FP Essentials

Dietary modifications can help to prevent and manage many chronic diseases. The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets emphasize consumption of fruits and vegetables while reducing intake of red meat. These diets are supported by well-established evidence for patients with cardiovascular disease and hypertension, respectively. Whole-food, plant-based diets have been shown to result in reduced body weight, lower A1c levels, and decreased insulin resistance in patients with diabetes...

The average adult needs 1 to 2 g protein/kg of body weight and 25 to 30 kcal/kg of body weight per day. Caloric needs in adults differ based on height, weight, activity level, and disease state. Malnutrition is defined as an imbalance of nutrition, including lack of adequate calories, protein, and/or other nutrients required for body functioning. Protein-calorie malnutrition is a specific type of malnutrition defined as deficient intake or uptake of protein and energy that leads to physiologic alterations such as inflammation, loss in fat-free mass, and/or decreased response to medical treatment...

Micronutrients are nutrients the body needs in small quantities, such as vitamins and minerals. Micronutrient deficiencies can occur when an individual is restricting calorie intake for weight loss or management, not consuming an adequate amount of food to meet energy requirements due to poor appetite or illness, eliminating one or more food groups from the diet on a regular basis, or consuming a diet low in micronutrient-rich foods despite adequate or excessive energy intake. Patient groups at risk include older adults, pregnant patients, patients with alcohol use disorder, patients with vegetarian or vegan diets, and patients with increased requirements secondary to medical conditions or long-term drug use that alters nutrient absorption, metabolism, or excretion...

Macronutrients are nutrients the body needs in large quantities, such as fats, carbohydrates, fiber, protein, and water. The exact quantity of macronutrients needed for an individual depends on multiple factors such as height, weight, sex, physical activity level, and medical conditions. For adequate intake, the Dietary Guidelines for Americans, 2020-2025 ( DGA ) recommend an overall healthy eating pattern rather than specific macronutrient amounts. A healthy eating pattern includes consumption of minimally processed, nutrient-dense foods and beverages such as vegetables, fruits, grains, dairy, proteins, and oils...

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Unintended pregnancy is seen commonly in the family medicine setting. It is defined as a pregnancy that is mistimed (occurring sooner than wanted) or unwanted (not desired at that time or any time in the future). Approximately 45% of all US pregnancies are unintended. Childbirth resulting from an undesired pregnancy has been associated with adverse maternal and child health outcomes. Clinicians should be prepared to manage unplanned pregnancies, including dating pregnancies and discussing pregnancy options...

Long-acting reversible contraceptives (LARCs) include progestin and copper intrauterine devices (IUDs) and progestin subdermal implants. LARCs may be the preferred for individuals who want a method that is highly effective and can last for several years, or for whom estrogen is contraindicated. LARCs should be offered using a shared decision-making approach, keeping in mind that historically these methods have been used coercively to control the reproductive choices of marginalized or disabled people. To ensure safe prescribing and reduce barriers to receiving LARCs, family physicians should be familiar with two evidence-based national contraceptive guidelines: the U...

Short-acting reversible contraceptives (SARCs) are prescribed routinely by primary care clinicians. SARCs are among the most commonly prescribed contraceptive methods and include combined hormonal oral contraceptive pills, the combined hormonal transdermal patch, the combined hormonal vaginal ring, progestin-only pills, and the 3-month depot medroxyprogesterone acetate injection. To ensure safe prescribing and reduce barriers to receiving SARC methods, family physicians should be familiar with two evidence-based national contraceptive guidelines, the U...

More than 65% of US women ages 15 to 49 years use contraception every year, many of whom seek care with family medicine. Family physicians are well equipped to provide comprehensive contraceptive counseling to patients in the primary care setting. When discussing options and providing education to patients, clinicians should consider patient preferences, patient autonomy, and adverse effect concerns, and should use a patient-centered approach that upholds the principles of reproductive justice. Nonhormonal methods of contraception include barrier methods and spermicides, fertility awareness-based methods, and (in postpartum individuals) lactational amenorrhea...

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The association between electronic health record (EHR) documentation and physician burnout is well-known. A combination of insufficient time to complete tasks, clinical documentation burden, and electronic inbox overload comprises the definition of documentation-related burnout. Burnout mitigation strategies related to clinical documentation include use of targeted EHR training for documentation, use of medical scribes, and institutional documentation redesign. Mitigation strategies related to electronic inbox overload include assigning designated administrative time for inbox management, tailoring of message content to decrease length, and a team-based approach to clinical workflows...

Remote patient monitoring (RPM) provides real-time clinical patient data to the medical team. The foundational element of RPM is communication, including data processing and integration in the electronic health record and communication of data between patients and clinicians. Patient portals are integral to this communication and their use can result in improved health outcomes and patient safety. Patient portals promote engagement of patients in their care, increase access to the medical team, and integrate RPM system data...

Telemedicine is defined as the provision of clinical services via telephone or video and is a type of telehealth. Telehealth is defined as the use of electronic information and telecommunications technologies for the delivery of health care, health education, and health information. During the COVID-19 pandemic, telemedicine availability and use of telehealth care significantly increased. The integral role of telemedicine during this time prompted the unprecedented integration of telehealth as a quasi-standard of care...

Electronic health record (EHR) systems have transformed the medical industry. Despite their known benefits, their implementation has resulted in new digital administrative tasks and responsibilities for physicians. This increase in administrative burden has been shown to contribute to physician burnout. Most sources of EHR-related burnout can be categorized into three groups: poor usability, excessive time spent in the EHR, and inefficient workflows. Evidence-based interventions for EHR-related burnout focus on training and education, which improve efficiency in EHR use and may reduce burnout...

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Acute pericarditis, the most common inflammatory heart condition, typically is caused by viral infections. Patients have sharp chest pain that improves when leaning forward. Electrocardiogram typically shows widespread ST-segment elevation; echocardiogram may show pericardial effusion; and levels of inflammatory markers may be elevated. Colchicine plus nonsteroidal anti-inflammatory drugs are first-line treatment. Patients with fever, elevated inflammatory marker levels, or pericardial effusion should be hospitalized...

Premature atrial contractions (PACs) occur in nearly all individuals. Although typically asymptomatic, they can cause palpitations. PACs previously were considered benign, but there is increasing recognition that frequent PACs are associated with developing atrial fibrillation. After potentially reversible causes (eg, electrolyte abnormalities, hyperthyroidism) are eliminated, symptomatic PACs can be treated with beta blockers; some patients are candidates for ablation. Premature ventricular contractions (PVCs) also are common, occurring in more than two-thirds of the population...

Patients with atrial fibrillation (AF) should receive anticoagulation with warfarin or direct oral anticoagulants (DOACs) if the CHA2 DS2 -VASc (Congestive heart failure, Hypertension, Age 75 years or older [doubled], Diabetes, prior Stroke or transient ischemic attack or thromboembolism [doubled], Vascular disease, Age 65 to 74 years, Sex category) score is at least 2 in men or 3 in women. Antiplatelet therapy is not recommended. DOACs typically are the first-line therapy. Anticoagulation requires special consideration in some patient groups (eg, patients with bleeding problems should be considered for left atrial appendage occlusion devices, rather than anticoagulation)...

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, with lifetime rates of 21% to 33%. There are numerous risk factors, including older age, hypertension, coronary disease, obstructive sleep apnea, diabetes, and others. Patients engaging in lifelong high-endurance exercise also have increased risk. Some organizations recommend screening; others do not. However, many patients identify AF themselves using mobile cardiac monitoring devices, some of which accurately detect the arrhythmia...

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