Annals of Family January/February 2025 Tip Sheet

(Press-News.org) Editorial

Family Medicine Journal Editors Suggest Guiding Principles for AI Use in Publishing

Background: This editorial by editors of family medicine journals provides a unified stance on the use of artificial intelligence (AI) in family medicine research and publishing. 

Editorial Stance: Family medicine journals must address the implications of AI, including ethical considerations, accuracy, and potential for bias. The authors recommend guiding principles for AI use in family medicine publishing, emphasizing:

Full disclosure of AI tool use in research and manuscript preparation

Accountability for content accuracy and originality by authors

Understanding of AI limitations and awareness of bias

Establishing transparent editorial policies to evaluate AI's role in the publication process

The editorial highlights the benefits of AI, such as improving efficiency and accessibility for non-native English speakers, alongside risks like perpetuating bias and generating inaccurate information.

Why It Matters: With AI tools becoming increasingly prevalent in academic publishing, their responsible use is critical to uphold scientific integrity. This editorial calls for unified action across family medicine journals to develop ethical, effective practices for integrating AI into research and publishing. 

Use of AI in Family Medicine Publications: A Joint Editorial From Journal Editors

Caroline R. Richardson, MD, Editor, et al 

Annals of Family Medicine

The Warren Alpert Medical School, Brown University, Providence, Rhode Island

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Special Report

AI in Primary Care Should Address Time Spent on Electronic Health Records and Other Real-World Needs 

Background and Goal: Primary care clinicians face significant burnout, driven by excessive administrative tasks and time spent on electronic health records (EHRs). This report emphasizes that generative AI tools must focus on addressing specific, impactful problems.

Key Insights: The Segway, once expected to revolutionize transportation, failed because it did not solve a real need. Conversely, rentable scooters succeeded by addressing a narrow, specific problem: the “last-mile” challenge in urban commutes. Similarly, AI in primary care must tackle clinicians' “last-mile” issue—time. With over half of their 11-hour workdays spent on EHR tasks, clinicians need AI to target key areas like documentation, chart reviews, medication management, and patient communications. 

Why It Matters: AI has the potential to reduce primary care burdens and improve work-life balance, but only if implemented thoughtfully in organizations that  prioritize clinician well-being and patient care.

For AI in Primary Care, Start With the Problem

John Thomas Menchaca, MD

Internal Medicine and Biomedical Informatics, University of Utah, Salt Lake City, Utah

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Editorial 

Wise Use of AI Could Transform Family Medicine

Background: Integrating  artificial intelligence (AI) into family medicine presents significant opportunities to improve patient care and physician workflow. This editorial, written by Annals of Family Medicine associate editors, urges family physicians to articulate a vision of what they want from AI and ensure it serves them and their patients.

Editorial Stance: The authors argue for a targeted approach to AI in family medicine. They emphasize using AI tools like automated note-taking, multilingual patient communication, and streamlined care coordination to reduce administrative burdens and improve the physician-patient relationship while cautioning against developing redundant diagnostic tools and risk calculators.

Why It Matters: AI has the potential to alleviate many pain points in family medicine, from reducing documentation tasks to creating accessible patient education tools.

The AI Moonshot: What We Need and What We Do Not

José E. Rodríguez, MD, FAAP

Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah

Yves Lussier, MD, FACMI

Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah

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Original Research

AI-Based Tool Uses Speech Patterns to Detect  Moderate to Severe Depression

Background and Goal: Depression impacts an  estimated 18 million Americans each year,  yet depression screening rarely occurs in the outpatient setting. This study evaluated an AI-based machine learning biomarker tool that uses speech patterns to detect moderate to severe depression, aiming to improve access to screening in primary care settings.

Study Approach: The study analyzed over 14,000 voice samples from U.S. and Canadian adults. Participants answered the question, “How was your day?” with at least 25 seconds of free-form speech. The tool analyzed vocal biomarkers associated with depression, including speech cadence, hesitations, pauses, and other acoustic features. These were compared to results from the Patient Health Questionnaire-9 (PHQ-9), a standard depression screening tool. A PHQ-9 score of 10 or higher indicated moderate to severe depression. The AI tool provided three outputs: Signs of Depression Detected, Signs of Depression Not Detected, and Further Evaluation Recommended (for uncertain cases).

Main Results: The dataset used to train the AI model consisted of 10,442 samples, while an additional 4,456 samples were used in a validation set to assess its accuracy. 

The tool demonstrated a sensitivity of 71%, correctly identifying depression in 71% of people who had it.

Specificity was 74%, correctly ruling out depression in 74% of people who did not have it.

Why It Matters: The study findings suggest that machine learning technology could serve as a complementary decision-support tool for assessing depression.

Evaluation of an AI-Based Voice Biomarker Tool to Detect Signals Consistent With Moderate to Severe Depression

Alexa Mazur, BA, et al 

Kintsugi Mindful Wellness, Inc, San Francisco, California

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Visual Abstract:

Original Research

Study Highlights General Practitioner Strategies to Ease Type 2 Diabetes Management Burden

Background and Goal: Managing type 2 diabetes involves complex treatment, workload, and costs that impose a significant burden on individuals, impacting their physical and mental health. This study examines how general practitioners (GPs) in China identify and respond to these burdens during patient consultations.

Study Approach: The study examined video recordings of 29 GP-patient consultations recorded between 2018 and 2019 in a primary care clinic in China. Researchers reviewed these consultations for discussions related to treatment burdens in managing type 2 diabetes and analyzed the interviews to identify specific burdens and the strategies GPs employed to address them.

Main Results: A total of 29 GP-patient video consultations were examined. Analysis identified 77 interview sections that focused on discussions related to treatment burden.

The median length of the 29 video-recorded consultations was about 24 minutes.

In 37.66% of the segments, the GP initiated and responded to discussions about treatment burden  while in 23.38%, the patient initiated the discussion, and the GP responded to it; In 38.96%, the patient initiated the discussion, but the GP did not respond. 

Medication was the most frequently identified component of treatment burden by both patients and GPs, followed by personal resources, medical information, and administrative burdens. 

Why It Matters: The findings from this study highlight the complexity of type 2 diabetes treatment burdens and emphasize the importance of tailored GP responses to improve patient engagement and reduce barriers to care.

Primary Care Physicians’ Responses to Treatment Burden in People With Type 2 Diabetes: A Qualitative Video Analysis in China

Yongsong Chen, MD, PhD, et al 

The First Affiliated Hospital of Shantou University Medical College, Shantou, China

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Original Research

Support Program for Small, Rural Primary Care Clinics Increases Their Ability to Prescribe Buprenorphine for Opioid Use Disorder Fivefold

Background and Goal: Despite the removal of the X-waiver requirement, which once restricted clinicians from prescribing buprenorphine for opioid use disorder (OUD), only a small percentage of primary care clinicians currently prescribe medication for OUD (MOUD). This study evaluated a structured support program to help small, rural primary care clinics improve their capacity to provide this treatment. 

Study Approach: Researchers worked with 15 primary care practices in Colorado over a 12-month period from January 2022 through January 2023. The program provided clinics with monthly educational sessions, direct access to an addiction medicine specialist, and support from practice facilitators to achieve specific milestones in MOUD implementation.. The researchers measured changes in buprenorphine prescribing and milestone completion rates at baseline and at 12 months.

Main Results:

The average number of active buprenorphine prescriptions per clinic increased significantly from 2.1 in the three months preceding the intervention (baseline) to 11.3 at 13 months. 

Clinic completion rates for MOUD implementation milestones also showed significant improvements:

Core Aim 1 ("Build Your Team"): Increased from 40% at the start of the program  to 93% at 12 months

Core Aim 2 ("Engage and Support Patients"): Increased from 23% to 84%

Core Aim 3 ("Connect with Recovery Support Services"): Increased from 28% to 93%

Why It Matters: The findings from this study highlight a potentially scalable and effective model to expand access to MOUD in rural communities, where treatment options for opioid use disorder are often limited. 

Evaluation of a Program Designed to Support Implementation of Prescribing Medication for Treatment of Opioid Use Disorder in Primary Care Practices

Tristen L. Hall, PhD, MPH, et al

University of Colorado Anschutz Medical Campus, Aurora, Colorado

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Original Research

Primary Care Physicians Face Significant Gaps in Caring for Adopted Adults With Limited Family Medical History

Background and Goal: Adopted individuals often have limited access to their family medical history, complicating  their health care. This study explored the approaches of primary care physicians when caring for adult adopted patients with limited family medical history.

Study Approach: Researchers conducted in-depth interviews, including hypothetical clinical scenarios,  with 23 primary care physicians from Rhode Island and Minnesota to understand their experiences, practices, knowledge, and training gaps when addressing limited family medical history and adoption-related issues.

Main Results: 

Primary care physicians report knowledge gaps and receive little training or resources on adult adoptees with limited family medical history. As a result, they seek guidance around appropriate preventative screening and genetic testing.

Mental illness and trauma are under-recognized and under-addressed.  

Primary care physicians often obtain family medical history imprecisely, risking miscommunication, microaggressions, and damage to the patient-physician relationship.

Why It Matters: The findings of this study highlight the significant gaps in knowledge and training for primary care physicians caring for adult adopted patients with limited family medical history. Addressing these gaps may improve the quality of care and strengthen physician-patient relationships. 

A Qualitative Study of Primary Care Physicians' Approaches to Caring for Adult Adopted Patients

Jade H. Wexler, BA, et al

Warren Alpert Medical School of Brown University, Providence, Rhode Island

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An accompanying Annals of Family Medicine podcast episode features the study’s lead author, Jade Wexler, a fourth-year medical student at Brown University, and one of her co-authors, Dr. Elizabeth Toll, a professor of pediatrics and medicine and a clinician educator at Brown University. Together, they discuss the study’s findings and implications in detail. The episode will be available starting Jan. 28 at 9 a.m. EST here.

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Original Research

International Disease Classification Codes Ambiguities Create Challenges in Comparing Respiratory Infection Diagnosis 

Background and Goal: The International Classification of Diseases (ICD) system standardizes diagnostic codes globally, enabling accurate comparisons of health data. This study investigated regional differences in respiratory infection diagnoses in Poland to identify potential ambiguities in ICD coding and their implications for data comparability.

Study Approach: Researchers analyzed over 292 million primary care visits for acute respiratory infections in Poland between 2010 and 2019, using ICD-10 codes (J00–J22). Diagnosis data were grouped by age (children, working-age adults, elders) and analyzed at the county level. Statistical methods and visualizations were used to uncover regional differences in how ICD codes were applied. These inconsistencies were further analyzed to determine whether they reflected genuine differences in diagnoses or systemic issues with code usage.

Main Results:

The most problematic code appeared to be "acute upper respiratory infections of multiple and unspecified sites" (J06), which was frequently used interchangeably with other codes, especially "common cold" (J00) and "bronchitis" (J20)

Significant differences were observed in how respiratory conditions were coded across counties, with no consistent regional patterns to explain these variations. Larger counties showed less variability, likely due to random factors canceling out.

Why It Matters: Variation in physician coding practices requires particular attention during analyses to avoid conclusions about differences that may simply be coding variation. 

Breaking ICD Codes: Identifying Ambiguous Respiratory Infection Codes via Regional Diagnosis Heterogeneity

Marcin Piotr Walkowiak, PhD, et al 

Department of Preventive Medicine, Poznan University of Medical Sciences, Poznań, Poland

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Original Research

Family Medicine Department Chairs Face High Patient Care Demands and Barriers to Scholarly Activity

Background and Goal: Research in family medicine is vital for improving patient care, health care systems, and population health. However, family medicine faces barriers to producing scholarly work, including high patient care demands and limited funding. This study examined whether financial incentives and department size influence the amount and type of scholarly activity produced by family medicine departments.

Study Approach: Researchers surveyed family medicine department chairs across the U.S. and Canada using a Council of Academic Family Medicine Educational Research Alliance (CERA) questionnaire. The survey gathered data on scholarly activities such as  research articles and presentations and whether departments offered financial incentives for such work. Researchers used statistical analysis to explore associations between financial incentives, department size, and scholarly output.

Main Results: Of 225 department chairs invited, 106 responded. 

Only 39% of responding departments offered financial incentives for scholarly activity, with 18% providing cash-based incentives.

Departments that offered financial incentives did not report high scholarly output rates.

Departments with fewer than 25 full-time faculty were 80% less likely to produce six or more presentations.

The main barriers to offering financial incentives were institutional budget constraints and department culture or tradition.

Why It Matters: Institutions aiming to increase scholarly productivity in family medicine departments may benefit from focusing on increasing faculty size or investing in consultants, statistical analysts, grant writers, or other research staff.

Impact of Financial Incentives and Department Size on Scholarly Activity Output

Dominique D. Munroe, MD, MPH, et al

Emory University, Department of Family and Preventive Medicine, Atlanta, Georgia

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Original Research

Flexible Practice-Centric Approach Improves Behavioral Health Integration in Primary Care Practices

Background and Goal: Integrated behavioral health (IBH), which combines behavioral health and primary care, improves patient outcomes and experience. This study evaluated whether a tailored, toolkit-based intervention could improve IBH and patient outcomes in primary care practices serving patients with multiple chronic medical and behavioral health conditions.

Study Approach: The study used a cluster randomized controlled trial design. Practices were randomized into two groups. The intervention arm received a comprehensive toolkit that included four components: workbooks to guide the quality improvement project, online education tailored to specific practice personnel roles, an online learning community to facilitate collaboration, and remote coaching provided by a trained quality improvement professional paired with a psychologist experienced in IBH. The control arm continued with their usual IBH services without receiving additional support. 

Main Results: A total of 42 practices were randomized in the study. 

Practices completing more intervention stages showed significant improvements in IBH integration, particularly in workflows, integration methods, and patient identification.

No significant clinically relevant differences were found in patient health outcomes—including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, and physical function—between the intervention and control groups. 

Why It Matters: A practice-centered, flexible intervention may help primary care practices tailor behavioral health integration to their specific needs and lead to better systems of care. 

Intervention Stage Completion and Behavioral Health Outcomes:  An Integrated Behavioral Health and Primary Care Randomized Pragmatic Trial

Kari A. Stephens, PhD, et al 

Department of Family Medicine, University of Washington, Seattle, Washington

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Original Research

Peer Health Navigators Improve Health Equity and Patient Well-Being for Transgender and Gender-Diverse Patients 

Background and Goal: Transgender and gender-diverse individuals often experience additional difficulties navigating health care. This study examined the effectiveness of a peer health navigator pilot program in Saskatchewan, Canada that aimed to improve access to affirming health care for transgender and gender-diverse individuals.

Study Approach: Two peer health navigators were recruited to pilot the program. The navigators were required to be transgender or gender diverse and have experience in health care or community-based organizations. Navigators supported clients by providing information on gender transition and identities and connecting them to affirming health care professionals and community resources. Navigators booked appointments, advocated for clients,  assisted with legal name and gender marker changes, and educated health care professionals through individual and group sessions. Researchers conducted semi-structured interviews with clients and health care practitioners from May to July 2022 to explore their navigator experiences. 

Main Results:

Navigators reduced structural barriers to affirming health care, improving access and reducing stress for transgender and gender-diverse individuals.

Clients valued the navigators’ shared lived experience, which fostered trust and understanding.

Navigators provided tailored guidance, connected clients to affirming providers and resources, and supported health care practitioners with accurate information.

The program positively impacted clients’ mental health by filling gaps in psychosocial support and reducing stress while awaiting formal counseling.

Why It Matters: The study findings highlight the critical role of peer health navigators in improving access to affirming health care for transgender and gender-diverse individuals. 

Interviews to Assess a Peer Health Navigator Service for People Who Are Transgender or Gender Diverse

Stéphanie J. Madill, PhD, et al 

University of Saskatchewan, School of Rehabilitation Sciences, Saskatoon, Saskatchewan, Canada

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Special Report

Special Report Proposes Strategies for Preserving Diversity in Medicine After Reshaped Affirmative Action Policies 

Background and Goal: In 2023, the Supreme Court of the United States (SCOTUS) struck down race-conscious admissions in higher education, reshaping affirmative action policies. This special report examines the ruling’s wide-reaching effects, particularly on underrepresented minority (URM) students, and proposes strategies for preserving diversity in higher education and professional fields, including medicine.

Key Insights: Institutions such as MIT and Amherst College have reported significant declines in Black and Latino student enrollment. In medical school admissions, the lack of standardized guidelines for evaluating applicants’ experiences tied to race risks further marginalizing students who are Black, Indigenous, or people of color (BIPOC). To address these challenges, institutions must innovate and engage at all levels, including expanding STEM enrichment programs, strengthening K-16 recruitment efforts, and maintaining holistic admissions processes. Admissions committees must receive robust training to ensure objective evaluations of applicants’ lived experiences. 

Why It Matters: A diverse higher education and health care workforce is critical for achieving equity and improving societal outcomes. Research consistently shows that diverse medical teams lead to better patient care, stronger clinician-patient relationships, and reduced health disparities.

Affirmative Action—A Crack in the Door to Higher Education

Billy Thomas, MD, MPH

Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas

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Essay

Medical Training Procedural Gaps Must Be Addressed for Better Patient Care and Physician Confidence 

Background: This essay reflects on the decline of procedural competency among medical trainees due to changes in work-hour restrictions, evolving staffing models, and reliance on advanced technology. The author contrasts the rigorous procedural training of previous generations with the limited opportunities available to today’s medical residents.

Key Argument: The reduction in procedural training has far-reaching consequences for patients, physicians, and the health care system. Physicians’ inability to perform core procedures leads to fragmented care, increased costs, and health care inequities, especially in under-resourced settings. The author argues for reinvigorating medical training by incorporating simulation, supervised practice, and mentorship from experienced clinicians.

Why It Matters: This essay highlights an urgent need to address gaps in medical training. Procedural skills are essential not only for patient care but also for physicians’ confidence and professional satisfaction. 

Not Like They Used To: The Decline of Procedural Competency in Medical Training

Eleanor R. Menzin, MD

Department of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts

Harvard Medical School, Boston, Massachusetts

Longwood Pediatrics, Boston, Massachusetts

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Essay

Sensory Experiences of Auditory Cues Play a Key Role in Shaping the Clinical Environment 

Background: This reflective essay captures the sensory experience of a family physician’s day, emphasizing often-overlooked sounds that define the rhythm and emotion of clinical practice. 

Key Argument: Through detailed descriptions, the essay highlights how sound shapes the clinical environment. From the joyful exclamations of a child discovering clinic tools to the somber silence following a terminal diagnosis, these sounds demonstrate the spectrum of life and emotion in family medicine.

Why It Matters: This essay underscores the role sensory experiences play in the physician-patient relationship and invites readers to reflect on the emotional and relational depths of primary care through a window into the humanity that permeates clinical practice and connection in family medicine.

The Soundtrack of a Clinic Day

Martina Ann Kelly, MB, BCh, BAO, PhD, 

Cumming School of Medicine, University of Calgary, Calgary, Canada

Gerard Gormley, MB, BCh, BAO, MD

Queen’s University Belfast, Northern Ireland, United Kingdom

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Innovations in Primary Care

Motivational Interviewing Techniques and Reframing Universal Screening for Patients With Alcohol Abuse or Risk Reduces Stigma

The AHRQ EvidenceNOW initiative, launched in 2019, implemented a comprehensive approach to help primary care practices reduce stigma and better serve patients who exhibit risky or harmful alcohol use.

The program engaged practice facilitators (PFs) to support primary care practices in integrating universal screening, brief interventions, and medication-assisted therapy/medication for alcohol use disorders. PFs trained clinicians to use person-centered communication, and modeled empathetic and nonjudgmental interactions, to normalize unhealthy alcohol use screenings. PFs also  taught clinicians motivational interviewing techniques and how to address stigma through respectful language. Through these techniques, PFs helped clinicians  and patients and reduced stigma.

Reducing Stigma Through Conversations in Primary Care About Unhealthy Alcohol Use

Hildie Cohen, MEd, MA

NORC at the University of Chicago, Chicago, Illinois

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