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https://doi.org/10.1370/afm.3145 Annals Early Access article BACKGROUND Post-COVID-19 conditions (PCC), or 'long COVID,' is an imminent public health emergency. Long COVID has already contributed to an estimated 3,500 American deaths, resulted [...], BACKGROUND For many patients with post-COVID-19 condition (long COVID), primary care is the first point of interaction with the health care system. In principle, primary care is well situated to manage long COVID. Beyond expressions of disempowerment, however, the patient's perspective regarding the quality of long COVID care is lacking. Therefore, this study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long COVID. METHODS A phenomenological approach guided this analysis. Using purposive sampling, we conducted semistructured interviews with English-speaking, adult primary care patients describing symptoms of long COVID. We deidentified and transcribed the recorded interviews. Transcripts were analyzed using inductive qualitative content analysis. RESULTS This article reports results from 19 interviews (53% female, mean age = 54 years). Patients expected their primary care practitioners (PCPs) to be knowledgeable about long COVID, attentive to their individual condition, and to engage in collaborative processes for treatment. Patients described 2 areas of experiences. First, interactions with clinicians were perceived as positive when clinicians were honest and validating, and negative when patients felt dismissed or discouraged. Second, patients described challenges navigating the fragmented US health care system when coordinating care, treatment and testing, and payment. CONCLUSION Primary care patients' experiences seeking care for long COVID are incongruent with their expectations. Patients must overcome barriers at each level of the health care system and are frustrated by the constant challenges. PCPs and other health care professionals might increase congruence with expectations and experiences through listening, validating, and advocating for patients with long COVID. Key words: primary care issues; long COVID; COVID-19; qualitative methods; patient perspective

The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact. [ABSTRACT FROM AUTHOR]

Presenters Elena Gardner, Dominik Ose, DrPH, MPH, ANDREW CURTIN, Kirsten Stoesser, MD, Jennifer Leiser, MD, Bernadette Kiraly, [...], Context Many patients who recovered from the acute phase of SARS-COV-2 infection have persistent symptoms. However, research regarding the prevalence of PCS symptoms in non- hospitalized primary care patients is scarce. Objective 1. Describe the prevalence of symptoms among patients in a primary care setting 2. Determine if symptoms were different in patients with a positive test compared with a negative test, focused on underrepresented minority groups (URMs). Study Design and Analysis This observational study was conducted using a survey available in English and Spanish. The survey was developed with clinicians and underwent an iterative review process before it was emailed to patients. Patients with both positive and negative COVID-19 test results were included in this study to compare groups. Adjusted logistic regression was used to determine associations between test results and symptoms. Setting and Dataset This study took place in Salt Lake City, UT. Patients had their survey responses matched to electronic medical records to provide clinic-demographic information. The information from medical records was used in the adjusted analysis. We excluded surveys that were mostly incomplete. Population Studied Included patients were aged 18+, visited at least one U of U primary healthcare center since 2019, spoke English or Spanish, and had a documented COVID-19 test result between March 2020 and October 2021. Patients were excluded if they experienced symptoms less than 90 days since the original test date or if they were hospitalized for COVID-19 infection. Results We included 2,924 responses in the final analysis (13.1% response rate). The average age was 44.6 years, and 63.6% of patients were women. The three most reported symptoms among all patients were fatigue (58.9% of positive tests, 44.5% of negative tests, p Conclusion Persistent symptoms were common in both groups, and several symptoms were statistically more likely in patients with positive COVID tests. More research is needed on URMs to understand their symptom burden.

Hypertension disparities persist and remain high among racial and ethnic minority populations in the United States (US). Data‐driven approaches based on electronic health records (EHRs) in primary care are seen as a strong opportunity to address this situation. This qualitative study evaluated the development, sustainability, and usability of an EHR‐integrated hypertension disparities dashboard for health care professionals in primary care. Ten semi‐structured interviews, exploring the approach and sustainability, as well as eight usability interviews, using the think aloud protocol were conducted with quality improvement managers, data analysts, program managers, evaluators, and primary care providers. For the results, dashboard development steps include having clear goals, defining a target audience, compiling data, and building multidisciplinary teams. For sustainability, the dashboard can enhance understanding of the social determinants of health or to inform QI projects. In terms of dashboard usability, positive aspects consisted of the inclusion of summary pages, patient's detail pages, and hover‐over interface. Important design considerations were refining sorting functions, gender inclusivity, and increasing dashboard visibility. In sum, an EHR‐driven dashboard can be a novel tool for addressing hypertension disparities in primary care. It offers a platform where clinicians can identify patients for culturally tailored interventions. Factors such as physician time constraints, data definitions, comprehensive patient demographic information, end‐users, and future sustenance, should be considered before implementing a dashboard. Additional research is needed to identify practices for integrating a dashboard into clinical workflow for hypertension. [ABSTRACT FROM AUTHOR]

Introduction: The United States is experiencing maternity care shortages. Family physicians can play a role in addressing these shortages. Family medicine obstetrics fellowships train family physicians in obstetrics care. Fellowship websites are important for promoting programs and attracting applicants. However, whether websites provide sufficient program information is unknown. This study aimed to assess completeness and utility of family medicine obstetrics fellowship websites across the United States. Method: The study analyzed 46 family medicine obstetrics fellowship websites. The component analysis evaluated the presence of 17 components related to orientation, curriculum, program, personnel, and additional content. The qualitative analysis included ratings for navigation and application, information quality, and esthetics. Analysis included percentages for websites and components and average qualitative ratings. Results: Common components included overviews, training requirements, and contact information. Description of the patient population was the least common component. Usability ratings varied across programs, with higher ratings observed for navigation and application, and information quality. Esthetics and visual appeal received lower ratings. Regional analysis indicated that websites from fellowships in the West and Southwest tended to include more components compared to those in the Southeast. Discussion: Family medicine obstetrics fellowship websites serve as valuable sources of program information for prospective applicants. However, not all websites include essential program details. Some information is rarely provided. Given the shortage of maternity care providers, it is crucial to develop informative and functional websites to attract applicants. Improving website content and design could prove to be a cost-effective strategy to increase the number of applicants. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic in 2020 led to the rapid adoption of telemedicine, including virtual visits, to minimize face-to-face contact between clinicians and patients. Family medicine clinics across the nation had to transform how they provided primary care while maintaining the core values of family medicine. The objective of this study was to analyze how family medicine faculty perceived the impact of virtual visits on patient access to care. Methods: This qualitative study took place in an academic primary care setting. We interviewed clinical faculty who utilized virtual visits about their experiences from June to December 2020. We used qualitative content analysis to evaluate the results of the interviews. Results: The study included a total of 20 participants. The mean age was 43.4 years, and 85% of participants were female. Researchers developed 3 themes, "Logistics of virtual visits," "reigniting the concept of home visits," and "barriers and benefits that affect specific patient populations" that describe how virtual visits have impacted patients' access to care. The results highlight how virtual visits improve access to care by increasing flexibility for patients and providers and provide a new perspective into a patient's home life. Challenges of virtual visits include language barriers, technological issues, and issues unique to vulnerable patient populations. Conclusion: Virtual visits can enhance family medicine's ability to provide accessible care, but there are concerns it may worsen health disparities. Further research and quality improvement projects are needed to examine ways to implement innovative care delivery solutions to avoid further exacerbating these disparities. [ABSTRACT FROM AUTHOR]

This study quantifies volatile sulfur compound (VSC) emissions from primary settling tanks and investigates their mechanisms of generation. Hydrogen sulfide (H2S) and methyl mercaptan (MM) concentrations in the off‐gas were dominant among the VSCs analyzed, while dimethyl sulfide (DMS) and dimethyl disulfide (DMDS) were under their odor threshold for most sampling dates. H2S emission in primary settling tanks was mainly the result of the stripping of dissolved sulfide (64%) generated in the sewers. Results indicate that MM emission was more dependent on the conditions in the primary clarifiers (only 16% stripping). Prevention of odor emission in primary settling tanks can be achieved by managing biofilms and microbial reactions in the sewer network. Controlling the biomass seeding and fermentation product availability in the primary settling tanks is essential to significantly minimize the kinetics of H2S and MM generation. Overall, the management of sludge blanket heights and thus avoiding time at low oxidation–reduction potential minimized odor emission independent of sewer conditions. Practitioner points: H2S emission from primary clarifiers mainly originated from the stripping of the dissolved sulfide formed in the sewers.MM emission contributed for 89% to overall odor emitted from primary clarifiers.Seeding of active biomass from the sewer into the primary clarifiers was be the main driver for both MM and H2S formation.Increased availability of fermentation products or fermenters increased MM production. [ABSTRACT FROM AUTHOR]