Family Medicine

Practice facilitation sharply increases alcohol screening and counseling in primary care

Twenty-one small and medium primary care practices in North Carolina received 12 months of facilitation to implement alcohol screening and brief counseling. Facilitation included QI coaching, EHR tools, and clinician training focused on unhealthy alcohol use. Mean screening rates rose from 17.4% per practice to 57.6% by the end of the second quarter of facilitation. Among screened adults, 13.9% had positive results, and documented brief counseling after a positive screen increased from 0% to 32.3%. Gains in screening and counseling were sustained after 6 months, although performance varied widely across practices. 1

Pay-it-forward model boosts pneumococcal and influenza vaccination in older adults

In a Chinese randomized trial of 221 adults aged 60 years or older, a pay-it-forward model covered two-thirds of pneumococcal vaccine cost. Participants in the pay-it-forward arm could optionally donate toward others’ vaccinations, compared with standard self-pay vaccination. Pneumococcal and influenza uptake were higher with pay-it-forward (70.9% and 30.0%) than standard-of-care (13.5% and 17.1%), with large adjusted odds ratios. Vaccine confidence in safety, importance, and effectiveness was also greater in the pay-it-forward group than in the standard-of-care group. The pay-it-forward model achieved more successful vaccine referrals and a lower economic cost per person vaccinated than standard-of-care. 2

Many patients show minimal engagement with home blood pressure monitoring

This retrospective cohort assessed engagement with home BP monitoring in 3,390 adults with uncontrolled hypertension in a remote management program. Patients received free automated devices, education, and navigator support with algorithm-guided medication titration. At baseline, 32.7% had no engagement, 14.3% had low engagement, 18.2% had intermediate engagement, and 34.8% had high engagement. Most patients had substantial comorbidity, yet regular home measurements remained suboptimal despite program supports. The authors suggest more convenient, less burdensome BP monitoring methods are needed to improve hypertension care. 3

LLM chatbot intake shortens specialist visits and improves perceived coordination

An LLM chatbot (PreA) conducted previsit history, preliminary assessment, and test ordering, generating referral reports for specialists. In a randomized trial of 2,069 patients seeing 111 specialists, patients were assigned to PreA-only, PreA with staff support, or no PreA. PreA-only use reduced specialist consultation duration by 28.7% compared with no-PreA (3.14 vs 4.41 minutes). Physicians reported substantially better care coordination and patients reported easier communication in PreA groups compared with no-PreA. Similar outcomes between PreA-only and PreA-human groups indicated that autonomous chatbot operation was feasible in these settings. 4