Annals of Family Medicine Research Highlights / Tip Sheet
July/August 2026 Issue
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Featured Research
Study Finds Offering Self-Sampling to Patients Increases HPV Detection and Cervical
Cancer Screenings
A randomized controlled trial in Singapore found that, compared with offering clinician sampling alone, offering self-sampling or clinician sampling increased both high-risk HPV detection (3.1% vs 0.3%) and overall screening uptake (56.6% vs 42.8%). A total of 650 women ages 30 to 69 due for cervical cancer screening were randomized to either an intervention arm or usual care arm (325 per arm). Study authors informed women in the intervention group about both methods and offered clinician sampling first, then self-sampling if they declined. Women in the usual-care group were offered clinician sampling only. Greater HPV detection in the intervention arm was largely attributable to screening uptake among previously unscreened women, who accounted for 7 of the 10 high-risk HPV cases; of these, five were detected through self sampling. Screening uptake increased particularly among women with no prior screening and among women with regular screening history. Among women in the intervention group who were screened, 56.4% chose self-sampling. Women with lower educational attainment were less likely to choose self-sampling over skipping screening altogether.
Why It Matters: Understanding how women weigh clinician sampling, self-sampling, and forgoing screening altogether can guide patient-centered efforts to reach under-screened groups.
Effect of Self-Sampling HPV DNA Testing on Cervical Cancer Screening in Singapore’s Primary Care: Pragmatic Randomized Controlled Trial
Corresponding Author: Xin Rong Ng, MBBS, et al
NHG Polyclinics, NHG Health, Singapore
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Permanent and shareable link (accessible beginning 5pm ET, Monday, July 27, 2026)
Patients with Long-Term Relationships with Family Physicians May Have Fewer Urgent Hospital Admissions and Lower Hospital Costs
A retrospective cohort study using longitudinal data from 100,450 patients across 48 general practices in and around Amsterdam found that patients registered with their practice for longer than 5 years had 9% to 21% lower odds of urgent hospital admission and 17%-28% lower hospital costs compared to those registered for 0 to 5 years. Consistently seeing the same general practitioner was associated with 6% to 7% lower hospital costs, but not with fewer urgent admissions. Researchers measured continuity associations with urgent hospital admissions and hospital costs in two ways: duration of the general practitioner-patient relationship and how concentrated a patient’s visits were with one physician.
Why It Matters: Keeping patients connected to the same practice and physician over time may help reduce avoidable hospital use.
Association of General Practice Continuity With Hospital Admissions and Costs: A Retrospective Study
Corresponding Author: Otto R. Maarsingh, MD, PhD, et al
Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
https://www.annfammed.org/content/24/4/321
Primary Care Physicians Weigh in On the Trade-Offs Between Health System Employment and Independent Practice
A qualitative interview study of 30 U.S. primary care physicians identified five major themes regarding the day-to-day experiences of health-system employed versus independent practitioners. Health system physicians reported less autonomy in scheduling and operations, but greater financial and legal protections. Health systems also offered embedded clinical support teams and easier access to specialists, while independent physicians managed needs with limited staff. Shared electronic health records and integrated networks in health systems facilitated care coordination and specialty care access. Independent physicians relied instead on manual outreach and professional relationships. Health system physicians worked within cultures emphasizing productivity and performance metrics. In contrast, independent physicians prioritized time and continuity with patients. Centralized communication structures hindered patient access in health systems, while patients of independent physicians were often able to reach a known staff member directly.
Implications: Currently, 55% of U.S. physicians are employed by hospital and health systems, representing a nearly 50% increase in health system employment since 2012. These findings highlight substantial contrasts and trade-offs in how physicians experience daily practice across the two organizational models.
Physician Experiences in Health System–Owned Practices and Independent Practices: Insights From Interviews With Primary Care Physicians
Corresponding Author: Justin W. Timbie, PhD, et al
RAND, Arlington, Virginia
Comprehensive Navigation Service Beats Signposting for Connecting Primary Care Patients to Needed Resources
A randomized, controlled trial found that patients assigned to a comprehensive navigation service, which helps patients understand the complexities of the medical system, had a significantly higher rate of self-reported access to needed resources three months after enrollment compared with control involving traditional signposting (50.3% vs 35.8%). The study compared two levels of social prescribing among 326 randomized patients in Ontario, Canada, and their impact on access to needed health and social resources and equity for Ontario’s Francophone minority population. The intervention arm consisted of a navigation service called the Access to Resources in the Community (ARC) model. The ARC model offered patients in-person appointments with a navigator who worked to understand their needs and create an engagement plan based on their priorities. The control arm consisted of signposting, wherein patients were directed to 211-Ontario, a free, online and multilingual phone service that patients contact themselves and which mostly provides information about available resources during the initial call with no planned follow-up. Patients in the ARC arm reported a significantly better experience and greater ability to engage in their care. ARC also improved Francophone patients’ access to French-language services specifically.
Why It Matters: The findings suggest a comprehensive, longitudinal navigation service may enable better access to needed health or social resources than a traditional signposting approach and offer insight into populations best served by this type of model.
A Randomized Controlled Trial of Social Prescribing: Comparing a Comprehensive Navigation Model With Signposting
Corresponding Author: Simone Dahrouge, PhD, et al
Bruyère Health Research Institute, University of Ottawa, Ontario, Canada
Accompanying Editorial
There is an accompanying editorial for this study titled “Social Care via In-person Navigation or Signposting? Evidence From a New Randomized Trial Points Toward Intensity”
Corresponding Author: Laura M. Gottlieb, MD, MPH, et al
Social Interventions Research and Evaluation Network, University of California, San Francisco, California
Additional Research Highlights
Study Identifies Four Self-Care Decision-Making Patterns Among Patients With Multiple Cardiometabolic Conditions
This qualitative interview study explored the self-care decision-making processes of 27 adults with multiple cardiometabolic conditions in Zhejiang Province, China. Four self-care decision-making patterns emerged: drawing on past experiences for quick responses, balancing health against competing life priorities, making decisions reactively only when compelled by acute crises or authoritative warnings, and leveraging multiple resources proactively to address potential health issues.
Why It Matters: Effective self-care behaviors involving lifestyle factors such as diet and physical activity can improve the quality of life among patients with multiple cardiometabolic conditions, including type 2 diabetes, coronary heart disease, and stroke.
Naturalistic Decision-Making Patterns in Cardiometabolic Multimorbidity Self-Care: A Qualitative Study
Corresponding Author: Jing Shao, PhD, et al
School of Nursing and Institute of Nursing Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang, University, Yiwu, Zhejiang, China
Family Medicine Residency Program Directors Report Their Programs Do Not Directly Assess Self-Directed Learning Skills
A survey of 314 family medicine residency program directors agreed that self-directed learning is an essential skill for family physicians. However, many reported their programs do not directly assess this skill set or include it in their curricula. The survey, part of a larger survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA), asked family medicine residency directors about their program’s readiness to teach and assess self-directed learning skills. While 93.6% of program directors agreed or strongly agreed that their recent graduates modeled lifelong learning, only 44% agreed or strongly agreed that their programs had written expectations around self-directed learning. More than one-half (57.6%) of responding program directors indicated self-directed learning was a high curricular priority, and 56.3% reported their programs collect evidence of engagement in self-directed learning.
Why It Matters: Creating a standardized curriculum for residency programs and recommending tools for assessment may improve program readiness for self-directed learning training.
Are Family Medicine Residency Programs Ready to Teach and Assess Learners’ Self-Directed Learning Skills?
Corresponding Author: Drew Keister, MD, et al
Department of Education, University of South Florida Morsani College of Medicine, Tampa, Florida
Special Report
Barriers to Dementia Care Arise When Medical Records of People Living with Dementia Are Not Linked with Medical Records of Their Caregivers
Most electronic health records create barriers to dementia care by offering no standard way to identify or connect medical records of patients living with dementia with their caregivers’ health records. This report describes a Canadian pilot study that examined ways to link the primary care health records of patients living with dementia to those of their caregivers in primary care. The report details methods for making this possible and highlights critical gaps that limit clinical application. The pilot study used the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a national network that collects de-identified electronic medical record (EMR) data from primary care practices in Canada. Researchers tested two methods: manual identification by clinic staff and an algorithm matching shared chart details such as a phone number. Both methods worked. However, each method faced barriers, including EMR incompatibility, varying provincial privacy rules, and consent requirements. A core barrier was that EMRs lack dedicated fields for caregiver information, making it difficult for health care professionals and researchers to access and connect data.
Why It Matters: Historically, a family’s charts may have been located together in one folder, giving physicians the context to see a patient within their family and deliver more personalized care. Designing tools that match the way family medicine physicians practice is a practical way to better support both physicians and their patients.
Advancing Family Medicine Through Dyadic Electronic Medical Record Linkage in Dementia Care
Corresponding Author: Annie Robitaille, PhD, et al
Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa
Also In This Issue
“Paradoxes” in Social Care Tensions Shed Light On Better Ways To Integrate Social Care Into Primary Care
A theory study identified 12 paradoxes in literature surrounding social care – health care that addresses the patient’s social needs – in primary care ambulatory contexts with the goal of offering a more nuanced understanding of social care to help integrate it into clinical practice. The study found 12 paradoxes, including whether social care promotes equity or reinforces stigma and whether tailoring care to context is a deviation from or deeper application of evidence-based medicine. Paradoxes also included whether screening reduces or amplifies experiences of shame. The authors proposed three potential reconciliation strategies for the proposed paradoxes.
Why It Matters: This article reframes tensions in social care as interdependent paradoxes rather than binary choices and offers a framework that may help primary care and health systems navigate these tensions.
The Paradoxes of Social Care: Reframing Apparent Conflicts
Corresponding Author: Laura R. Porterfield, MD, MPH, et al
Department of Family Medicine and Community Health, University of Texas Medical
Branch, Galveston, Texas
Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, 301 University Blvd,
Galveston, Texas
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Study Highlights the Values of Generalist Physicians as Health Care Grows More Fragmented
A qualitative theory study identified three themes in how generalist physicians understand their own work and role. In the first phase, researchers interviewed 13 international generalist physicians. In the second phase, 89 generalist physicians contributed written reflections and group discussions at an international family medicine conference. The first theme, which study authors labeled "The Way," describes generalism as a way of seeing and being with patients over time. The second, "The Privilege," captures the gratitude and meaning physicians described in their work. The third, "The Indescribable Whole," reflects how physicians struggled to put into words the integrative, relational core of their work, which they said is valuable but hard to see or measure and easily overlooked.
Why It Matters: Health policies worldwide are shifting toward a narrower, single-disease focus, leading patients to experience more fragmented care . This report reinforces the case for policies and investment that protect the time and energy this relational work requires.
International Generalist Physicians’ Conceptions of Generalism: “The Way,” “The Privilege,” and “The Indescribable Whole”
Corresponding Author: Johanna M. Lynch, MBBS, PhD, FRACGP, FASPM, et al
The University of Queensland, Queensland, Australia
New Medical Education Pty Ltd, Brisbane, Australia
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Innovations in Primary Care
Handheld Cardiac Ultrasound Guided by Artificial Intelligence May Offer Early Detection and Substantial Savings for Patients and Clinics
Dyspnea, otherwise known as shortness of breath or labored breathing, is a common concern family physicians address. Because dyspnea can stem from the heart or many other causes, pinpointing the cause often requires an echocardiogram, which typically means a specialist referral and longer wait times. In Spain, patients wait an average of 64 days to see a cardiologist and up to 25% of urgent referrals are later found to be unnecessary. Nine family medicine clinics across Granada, Madrid, and Barcelona piloted a program that taught family physicians to perform echocardiography with an AI-guided handheld ultrasound device. Physicians with no prior echocardiographic experience completed 12 hours of structured education divided into theoretical instruction and hands-on practice with the device. When patients presented with dyspnea, physicians performed a 12- to 15-minute bedside examination with the AI-guided cardiac ultrasound to assess cardiac function. This approach costs about 20 euros per patient compared to 280 euros for a cardiology referral. The authors estimate this could yield annual savings of 70,000 per clinic in Spain.
Handheld Cardiac Ultrasound Guided by Artificial Intelligence to Detect Heart Failure Across Primary Care
Corresponding Author: Diego Segura-Rodríguez, et al
Cardiology Department, Hospital Universitario San Cecilio, Granada, Spain
Reflections
Seeing the Full Spectrum: A Personal Reflection on Autism: A pediatric physician and mother of a child with autism highlights the many ways autism shapes family life and touches every family differently, calling for deeper empathy toward the unique journeys behind the diagnosis.
Corresponding Author: Eleny Romanos-Sirakis, MD, MS, FAAP
Northwell SIUH, Division of Pediatric Hematology/Oncology, New Hyde Park, New York
Zucker School of Medicine, Hempstead, New York
Continuity at the Incision: Why Cesarean Delivery Belongs in Family Medicine: As obstetric services disappear from rural communities, a family physician draws on rural clinical experience to argue that maintaining cesarean delivery capacity is an essential part of family medicine’s commitment to continuity and access. The author also considers the ethical implications of physicians stepping away from operative obstetrics.
Corresponding Author: Jesus Ruiz, MD
Department of Family Medicine, University of North Carolina at Chapel Hill-School of Medicine, Chapel Hill, North Carolina
Echoes of Escape: Healing Refugees, Healing Myself: Years after fleeing Iran as a child, a family physician caring for newly arrived refugees hears echoes of her own escape in their patients’ lives and finds unexpected healing in their care.
Corresponding Author: Baharak Tabarsi, MD, MHA, FAAFP
Banner Medical Group, Mesa, Arizona
University of Arizona College of Medicine, Phoenix, Arizona
I’m Still Standing: Highs, Lows, and Lessons Learned From Ménière’s Disease: A physician reflects on how his experience living with Ménière's disease, a chronic disorder of the inner ear, has made him more knowledgeable and empathetic in his practice.
Corresponding Author: Samuel Steven Cross, MD
University of Virginia Health System, Fishersville, Virginia
Maybe I Should Have Taken the Fork: A primary care physician at the Department of Veterans Affairs describes the toll of staffing cuts and policy shifts on veterans and clinicians.
Corresponding Author: David Bittleman, MD
Veterans Affairs San Diego, San Diego, California
Editorial
Annals of Family Medicine Launches Multilingual Abstract Translations To Widen Access to Primary Care Research
In this editorial, an international group of coauthors and primary care researchers announce the Abstract Translation for Accessible Science (ATLAS) initiative, which translates abstracts of research published in the Annals of Family Medicine journal into several languages. including Arabic, Chinese, French, German, Hindi, Indonesian, Japanese, Portuguese, and Spanish.
Expanding Access to Primary Care Research for Non-English-Speaking Primary Care Providers, Researchers, and Policy Makers
Corresponding Author: Diego Garcia-Huidobro, MD, PhD, et al
Escuela de Medicina UC, Pontificia Universidad Catolica de Chile, Santiago, Chile
The Annals of Family Medicine
Tip Sheet and Summaries Annals of Family Medicine March/April 2026
27-Jul-2026