Annals of Family Medicine New Research
September/October 2026 Issue
Featured New Research
Using AI-Enhanced Handheld Ultrasound Images May Improve Carotid Plaque Detection
Handheld ultrasound devices’ lower image quality can make small or faint carotid plaque hard to see. Researchers in Hunan Province, China, developed an artificial intelligence (AI) model that sharpens handheld ultrasound images after they are taken. Researchers then tested it in a community screening program of adults aged 40 and older. Here’s what they found:
Among 153 carotid plaques in 117 participants, the AI-enhanced images showed 94.8% (145/153) of plaques compared with 87.6% (134/153) on the standard handheld ultrasound images.
The 11 additional plaques detected after the AI image enhancement were mainly small or low-contrast plaques with mild vessel narrowing on reference imaging
The AI-enhanced images correctly flagged 63.2% of plaques that looked unstable, up from 47.4%, and correctly ruled out stable-appearing plaques about 96% of the time
However, the enhanced images still missed more than one-third of plaques with unstable-appearing features, suggesting that the tool should not be used on its own to rule out risk
Why It Matters: Using AI to enhance handheld ultrasound images could help clinicians in community and primary care settings decide who needs confirmatory imaging, closer follow-up, or more intensive management of stroke risk factors.
AI-Enhanced Super-Resolution Handheld Ultrasound for Carotid Plaque Detection in Community Screening
Corresponding Author: Jie Lan, MMed, et al
Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, Hengyang Medical School, The Affiliated Changsha Central Hospital, University of South China, Changsha, China
Accompanying this study is an editorial on what health systems need before AI-point-of-care ultrasound can scale:
The AI-POCUS Revolution is Here—Are Family Physicians and Our Health Systems Ready?
Corresponding Author: Daria Szkwarko, DO, MPH, et al
The Warren Alpert Medical School of Brown University, Department of Family Medicine, Providence, Rhode Island
Physician Warmth and Competence May Help Patients Worry Less Over Normal Test Results
Communicating normal test results that reveal no abnormalities isn’t always enough to ease a patient’s worries. In this study, researchers asked 349 participants to imagine having gastrointestinal symptoms and a relative recently diagnosed with bowel cancer. Participants then watched one of four videos in which a physician delivered the same identical normal test results. In every video, the physician provided identical clinical advice, but her communication style varied in warmth and competence. Physicians conveying high warmth made eye contact, smiled, and used collaborative language, while physicians expressing low-warmth folded their arms and avoided eye contact. High-competence physicians sat upright and delivered precise explanations, whereas low-competence physicians fidgeted, used filler words, and searched through patient files. Participants who saw a physician high in competence rated the likelihood of a serious disease, including bowel cancer, lower, reported less emotional concern, and expressed less desire to seek another physician’s opinion or to undergo a colonoscopy. Patients were inclined to question the validity of the diagnostic information if the physician showed low competence compared with high competence, and also to a lesser extent if the physician showed low warmth compared with high warmth.
Why It Matters: The findings show that a physician’s behavior directly influences how patients evaluate diagnostic information and suggest that high warmth and competence when communicating normal test results may help patients worry less.
Influence of Physician Behaviors on How Patients Interpret Normal Test Results
Corresponding Author: Tobias Kube, PhD, and Anna Seewald, PhD
Funding Support: Funded by a Junior Research Grant from the RPTU University of Kaiserslautern-Landau
Combining PEth Alcohol Biomarker and Self-Reported Measures May Help Identify Dangerous Patient Alcohol Use
Primary care professionals screen patients for harmful alcohol use by using questionnaires such as the Alcohol Use Disorders Identification Test (AUDIT) and by asking patients about their typical weekly alcohol consumption. Phosphatidylethanol (PEth) is a blood alcohol biomarker that can provide an alternative approach to identifying hazardous alcohol use in primary care by reflecting alcohol consumption over preceding weeks. Researchers in Sweden used health record data from 2013 to 2023 to examine the alignment between patients’ two self-reported measures of alcohol use and PEth tests. Hazardous alcohol use was defined as a PEth level of greater than 210 ng/mL (0.30 µmol/L), an AUDIT score of 8 or higher, and a reported consumption of 10 or more drinks per week. Here’s what they found:
5.8% of primary care patients who reported below threshold (<8 points) for hazardous alcohol use on the AUDIT questionnaire had hazardous levels of alcohol on their PEth blood biomarker test.
Estimates of hazardous alcohol use varied substantially, depending on the assessment method. The AUDIT questionnaire flagged the most patients (26.5%) for risky alcohol consumption. The PEth blood biomarker test flagged 15% to 18%. Asking patients how much they drank each week flagged the fewest, at 8.5%.
At similar PEth biomarker test result levels, men and patients with higher education or income reported greater weekly alcohol use, while younger patients had higher AUDIT questionnaire scores.
Why It Matters: The study findings show that no single measure captures the full picture of a patient's drinking and support a multimethod approach to alcohol screening in primary care where PEth biomarker tests and self-reports are used as complementary rather than interchangeable tools.
Identifying Hazardous Alcohol Use in Primary Care: Concordance Between Phosphaidylethanol and Self-Reports
Corresponding Author: Viktor Månsson, PhD, et al
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Division of Psychiatry and Habilitation Services, Region Dalarna, Sweden
Patients With Chronic Pain May Benefit from Group Medical Visits
More than one in five U.S. adults lives with chronic pain, which isolation and stigma can worsen. Group medical visits allow multiple patients with a common condition to receive care alongside health education and peer support. This study examined how group medical visits facilitate four types of social support: emotional, appraisal, informational, and instrumental. Qualitative data was collected within a randomized trial at San Francisco safety-net clinics. Patients were assigned to group visits consisting of 12 weekly two-hour sessions of clinical care, pain education, mindfulness, gentle movement, and discussion. Groups were co-facilitated by primary care and behavioral health clinicians, as well as a movement and mindfulness instructor. Patients reported all four types of social support. The nonjudgemental space and trust built within the group encouraged emotional support, such as removing shame over late arrivals or absences, and also from naming and discussing grief. Facilitators gave appraisal support by disclosing their own setbacks and peers offered affirmations that encouraged self-compassion. Informational support came from the curriculum and from peers, who traded tips like using frozen water bottles for plantar fasciitis. Instrumental support included peers bringing food to share and facilitators referring participants for counseling and other care.
Why It Matters: Through deliberate facilitation and peer exchange, group medical visits mobilize four reinforcing forms of social support as core therapeutic processes. Group medical visits are one model of biopsychosocial chronic pain management in primary care.
Social Support in Group Medical Visits for Chronic Pain in Primary Care
Corresponding Author: Maria T. Chao, DrPH, MPA, et al
Osher Center for Integrative Health, University of California, San Francisco, San Francisco, California
Department of Medicine, University of California, San Francisco, San Francisco, California
An accompanying podcast with authors Dr. Chao and Jesse Wennik about this study will be available at 10 AM ET on Tuesday, September 22 here as well as other audio streaming platforms.
Prescribers Face Barriers and Confusion to Providing Prescription Medication Instructions for Patients
Pharmacies that receive federal funds must provide language support to make sure patients can understand their medication instructions. A survey of 169 outpatient prescribers at a large academic medical center found widespread uncertainty about how language support actually works. The researchers found:
The majority of respondents (61.5%) reported a lack of awareness of best practices for providing non-English medication instructions to patients or pharmacies.
Most (80.5%) did not know whether the pharmacy provided translated labels.
Only 5.9% used the prescription's free-text field to flag the need.
More than one-fourth of prescribers (27.8%) were unsure whether the pharmacy received their communications about instruction translation.
Few respondents (8.3%) informed patients that they could request non-English medication instructions from their pharmacy.
Many prescribers (69.8%) doubted their patients got accurate written instructions.
The obstacles named most often were time constraints (69.2%), lack of translation resources (62.7%), reaching interpreters between visits (51.5%) and inability to use a non-Latin alphabet (40.8%).
Why It Matters: These findings highlight the critical need to coordinate language services between institutions and among patients, prescribers, and pharmacy team members.
Prescriber Practices and Barriers to Providing Prescription Medication Instructions for Patients With a Non-English Language Preference
Corresponding Author: Beatriz Manzor, PharmD, BCPS, et al
University of Michigan College of Pharmacy, University of Michigan, Ann Arbor, Michigan
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Additional Research Highlights
Family Medicine Residents Working in Teams Continuing Quality Improvement Projects Across Classes Are More Likely To Change Patient Care
There is no standard curriculum or metric for evaluating success of family residency quality improvement (QI) projects. A survey of 321 U.S. family medicine residency program directors asked how programs teach QI and who supervises projects. The survey also asked whether residents can get to clinic data, how projects are organized, and what the projects achieve. They found:
Most programs used a hybrid curriculum combining their own materials with outside resources (46.8%) or a curriculum they built themselves (38.8%).
More than one-quarter of programs (26.6%) said residents faced significant barriers getting the clinic data their projects required.
Graduates were rated as more skilled in programs using a hybrid curriculum, where core faculty supervised projects, residents had better data access, projects were handed down from one resident class to the next, and results were shared beyond the program.
The three project factors linked to tangible clinical change were having residents working in teams rather than alone, projects continuing across resident classes, and results being presented or published.
Why It Matters: The findings suggest that a successful residency quality improvement education results from a system built on a formal curriculum, accessible data infrastructure, and projects designed to outlast a single resident’s experience.
Quality Improvement in Residency: Training, Projects, and Outcomes
Corresponding Author: Lauren E. Harriet, DO, MBA, et al
Department of Family Medicine, University of Chicago, Chicago, Illinois
Integrating Peer Support Into Medicare-Funded Care Faces Implementation Barriers
In the U.S., 21.8% of adults receive behavioral health treatment annually. In 2024, Medicare began allowing physicians to bill Medicare for certified peer-support specialists through the introduction of principal illness navigation peer-support (PIN-PS) reimbursement codes. An interview study with 20 participants, including physicians, certified peer support specialists and leaders, policy professionals, payer representatives, and behavioral health organization leaders, examined barriers and facilitators to PIN-PS adoption. The study found:
Barriers included limited knowledge of the Medicare navigation codes, skepticism about the impact of peer support, how to integrate support into existing workflows, limited familiarity with billing requirements, and uncertainty about how to schedule and document PIN-PS encounters.
Administrative and billing complexity, Medicare cost-sharing requirements, and constraints in reimbursable service time were additional barriers.
Facilitators included believing the codes could expand access and reduce inappropriate hospitalizations.
Why It Matters: These findings may inform ongoing implementation and policy refinement as Medicare-funded peer support continues to develop.
Integrating Peer Support Into Medicare-Funded Care: A Qualitative Study of System-Level Insights From Early Implementation
Corresponding Author: Karen L. Fortuna, PhD, LICSW, et al
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth,Hanover, New Hampshire
Patient Innovation Lab, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
Reorganizing Large Clinics Into Small Teams for Chronic Disease Care May Lower Costs
Polyclinics are large primary care facilities that provide a broad range of outpatient medical care, including chronic disease management. However, patients are typically assigned to any available doctor from a common pool rather than a dedicated family physician. In 2014, a small team (“teamlet”) model was introduced within Singapore polyclinics to improve care for patients with chronic disease. The teamlet consisted of two family physicians, a nurse, and a care coordinator. A study comparing 22,632 teamlet patients with at least one chronic condition against 163,055 similar patients who received usual care from 2014 to 2021 found that the teamlet model was associated with decreased overall health care costs for people with chronic disease over six years. The savings came mainly from fewer hospital stays, and to a lesser extent, decreased specialist outpatient visits, and fewer emergency department visits. Primary care costs rose due to teamlet patients visiting the polyclinics more often. After five years, teamlet patients had diabetes foot screenings 16 percentage points more often and eye screenings 6 points more often than patients in usual care. Blood sugar, blood pressure and cholesterol in the teamlet model improved slightly.
Why It Matters: The findings from this study suggest that reorganizing existing staff into small teams can produce meaningful savings and improve care in high-volume primary care settings.
Assessing 5-Year Outcomes of a Teamlet Care Model in Singapore Polyclinics: A Matched Difference-in-Difference Analysis
Corresponding Author: Sabrina Kay Wye Wong, PhD, MBBS, MMed(FM), et al
NHG Polyclinics, NHG Health, Singapore
Also In This Issue
Editorial
Family Medicine Journal Editors Issue Joint Call to Invest in Primary Care
Editors of seven U.S. family medicine journals argue in a joint editorial that primary care is the foundation of better health and the answer to the nation's health care crisis, yet remains chronically underfunded. They call for payment reform, investment in research and technology, and advocacy by clinicians, educators and researchers.
The Power of Primary Care to Improve Health
Editors of Family Medicine Journals
Innovations in Primary Care
Analyzing Medical Assistant Tasks at a Family Medicine Practice Improved Workflow
A family medicine student recorded medical assistants’ tasks over nine days at a family medicine residency practice. About 30% of their time was idle with no task available. Indirect care such as room setup and testing accounted for 40% of their time, direct patient care for 25% and administrative work such as messages and chart review for 5%. In response, the practice began trialing a new arrangement which involves matching each assistant to a single physician or a pair, depending on patient load rather than sharing medical assistants across a pod of physicians. The practice administrator and nurse manager describe a subjective improvement in workflow, and satisfaction among physicians and assistants improved as well.
Analyzing Medical Assistant Workflow to Improve Office Efficiency
Corresponding Author: Caleb Haeussler, MD, et al
Department of Family Medicine, OhioHealth Riverside Methodist Hospital, Columbus, Ohio
“Learning Tour” Connects Primary Care Clinicians with Practice Based-Research Network Resources
It can be challenging for primary care clinicians to find time to engage in research. In response, the Northern New England CO-OP Practice and Community-Based Research Network took a boots on-the-ground approach. Between 2023 and 2025, CO-OP leaders and staff made 36 “Learning Tours” visits, reaching 82 primary care sites and more than 300 clinicians, medical directors and staff across northern New England and bordering states. They credit the tours in part to CO-OP Network membership rising 102% and annual meeting attendance 37%.
Learning Tour Drives Primary Care Clinician Engagement Within a Practice-Based Research Network
Corresponding Author: Paula Hudon, DNP, RN, et al
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
New Care Model That Includes Longer Visits Aims to Reach Patients Before They Need Emergency or Hospital Services
Medicaid patients have mounting care needs, poorly managed chronic conditions and often socioeconomic barriers that keep them from preventive care. The ambulatory care department at Jamaica Hospital Medical Center, a safety-net hospital serving an under-resourced, heavily Medicaid population in Queens, New York, introduced a new care delivery model to reach these patients earlier. First, they used a third-party vendor to incorporate a risk-scoring tool to find patients at the highest risk of needing hospital or emergency care. A team of clinicians, case managers, navigators, behavioral health staff, and social workers chose who to prioritize, then planned and debriefed the visits. Those patients received 40-minute high-value visits, more than twice the 18-minute average for primary care. Physicians and residents were trained to look past the diagnosis to what gives patients’ lives meaning and to behavioral and environmental factors that may affect their health. Patient navigators, hired with state funding through a Medicaid demonstration waiver, handled outreach, prescriptions, lab work and referrals and identified barriers such as transportation and housing. The model led to reduced care use, improved chronic disease management, and lower costs within the Medicaid managed population.
A Novel Care Model for Managing the Rising-Risk Medicaid Population in a Safety-Net Hospital
Corresponding Author: Alan Roth, DO, FAAFP, et al
Jamaica Hospital Medical Center, Jamaica, New York
Reflection/Essay
Family Physician Who Grew Up Undocumented Uses His Experience To Provide Better Patient Care
A rural family physician and U.S. citizen reflects on how growing up as an undocumented immigrant shaped his role as a physician and how he cares for patients in his community.
Corresponding Author: Jesus Ruiz, MD
School of Medicine, University of North Carolina at Chapel Hill
Department of Family Medicine, Chapel Hill, North Carolina
Residents’ Lengthy Task List Can Impede Patient Connection
A social worker reflects on the pull residents feel between connecting with patients and running ‘the list,” a running list of labs, orders, medical problems, and tasks to get through in a clinical day.
Corresponding Author: Rebekah Schiefer, MSW, LCSW
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
Family Medicine Update
New from the Association of the Departments of Family Medicine (ADFM): The Strategic Value of Family Medicine — one-pagers of evidence-informed talking points for school of medicine and health system leaders, with companion question guides and reference lists. https://www.adfm.org/resources/the-strategic-value-of-family-medicine/
The Annals of Family Medicine
Tip Sheet and Summaries Annals of Family Medicine September/October 2026
21-Sep-2026