this age group, clear evidence-based recommendations are lacking. Without adequate guidance, family physicians are left to make diagnostic and treatment decisions, which can lead to undertreatment of asthm...
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Cave, A. J., Atkinson, L. L. Tags: Clinical Reviews Source Type: research

Panel Workload Assessment in US Primary Care: Accounting for Non-Face-to-Face Panel Management Activities
Conclusions: We used PCP survey results coupled with EHR data to assess PCP workload associated with both face-to-face as well as non–face-to-face panel management activities in primary care. The non–face-to-face workload was an important contributor to overall PCP workload for all patients regardless of overall health status. This is an important consideration for PCP workload assessment given the changing nature of primary care that requires more non–face-to-face effort, resulting in an overall increase in PCP workload. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Arndt, B., Tuan, W.-J., White, J., Schumacher, J. Tags: Family Medicine and the Health Care System Source Type: research

Depression Screening and Treatment in Uninsured Urban Patients
Background: Depression has been widely studied in primary care settings, yet studies of medically uninsured populations are lacking. We sought to determine whether depression screening and treatment improved depression scores of a medically uninsured, mostly African American primary care population. Methods: The study was a prospective repeated-measures design that recruited uninsured patients. Patients were screened for depression, and the rate of depression diagnosis was compared with baseline. Patients who were diagnosed and accepted treatment were randomized to 1 of 4 treatment arms: (1) usual care; (2) usual care and...
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Meyers, M. A., Groh, C. J., Binienda, J. Tags: Original Research Source Type: research

Inaccurate Risk Perceptions and Individualized Risk Estimates by Patients with Type 2 Diabetes
Conclusions: Personalized risk estimates, particularly about mortality, had limited salience. Some participants could not understand the information, despite presentation in ways suggested by previous research. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Saver, B. G., Mazor, K. M., Hargraves, J. L., Hayes, M. Tags: Original Research Source Type: research

A Predictive Equation to Guide Vitamin D Replacement Dose in Patients
Conclusions: The recommended daily allowance for vitamin D is grossly inadequate for correcting low serum concentrations of 25-hydroxyvitamin D in many adult patients. About 5000 IU vitamin D3/day is usually needed to correct deficiency, and the maintenance dose should be ≥2000 IU/day. The required dose may be calculated from the predictive equations specific for ambulatory and nursing home patients. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Singh, G., Bonham, A. J. Tags: Original Research Source Type: research

Workplace Phobia, Workplace Problems, and Work Ability among Primary Care Patients with Chronic Mental Disorders
Conclusions: Workplace phobia seems to be a frequent problem in primary care. It may behoove primary care clinicians to consider workplace-related anxiety, including phobia, particularly when patients ask for a work excuse for nonspecific somatic complaints. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Muschalla, B., Linden, M. Tags: Original Research Source Type: research

Non-Visit-Based Cancer Screening Using a Novel Population Management System
Background: Advances in information technology (IT) now permit population-based preventive screening, but the best methods remain uncertain. We evaluated whether involving primary care providers (PCPs) in a visit-independent population management IT application led to more effective cancer screening. Methods: We conducted a cluster-randomized trial involving 18 primary care practice sites and 169 PCPs from June 15, 2011, to June 14, 2012. Participants included adults eligible for breast, cervical, and/or colorectal cancer screening. In practices randomized to the intervention group, PCPs reviewed real-time rosters of thei...
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Atlas, S. J., Zai, A. H., Ashburner, J. M., Chang, Y., Percac-Lima, S., Levy, D. E., Chueh, H. C., Grant, R. W. Tags: Original Research Source Type: research

Generational Differences in Complementary and Alternative Medicine (CAM) Use in the Context of Chronic Diseases and Pain: Baby Boomers versus the Silent Generation
This study compares CAM usage between baby boomers (n = 7734) and the silent generation (n = 4682) through secondary analyses of the 2007 National Health Interview Survey data. The analysis also compares chronic disease and pain status. Multivariate logistic regression models were developed to identify generational differences. Results: Although the silent generation reported twice as many chronic disease (51.3% vs 26.1%; P
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Ho, T. F., Rowland-Seymour, A., Frankel, E. S., Li, S. Q., Mao, J. J. Tags: Original Research Source Type: research

Childhood Vaccine Beliefs Reported by Somali and Non-Somali Parents
Conclusions: Statistically significant differences in perceptions and use of vaccines were reported by Somali and non-Somali participants. Somali parents are more likely to believe that the MMR vaccine causes autism and more likely to refuse the MMR vaccine than non-Somali parents. These beliefs have contributed to an immunization gap between Somali and non-Somali children. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Wolff, E. R., Madlon-Kay, D. J. Tags: Original Research Source Type: research

Challenges of Medical Home Transformation Reported by 118 Patient-Centered Medical Home (PCMH) Leaders
Background: Little is known about the most important organizational factors and strategies for transforming primary care clinics into patient-centered medical homes (PCMHs), so we studied this in newly certified medical homes in Minnesota. Methods: We collected the following information from the first 120 clinics serving adults to be certified: (1) a 105-item survey about the presence and function of practice systems now and 3 years ago; (2) standardized composite clinic performance measures for diabetes and cardiovascular disease; and (3) a 44-item survey about PCMH transformation derived from 31 qualitative interviews a...
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Solberg, L. I., Crain, A. L., Tillema, J. O., Fontaine, P. L., Whitebird, R. R., Flottemesch, T. J., Scholle, S. H., Crabtree, B. F. Tags: Original Research Source Type: research

One in Fifteen Family Physicians Principally Provide Emergency or Urgent Care
A small but nontrivial proportion of US family physicians devote most of their time providing emergency or urgent care. With considerable attention focused on expanding access to primary care, it is important to account for providers principally working outside of traditional primary care. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Petterson, S., Peterson, L., Phillips, R. L., Moore, M., Finnegan, S., Coffman, M., Bazemore, A. Tags: Policy Brief Source Type: research

Urgent and Emergency Family Physicians in Rural Communities
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Klink, K. Tags: Commentaries Source Type: research

Re: Counterpoint: Rationing on the Fly: The Opportunity Cost of Clinical Guidelines
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Ganiats, T. G., Kempster, J. A. Tags: Commentaries Source Type: research

Counterpoint: Rationing on the Fly: The Opportunity Cost of Clinical Guidelines
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Culpepper, L. Tags: Commentaries Source Type: research

Rationing on the Fly: The Opportunity Cost of Clinical Guidelines
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Ganiats, T. G., Kempster, J. A. Tags: Commentaries Source Type: research

Call for Papers and JABFM Editorial Board Member Honored with Fellowship
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Lupo, P., Neale, A. V., Bowman, M. A. Tags: Editorial Office News and Notes Source Type: research

Context and Trade-offs in Family Medicine
This issue contains several articles that highlight the effect of context and tradeoffs encountered in the practice of family medicine. Some articles demonstrate how context affects the implementation of the patient-centered medical home model, the community risk of a measles outbreak, the rate of complementary and alternative medicine among different generations, and the number of family physicians primarily providing urgent and emergent care in a region. Tradeoffs are explored in articles that look at how electronic medical record use has changed the composition of workload in primary care and how the burgeoning number o...
Source: Journal of the American Board of Family Medicine - July 7, 2014 Category: Primary Care Authors: Seehusen, D. A., Bowman, M. A., Neale, A. V. Tags: Editors ' Note Source Type: research

The Consequential Validity of ABFM Examinations
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Royal, K. D., Puffer, J. C. Tags: Board News Source Type: research

Use of Ovulation Predictor Kits as Adjuncts When Using Fertility Awareness Methods (FAMs): A Pilot Study
Conclusions: Among this population, LH kits may offer an adjunct for women who may wish to have an additional double-check. However, there are still clinical circumstances when even an LH kit does not provide confirmation. More research in this area is encouraged. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Leiva, R., Burhan, U., Kyrillos, E., Fehring, R., McLaren, R., Dalzell, C., Tanguay, E. Tags: Research Letter Source Type: research

Association between C-Reactive Protein Rapid Test and Group A Streptococcus Infection in Acute Pharyngitis
Conclusion: CRP concentrations are not associated with group A streptococcus infection in patients with acute pharyngitis. The use of this point of care test is therefore not useful for distinguishing patients who require antibiotic therapy. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Calvino, O., Llor, C., Gomez, F., Gonzalez, E., Sarvise, C., Hernandez, S. Tags: Brief Reports Source Type: research

Multisystem Manifestations of Benign Ovarian Teratomas
A 26-year-old woman presented with acute onset of right-sided pelvic pain and had a medical history significant for migraine headaches and polycystic ovarian disease. Ultrasonography demonstrated bilateral ovarian tumors, and the patient underwent laparoscopic removal of bilateral cystic teratomas. A literature review focused on similar presentations of teratomas revealed isolated cases of migraines and polycystic ovarian disease associated with teratomas and an increased risk for ovarian torsion. Our patient experienced complete resolution of her acute abdominal pain, as well as her long-standing headaches and hormonal sy...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Murdoch, W., Sadoski, J., Rosin, F. C. Tags: Brief Reports Source Type: research

Advanced Therapy for Inflammatory Bowel Disease: A Guide for the Primary Care Physician
This article discusses general concepts about azathioprine, 6-mercaptopurine, methotrexate, and common biologic drugs used in IBD. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Thomas, A., Lodhia, N. Tags: Clinical Reviews Source Type: research

Tobacco Use Treatment in Primary Care Patients with Psychiatric Illness
The prevalence of smoking is higher in patients with psychiatric illness compared with the general population. Smoking causes chronic illnesses, which lead to premature mortality in those with psychiatric illness, is associated with greater burden of psychiatric symptoms, and contributes to the social isolation experienced by individuals with psychiatric disorders. Most patients with a psychiatric illness present initially to primary care rather than specialty care settings, and some patients receive care exclusively in the primary care setting. Therefore, family physicians and other primary care clinicians have an importa...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Cerimele, J. M., Halperin, A. C., Saxon, A. J. Tags: Clinical Reviews Source Type: research

Improving Quality of Care and Guideline Adherence for Asthma Through a Group Self-Assessment Module
Conclusions: Group SAMs may be an effective method to increase physicians' knowledge of and adherence to clinical guidelines. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Elward, K., Blackburn, B., Peterson, L. E., Greenawald, M., Hagen, M. D. Tags: Original Research Source Type: research

Community Size and Organization of Practice Predict Family Physician Recertification Success
Conclusion: Rural physicians were more likely to pass the MOC examination, suggesting that rural health disparities do not result from a lack of provider knowledge. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Schulte, B. M., Mannino, D. M., Royal, K. D., Brown, S. L., Peterson, L. E., Puffer, J. C. Tags: Original Research Source Type: research

Provider Perspectives on Integrating Primary and Behavioral Health: A Report from the High Plains Research Network
The objective of this study was to identify rural PCP and BHP perspectives on integration. Methods: Written and electronic surveys were distributed to PCPs and BHPs in the High Plains Research Network in rural eastern Colorado. Items included perspectives on improving behavioral health care, barriers to integration, and confidence in the ability to integrate primary and behavioral care. Results: Surveys were completed by 88 PCPs (60%), and 49 BHPs (63%), for an overall response rate of 61%. PCPs were significantly more likely than BHPs to prefer improving referral methods (odds ratio [OR], 2.2; P = .03) and significantly...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Burfeind, G., Seymour, D., Sillau, S. H., Zittleman, L., Westfall, J. M. Tags: Original Research Source Type: research

Primary Care, Behavioral Health, Provider Colocation, and Rurality
Purpose: The purpose of this study was to characterize the proximity of primary care and behavioral health service delivery sites in the United States and factors influencing their colocation. Methods: We geocoded the practice addresses of primary care and behavioral health providers found in the Centers for Medicare & Medicaid Services' National Plan and Provider Enumeration System Downloadable File to report where colocation is occurring throughout the country. Results: The extent to which primary care physicians are colocated with behavioral health providers is strongly associated with rurality. Specifically, 40.2...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Miller, B. F., Petterson, S., Brown Levey, S. M., Payne-Murphy, J. C., Moore, M., Bazemore, A. Tags: Original Research Source Type: research

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment
Conclusions: Primary care practices will need to revamp their patient-reported data collection processes to integrate routine health behavior assessments. Implementation support will be required if health assessments are to be actively used as part of routine primary care. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Rodriguez, H. P., Glenn, B. A., Olmos, T. T., Krist, A. H., Shimada, S. L., Kessler, R., Heurtin-Roberts, S., Bastani, R. Tags: Original Research Source Type: research

A Randomized Controlled Trial of Two Interventions to Improve Medication Reconciliation
Conclusions: While neither intervention alone improved medication list agreement, these interventions may have value in a multistep protocol to improve the agreement of medication lists in primary care offices. Baseline agreement was much higher than expected, possibly reflecting a Hawthorne effect. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Wolff, C. M., Nowacki, A. S., Yeh, J.-Y., Hickner, J. M. Tags: Original Research Source Type: research

Hand Hygiene and Face Touching in Family Medicine Offices: A Cincinnati Area Research and Improvement Group (CARInG) Network Study
Background: Family medicine offices may play an important role in the transmission of common illnesses such as upper respiratory tract infections (URTIs). There has, however, been little study of whether physicians teach patients about URTI transmission and what their own actions are to prevent infection. The purpose of this study was to assess the quality of hand hygiene and the frequency with which family physicians and staff touch their eyes, nose, and mouth (the T-zone) as well as physician and staff self-reported behaviors and recommendations given to patients regarding URTI prevention. Methods: We observed family ph...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Elder, N. C., Sawyer, W., Pallerla, H., Khaja, S., Blacker, M. Tags: Original Research Source Type: research

Risk of Adverse Health Outcomes with Increasing Duration and Regularity of Opioid Therapy
Conclusions: Adverse health outcomes can increase with accumulating opioid use and increasing dosage. Existing guidelines developed by specialty societies for managing patients using opioids daily or nearly daily do not address the larger number of patients who use opioids intermittently over periods of years. Practitioners should consider applying such guidelines to patients who use opioids less frequently. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Paulozzi, L. J., Zhang, K., Jones, C. M., Mack, K. A. Tags: Original Research Source Type: research

An Intensive Family Intervention Clinic for Reducing Childhood Obesity
The objective of this study was to examine the effect of intensive treatment designed to reduce weight using a parent-child lifestyle modification intervention in a family health care clinic for obese and overweight children who had failed previous treatment attempts. Methods: This was a practice-based 6-month intervention at Maccabi Health Care Services, an Israeli health maintenance organization, consisting of parental education, individual child consultation, and physical activity classes. We included in the intervention 100 obese or overweight children aged 5 to 14 years and their parents and 943 comparison children a...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Endevelt, R., Elkayam, O., Cohen, R., Peled, R., Tal-Pony, L., Michaelis Grunwald, R., Valinsky, L., Porath, A., Heymann, A. D. Tags: Original Research Source Type: research

Incidental Computer Tomography Radiologic Findings through Research Participation in the North Texas Healthy Heart Study
Conclusion: Although CT scans were completed for research purposes, study procedures resulted in the diagnosis and treatment of individuals who were previously asymptomatic. Potential clinical benefits in imaging research are moderated by considerations regarding possible harm and costs resulting from uncertain findings and the use of CT scans for nonclinical purposes. The continued development of protocols for the handling of incidental findings in research and the establishment of guidelines are needed to ensure that research procedures mirror the best interests of participants. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Espinoza, A., Malone, K., Balyakina, E., Fulda, K. G., Cardarelli, R. Tags: Original Research Source Type: research

National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) Recognition Is Suboptimal Even Among Innovative Primary Care Practices
The National Committee for Quality Assurance (NCQA) has promoted patient-centered medical home (PCMH) recognition among primary care practices since 2008 as a standard indicator of which practices have transformed into medical homes. A 40% PCMH adoption rate among a large national cohort of identified practices with innovative staffing (n = 131) calls into question whether the NCQA recognition process is truly transformative and patient-centered or simply another certificate to hang on the wall. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Hahn, K. A., Gonzalez, M. M., Etz, R. S., Crabtree, B. F. Tags: Policy Brief Source Type: research

Patient-Centered Medical Home (PCMH) Recognition: A Time for Promoting Innovation, Not Measuring Standards
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Miller, W. L. Tags: Commentary Source Type: research

Content Usage and the Most Frequently Read Articles by Issue in 2013
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Lupo, P., Neale, A. V., Bowman, M. A. Tags: Editorial Office News and Notes Source Type: research

A Panoply of Information for the Practice of Family Medicine
The majority of articles in this issue report on clinical conditions, adding to our knowledge base with which we practice family medicine. Topics range from childhood obesity to tobacco abuse treatment for patients with psychiatric disorders. We also have clinical papers on testing for group A streptococcus pharyngitis, incidentalomas identified in chest computed tomography exams, and a case of migraines associated with an ovarian teratoma. Others include long-term use of opioids (with information that could be surprising), and hand washing and face touching in the office. Enjoy the panoply of clinical information! We also...
Source: Journal of the American Board of Family Medicine - May 7, 2014 Category: Primary Care Authors: Bowman, M. A., Neale, A. V. Tags: Editors ' Note Source Type: research