30-Second Takeaway
- Routine ADRD screening in primary care does not improve family caregivers’ quality of life, preparedness, or mental health.
- A brief, multifaceted stewardship program can sharply reduce systemic steroid prescribing for acute respiratory infections in urgent care.
- Organized invitations for oral exams dramatically increase screening and early lesion detection among high-risk tobacco users.
- Simple scheduling changes, like protected video-only sessions, can reverse declining telehealth use in family medicine.
- Health-related social needs in youth are tightly linked with obesity, smoking, and diabetes/prediabetes, supporting social risk screening.
Week ending April 25, 2026
Practical Updates for Family Physicians: Screening, Stewardship, Telehealth, Documentation, and Youth CVD Risk
Dementia Screening Offers No Measurable Benefit for Family Members in Primary Care
In this 29-clinic randomized trial, 1808 older adult–family dyads were assigned to ADRD screening only, screening plus referral, or no screening. Only 5.1% of patients screened positive, and more than one-third of screen-positive patients in the referral arm declined diagnostic follow-up. At 24 months, family members’ SF-36 physical and mental scores were similar between combined screening and no-screening groups. Caregiver preparedness, caregiving self-efficacy, and depressive and anxiety symptoms were unchanged by screening. Patient quality-of-life and mood outcomes were also unaffected, suggesting minimal family benefit from routine ADRD screening in primary care.
Urgent Care Stewardship Substantially Reduces Steroid Prescribing for ARIs
This quality-improvement study tested a steroid stewardship program for acute respiratory infections across 2 urgent care centers. Among 96 clinicians and 14,530 stewardship-eligible visits, mean systemic glucocorticoid prescribing fell from 20.4 to 8.8 per 100 visits. The program combined a brief virtual education, patient educational pamphlets, and peer-comparison email feedback with descriptive and injunctive norms. Interrupted time-series analysis showed a continued relative monthly prescribing rate reduction of 0.94 (95% CI, 0.92-0.96) during stewardship. Findings support low-touch outpatient stewardship interventions to curb unnecessary systemic steroids for uncomplicated ARIs.
Organized Oral Cancer Screening Greatly Expands Exams for High-Risk Smokers
This cluster-randomized trial in 35 Brazilian primary care units targeted adults ≥35 years who used tobacco and were high risk for oral cancer. Organized strategies using invitations plus either home visits or awareness campaigns achieved 77.2% preventive oral exam coverage versus 3.6% with opportunistic care. Adherence was higher with invitations plus community awareness (77.2%) than with invitations plus home-visit support (58.1%). Within organized arms, 15 biopsies identified 6 oral potentially malignant disorders and 5 oral cancers, with higher detection than biopsies outside the program. Results support structured, invitation-based oral exams in primary care to reach vulnerable smokers and detect lesions earlier.
ED-Initiated Video-Enhanced ACP Improves Documentation and Goal-Concordant Care
In this multicenter RCT, 598 older or seriously ill ED patients were randomized to video-enhanced ACP plus EHR notifications or usual care. At 3 months, ACP documentation was higher with the intervention (45.6% vs 31.3%; rate difference 14.3%, 95% CI 6.6%-22.0%). Benefits persisted at 6 months, and ACP knowledge and engagement scores were higher in the intervention group. Among 94 decedents, goal-concordant care scores were greater with the intervention (median 10 vs 7; P < .001). Brief, structured ACP workflows initiated during acute visits can increase documentation and better align end-of-life care with patient preferences.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.