Original Research
Patients Find Relief from Pain and Anxiety After Receiving Five Minutes of In-Person Prayer vs. Listening to Music
Background: This randomized controlled trial focused on in-person prayer, known as proximal intercessory prayer (PIP), for another person’s well-being. Researchers at the University of Maryland recruited 180 adult patients from a family medicine waiting room who reported moderate-to-severe pain and/or anxiety. Participants were randomized to receive either five minutes of Christian in-person prayer from a trained volunteer or music after their appointments. Researchers examined whether participants in the PIP intervention versus music control group would report significant changes in pain or anxiety.
What They Found: Both groups improved. However, patients who received prayer reported greater relief from both pain and anxiety than those who listened to music. Prayer recipients reported greater reductions in pain immediately and at two weeks compared to the music group. Prayer recipients with anxiety reported greater reductions immediately and at both two and six weeks. Black participants reported larger improvements in both pain and anxiety than other participants.
Implications: The findings suggest proximal intercessory prayer may be a low-cost, non-pharmacologic, effective complement to standard care for a wide range of patients.
Prayer for Pain and Anxiety in a Primary Care Setting: A Randomized Controlled Trial
Corresponding author: Jennifer Zipp, DNP, et al
University of Maryland School of Medicine, Department of Family and Community Medicine
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Original Research
Mayo Clinic Study Details Set of Options Family Medicine Physicians May Consider to Treat ME/CFS and Long Covid
Background: U.S. prevalence of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), a multisystem neurologic disease and debilitating chronic condition, averaged 1 million to 2.5 million before the COVID-19 pandemic. Incidence rates are now reported to be 15 times greater, related at least in part to long COVID. This retrospective chart review analyzed records of medications and supplements tried before specialty consultation from 571 adults with ME/CFS seen at a Mayo Clinic specialty clinic from 2018 to 2022.
What This Study Found: Medications used commonly for pain, impaired sleep, and mood disorders were the ones most often prescribed before consultation. Medications that have been suggested for core symptoms of ME/CFS, such as fatigue, brain fog, postexertional malaise, orthostatic intolerance, or allergy/inflammation, had less often been tried. Most (72%) of the individuals used at least one supplement.
Implications: The findings suggest potentially helpful medications used by ME/CFS specialists, most of which are well known and used in primary care for other diagnoses, may be under utilized to treat ME/CFS in primary care. To help clinicians navigate available options, researchers created two tables with medications and supplements that ME/CFS specialists commonly discuss with patients in the clinic, organized by symptom category, along with a summary of the current evidence for each.
Underuse of Pharmacologic Therapies for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Before Specialist Evaluation
Corresponding author: Stephanie L. Grach, MD, MS, et al
Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Original Research
Black and Hispanic Patients Face Barriers and Confusion About Medicare Free Annual Wellness Visits
Background: Medicare Annual Wellness Visits (AWVs) are free, yearly preventive checkups available to all Medicare and Medicare Advantage enrollees. However, research shows low AWV completion in racial and ethnic minority groups. Researchers at Northwestern University Feinberg School of Medicine sought to understand older and minority patients’ attitudes and preferences related to preventive care and AWVs.
What They Found: In focus groups with 45 Black and Hispanic Medicare patients aged 66 years or older across two Chicago primary care settings, five key themes emerged. Participants strongly valued their health and preventive care, placing high importance on long-standing relationships with their primary care physicians. However, they reported barriers, including long hold times when scheduling appointments, limited appointment availability, and transportation costs. Many were confused about what an "Annual Wellness Visit" actually is. Many patients did not know whether they had completed one, and many confused it with in-home exams offered by Medicare Advantage insurers. Participants also raised concerns about historical racial discrimination in medicine, including suspicion that AWVs might be a lower-quality service offered only to disfavored populations.
Implications: The authors call for interventions that reach patients through multiple communication channels, use plain language such as calling AWVs "checkups," and highlight that AWVs are recommended for all Medicare enrollees, not only groups who have been historically discriminated against in medicine.
Older Black and Hispanic Patient Perceptions of Medicare Annual Wellness Visits: A Qualitative Study
Corresponding author: Corresponding author: David T. Liss, PhD, et al
Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
AllianceChicago, Chicago, Illinois
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Research Brief
Adults With Intellectual and Developmental Disabilities or Cerebral Palsy Experience Higher Fall-Injury Risk at Younger Ages
Background: Falls are a common cause of injury, especially for adults over age 65. But adults with intellectual and/or developmental disabilities or cerebral palsy may also be at higher risk. Researchers analyzed more than 35.8 million emergency department visits across 21 states using 2019 emergency department data to compare fall-related emergency department visits and age-related trends among adults with and without intellectual and/or developmental disability or cerebral palsy.
What They Found: Adults with intellectual and/or developmental disabilities and/or cerebral palsy were more likely to visit the emergency department because of a fall injury than adults without intellectual and/or developmental disabilities or cerebral palsy. Among adults with no developmental disabilities, 7.3% of emergency department visits at ages 62-65 years were due to falls. Similar rates were seen in middle age for adults with intellectual and/or developmental disabilities (42-45 years) or cerebral palsy (34-41 years), indicating earlier risk.
Implications: The findings suggest that clinicians should consider screening these patient populations for fall risk as early as ages 34-45 years.
Fall-Related Emergency Department Visits Among Adults With and Without Intellectual and Developmental Disabilities or Cerebral Palsy
Corresponding author: Teal W. Benevides, PhD, et al
Department of Community and Behavioral Health Sciences, School of Public Health, Augusta University, Augusta, Georgia
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A new episode of the Annals of Family Medicine Podcast with Dr. Teal Benevides and Dr. Michael McKee discussing this study will be available on YouTube here and most audio streaming platforms at 10 a.m. on Wednesday, May 27, 2026.
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Original Research
Researchers in China Examine Use of AI-Assisted Ultrasound by General Practitioners To Detect Carotid Artery Plaque
Background: Carotid plaque is a buildup in the walls of the arteries of the neck that is associated with the onset of atherosclerotic cardiovascular disease. This study examined whether general practitioners (GPs) in China could reliably detect carotid plaque using AI-enhanced point-of-care ultrasound (POCUS) following structured training. Seven GPs across four Shanghai community health centers completed approximately five weeks of training before screening 169 older adults at high risk for atherosclerotic cardiovascular disease.
What They Found: Compared against expert ultrasonologists, the GPs correctly identified plaque when it was present 87% of the time and correctly cleared patients when no plaque existed 91% of the time. Overall agreement with expert readings was strong. Missed cases were concentrated at the fork where the carotid artery splits and performance varied across the seven GPs.
Implications: These findings offer early evidence that structured training paired with AI-assisted point-of-care ultrasound can extend carotid plaque screening into community primary care.
Diagnostic Performance of General Practitioners in Carotid Plaque Detection Using AI-Enhanced Point-of-Care Ultrasound After Systematic Training
Corresponding author: Xiaochuan Liu, MD, et al
Department of General Practice, Zhongshan hospital, Fudan University, Shanghai, China
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Original Research
Family Physician Administrative Workload per Patient Visit Increased Substantially Over 11 Years in Canada
Background: Family physicians dedicate substantial time to managing and coordinating care outside of patient interactions. This growing administrative workload causes burnout and overwork. This study used electronic health record (EHR) data from over 900 Canadian family physicians across six provinces to describe changes in physician workload between 2011 and 2021.
What They Found: Family physicians had more patient contacts, saw more unique patients, and worked more days in 2021 than in 2011. Referral rates per patient visit increased by 57% and laboratory tests by 29%, while the rate of prescriptions per patient contact stayed about the same. The average number of chronic conditions per medical encounter remained stable over the analysis period.
Implications: These findings demonstrate a growing demand and expectation for family physicians to streamline administrative tasks through improved technological interoperability, careful evaluation of AI, and team-based task sharing to allow more time for patient care.
More Indirect Patient Care Activities per Visit: 11-Year Analysis of Family Physician Electronic Health Records in Canada
Corresponding author: François Gallant, PhD, et al
Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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Research Brief
Study Finds Colorectal Cancer Screening Intervention Had Similar Effects Across Race/Ethnicity at Federally Qualified Health Centers
Background: Racially and ethnically minoritized patients are underscreened for colorectal cancer, resulting in racial/ethnic disparities. This study examined an intervention consisting of a mailed fecal immunochemical test (FIT) to patients due for screening, plus patient navigation for positive tests, at two federally qualified health centers (FQHC) systems in North Carolina.
What They Found: In this secondary analysis of a randomized clinical trial of 3,734 patients, the intervention increased colorectal cancer screening by 18.3 percentage points overall. The intervention effect was similar across Hispanic, non-Hispanic Black, and non-Hispanic White patients and did not differ significantly by race or ethnicity. Among patients with a positive FIT who required follow-up colonoscopy, the intervention's effect was also similar across racial groups. However, overall completion rates remained substantially lower for Black patients than White patients, even in the intervention arm.
Implications: Broad implementation in FQHCs among minoritized populations could improve CRC screening disparities.
Equity Evaluation of an Intervention to Increase Colorectal Cancer Screening at Federally Qualified Health Centers
Corresponding author: Anisha P. Ganguly, MD, MPH, et al
Division of General Medicine and Clinical Epidemiology, Department of Medicine, School
of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Systematic Review
Shorter Primary Care Wait Times and Stronger Patient-Physician Continuity Linked to Advanced Access Model for Scheduling
Background: The possibility of seeing a clinician on the same day or following day is limited and declining in high-income countries, directly contributing to overcrowding of emergency departments for nonurgent medical issues. This systematic review examined 29 studies on advanced access, a scheduling model that involves keeping a substantial proportion of appointment slots open each day to accommodate same-day demand.
What They Found: Using Advanced access in primary care caused wait times to fall in all 23 studies that measured them, though only 13 provided statistical confirmation. Among the 13 studies assessing continuity of care, 11 reported improvements after implementation of advanced access. Of these, 7 studies demonstrated statistically significant improvements. In contrast, two studies observed declines in continuity of care after implementation of advanced access, one of which reached statistical significance. All three studies that measured emergency department use reported fewer visits, though none reached statistical significance. Patient satisfaction improved in 8 studies, with 3 reporting statistically significant improvements.
Implications: The authors describe advanced access as a potentially promising approach for improving how primary care appointments are scheduled.
Association of Advanced Access With Primary Care Performance: A Systematic Review
Corresponding author: Simon Berthelot, MD, MSc, et al
Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
Département de médecine de famille et de médecine d’urgence, Université Laval, Québec City, Québec, Canada
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Original Research
"School of Caring" Program Eases Burden and Improves Well-Being for Informal Dementia Caregivers
Background: This study in rural Spain evaluated the effectiveness of a program called the School of Caring, a nine-session weekly group program for informal caregivers of people with dementia. The program combined dementia education, psychological support, and guidance on community resources for 132 informal caregivers. Researchers examined outcomes of burden, quality of life, well-being, self-efficacy, and social support at three time points over nine months.
What They Found: The program produced significant improvements across all measured outcomes immediately after the intervention, with effects sustained at six months. Caregivers new to the role (less than one year) benefited most and continued improving during follow-up. Key factors associated with greater burden included having a personal health problem and spending more hours per day caregiving.
Implications: The findings support integrating structured, multidisciplinary caregiver support programs into routine primary care.
Multicomponent School of Caring Program to Support Caregivers of Patients With Dementia: A Quasi-Experimental Effectiveness Study in Primary Care
Corresponding author: Macarena Pozo Ariza, PhD, et al
Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
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Innovations in Primary Care
Automated EHR Alert Improved Hepatitis B Monitoring Rates at a Primary Care Clinic
At an urban safety-net primary care clinic in St. Paul, Minnesota, monitoring of patients with chronic hepatitis B, a liver infection requiring regular blood tests to prevent serious complications, mirrored national challenges. Many patients diagnosed with chronic hepatitis B were referred to gastroenterology but later returned only to primary care for unrelated needs. Without systematic prompting, hepatitis B monitoring rarely surfaced during these visits, and efforts to re-engage patients through phone calls, letters, and scheduling attempts proved labor-intensive and often ineffective. In May 2024, the health system and clinic noted the appearance of a new “care gap” alert in their Epic electronic health record (EHR) system that flagged patients with hepatitis B who were overdue for one blood test, the hepatitis B DNA test. As part of the existing workflow to address care gaps at every visit, the alert prompted clinic staff to discuss the test during whatever appointment the patient was already attending. Among 104 patients with chronic hepatitis B, the share getting timely monitoring in the subgroup not requiring liver cancer screening rose from 34% to 51% in the 14 months after the alert was activated. Overall monitoring across all 104 patients had reached 27%, above the 11% to 21% range reported in national evaluations.
Impact of Epic Care Gaps on Hepatitis B Care Retention
Corresponding author: Mark Berg, et al
University of Minnesota, St Paul, Minnesota
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Innovation in Primary Care
Brazilian Medical Students Increase Vaccine Confidence
Vaccination coverage in Brazil has declined in recent years, largely driven by misinformation, fear, and distrust. Medical students at the University of Pernambuco designed and delivered a low-cost, two-hour educational intervention for 25 parents and caregivers waiting for routine appointments at a Family Health Unit in Recife. The session began with an interactive "Myths and Truths About Vaccines" game where participants voted on common misconceptions about vaccine safety and side effects, followed by a short lecture and open discussion. The session concluded with take-home educational materials. Caregivers' hesitation appeared rooted in fear and confusion rather than outright refusal, and participants frequently reported getting vaccine information from social media, messaging apps, and family members rather than health professionals. Participants were notably receptive to information from medical students.
Building Vaccine Confidence in Primary Care: A Student-Led Educational Innovation
Corresponding author: Sofia Fernandes Coriolano Araujo, et al
Universidade de Pernambuco, Faculdade de Ciências Médicas (FCM-UPE), Recife, Brazil
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Special Report
Primary Care Engaged Research for Cancer Survivorship Care (PERCS) Initiative Promotes Comprehensive Care for Cancer Survivors
Despite more than 60% of cancer survivors seeing primary care clinicians, this care does not always include the full range of services people need during and after cancer (survivorship care). This special report describes the Primary Care Engaged Research for Cancer Survivorship Care (PERCS) initiative, a National Cancer Institute-funded umbrella of four system-level randomized controlled trials designed to improve how primary care clinicians deliver survivorship care to more than 18 million cancer survivors in the US. These four trials aim to develop and test primary care practice and health system–level interventions to promote comprehensive survivorship care for adult cancer survivors during and/or after treatment.
Addressing Primary Care Needs of Cancer Survivors: The Primary Care Engaged Research for Cancer Survivorship Care (PERCS) Initiative
Corresponding author: Michelle A. Mollica, PhD, MPH, RN, et al
National Cancer Institute, Division of Cancer Control and Population Science, Bethesda, Maryland
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Essay
Physician’s Breastfeeding Experience Prompts Call for Clinicians to Make Breastfeeding More Attainable
In this essay, a physician highlights her difficult journey to breastfeed her son. She discusses the physical, mental, monetary, and temporal difficulties faced by those who desire to breastfeed and offers recommendations for health care professionals and society to make breastfeeding more attainable. The author argues that breastfeeding should not be a privilege, but an option accessible to all patients and that clinicians can take action to better prepare their patients to navigate common obstacles and understand the true reality of breastfeeding.
Breastfeeding Should Not Be a Privilege
Corresponding author: Dhanalakshmi Thiyagarajan, MD, MPH
Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, Michigan
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Essay
Old Age is Not a Disease: What Japan's Concept of Rousui Offers Medicine
In Japan, home to the world's fastest-aging population, rousui — death from old age — is officially recognized on death certificates and is the country's third leading cause of death. Rousui describes a gradual decline in physiological function leading to death without a specific underlying disease and is the terminal stage of frailty rather than the failure of any single organ. In this essay, a Japanese family physician recounts diagnosing rousui for the first time two decades ago for a woman in her 90s whose slow, multidimensional decline had no reversible cause. The author uses that experience to examine the clinical and ethical ambiguities the concept of rousui creates. For example, labeling a death as rousui may lead to too few interventions while avoiding the label may lead to burdensome treatments that prolong suffering without meaningful benefit. The author calls for a rebalancing for aging populations, including more standardized diagnostic processes, shared language for patients and families, and deeper discussion of what cannot be standardized, all without recasting old age as a disease category.
Death by Rousui in Japan: Rethinking Death, Diagnosis, and Care in an Aging Society
Corresponding author: Teruhiko Imanaga, MD, PhD
Kanade Clinic, Hasuda City, Saitama, Japan
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Essay
Where We Learn to Doctor: Rural Practice as Essential Medical Educatio
This essay encourages medical students, residents, and early-career physicians to consider training and working in rural communities. The author, a family physician drawing on experiences in Tanzania, Northern Canada, rural Mississippi, and rural Minnesota, argues that rural medicine is a formative educational experience that teaches resilience, sharpens diagnostic skills, and expands procedural confidence through the "discomfort" of limited resources and broad responsibility.
Where We Learn to Doctor: Rural Practice as Essential Medical Education
Corresponding author: Dominika Jegen, MD, MA, CCFP(EM), FCFP, DABFM
Department of Family Medicine, Mayo School of Medicine and Science, Mayo Clinic, Rochester, Minnesota
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Essay
Physician’s Cultural Humility and Listening Skills in Rural Practice Facilitates Healing in Patients Who “Feel Seen”
In this essay, a physician reflects on his time posted to a rural primary health center in India. Through three patient encounters, the author finds that beneath ordinary complaints lay unspoken burdens shaped by gender, belief, poverty, and hierarchy. Cultural humility and listening became his most reliable tools, and he finds that in medicine, healing often begins where diagnosis and treatment end. While physicians are trained to measure vital signs and prescribe treatments, rural practice taught him to also measure the weight of silence, the depth of stories, and the healing that begins when someone feels seen.
Navigating Invisible Complexities in Rural Practice
Corresponding author: Dheeraj Sharma, MBBS, MD
Department of Community Medicine, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India
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Essay
Chance Encounter with Former Patient Prompts Ophthalmology Resident to Notice and Honor Her Story
An ophthalmology resident working 12-hour shifts at a 24-hour eye emergency department describes a chance encounter in a bookstore with a patient he treated for optic neuritis months earlier. He initially did not remember her, though she remembered him in detail. The meeting prompts him to examine what high clinical volume does to a physician's attention. The night that was ordinary for him was, for her, the border between one life with sight and another without it. He asks how a physician can carry less and notice more, leaning on narrative medicine's framework of attention, representation, and affiliation as small disciplines that help a clinician notice and honor a patient's story without being overwhelmed by it.
When Routine Care Changes a Life
Corresponding author: Henry Bair, MD
Wills Eye Hospital, Philadelphia, Pennsylvania
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Editorial
Celebrating Family Medicine at the National Academy of Medicine, 2025
This editorial focuses on five family physicians elected to the National Academy of Medicine in 2025: Drs. Andrea Anderson, Mohammed Kumail Ali, Esa Davis, Christine Dehlendorf, and Donald Warne. Each honoree is recognized for transformative contributions spanning medical education and regulatory medicine, chronic disease and implementation science, maternal-child health equity, reproductive health research, and Indigenous health policy, respectively.
Celebrating Family Medicine at the National Academy of Medicine, 2025
Corresponding authors: Diana N. Carvajal, MD, MPH, FAAFP, and José E. Rodríguez, MD, FAAFP
Department of Family and Community Health, University of Wisconsin, Madison, Wisconsin
Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee
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Family Medicine Updates
STFM Webinars and Podcasts: Expanding Access to Faculty Development in Family Medicine
The Society of Teachers of Family Medicine (STFM) has expanded its digital educational offerings through webinars and podcasts that support faculty development, leadership, and innovation in academic family medicine. The new STFM GME Leadership Panel Series: Stages of GME Leadership – From Idealism to Sustainability features 5 webinars from 2025-2026 that address relevant leadership challenges and solutions for faculty working in family medicine GME.
To access STFM’s webinars, visit https://stfm.org/webinars
To access STFM’s podcasts, visit https://www.stfm.org/publicationsresearch/publications/podcasts
Journal
The Annals of Family Medicine
Article Title
Tip Sheet and Summaries Annals of Family Medicine May/June 2026