This Week in Family Medicine — May 28, 2026

Welcome to This Week in Family Medicine. This week we're covering 9 notable papers spanning the evolving challenges of primary care practice, new frontiers in disease screening and treatment, and a look at global health trends. Let's dive in.

The Evolving Landscape of Primary Care Practice We begin with three papers that paint a picture of the growing complexity and administrative burden in modern family medicine. A study in the *Annals of Family Medicine* provides hard data on the rise of indirect patient care activities [7]. Using over a decade of electronic health record data from Canadian family physicians, investigators tracked trends in orders from 2011 to 2021. They found that while the number of prescriptions per patient contact remained stable, the rate of referrals increased by 57% and the rate of laboratory tests increased by 29%. This confirms with data what many clinicians feel in their daily practice: a significant increase in the administrative workload required for each patient encounter, often referred to as 'desktop medicine'.

So why is care becoming more complex? A qualitative study in *JAMA Internal Medicine* offers some insight by examining the challenges faced by a particularly vulnerable group: older adults with cognitive impairment who live alone [3]. Based on hundreds of interviews with patients and their social contacts across three states in the United States, the study identified substantial barriers to safe medication management. At the individual level, patients reported a lack of reminders without a cohabitant, and a fear of experiencing adverse effects while alone. At a system level, they struggled to navigate health system logistics without an advocate. While non-cohabiting family and friends provided crucial support, it was often intermittent, leaving patients in a precarious situation. For clinicians, identifying cognitive impairment in an older adult who lives alone should be a red flag, prompting targeted efforts to simplify regimens and connect patients with home- and community-based support services.

Adding another layer of complexity, a realist evaluation in *BJGP Open* explored how medicine optimization works for older people from ethnic minority communities with polypharmacy [8]. Interviewing primary care practitioners in the United Kingdom, the study found that success hinges on relationship-based, context-sensitive care. Medicine optimization worked well when practitioners showed respect, adapted their communication to cultural and language contexts, and successfully negotiated family involvement. Conversely, barriers included patient-related factors like stigma or deference to authority, as well as system constraints like time pressure and the limitations of remote consultations. This research underscores that effective deprescribing and polypharmacy management in diverse populations require more than a simple medication list review; they demand time, cultural humility, and strong patient-practitioner relationships.

New Frontiers in Disease Management and Screening Next, we turn to three studies showcasing advances in screening for and treating chronic and rare diseases. A large population-based study in *JAMA* reports on screening children for early-stage Type 1 diabetes in Germany [6].

The Study Over 220,000 children aged roughly 2 to 11 years were screened for islet autoantibodies. The goal was to estimate the prevalence of pre-symptomatic, early-stage disease and track progression.

Results The adjusted population frequency of early-stage Type 1 diabetes, defined by having two or more autoantibodies, was 0.3%. During a median follow-up of nearly 6 years, the five-year risk of progressing from an early-stage diagnosis to clinical, or stage 3, diabetes was about 36%. Critically, this progression risk was not significantly different between children with and without a first-degree family history of the disease.

Conclusions These findings challenge the current paradigm of limiting screening to genetically high-risk individuals. As disease-modifying therapies that can delay the onset of clinical Type 1 diabetes become available, this evidence suggests that general population screening can be considered to identify children who may benefit.

From screening, we move to a potential new treatment paradigm for chronic Hepatitis B virus infection, detailed in *The New England Journal of Medicine* [1]. This publication presents results from two replicate phase 3 trials, B-Well 1 and B-Well 2. They evaluated bepirovirsen, an antisense oligonucleotide, in adults with chronic HBV who were already on stable nucleoside or nucleotide analogue, or NA, therapy. Patients received either bepirovirsen or placebo weekly for 24 weeks, then stopped their NA therapy at 48 weeks. The primary outcome was a functional cure at 72 weeks, defined as sustained HBsAg loss and undetectable HBV DNA. The results were significant: in the two trials, 20% and 19% of patients receiving bepirovirsen achieved a functional cure, compared with zero patients in the placebo groups. Adverse events, primarily grade 3 elevations in ALT, were more common with bepirovirsen. This is a major development, as it represents a significant step toward a finite treatment course that can result in a functional cure, rather than lifelong viral suppression, for a subset of patients.

Finally, a phase 2 trial in *Nature Medicine* highlights the power of precision oncology, even for rare tumors [2]. The study tested the targeted inhibitor rogaratinib in 24 patients with an advanced, rare subtype of gastrointestinal stromal tumor, or GIST, known as SDH-deficient GIST. This cancer is driven by an epigenetic mechanism that activates fibroblast growth factor receptors. The treatment resulted in a partial response for 10 patients, yielding an objective response rate of over 41%. The median progression-free survival was an impressive 31 months, with manageable toxicities. While this is a rare disease, the study is a successful demonstration of a targeted therapy based on a deep understanding of the underlying disease biology, offering a glimpse into the future of personalized medicine.

Global Health and Research Perspectives Finally, we zoom out to look at the bigger picture with three papers on global health burdens, costs, and research methodology. First, the 2023 update from the Global Burden of Disease Study, published in *The Lancet*, provides sobering new data on mental disorders [5]. The systematic analysis found that in 2023, there were an estimated 1.17 billion prevalent cases of mental disorders globally. Since 1990, the age-standardized prevalence rate has increased by over 24%. As a result, mental disorders have risen from the 12th leading cause of global disease burden in 1990 to the fifth leading cause in 2023. Most strikingly, they are now the single leading cause of years lived with disability worldwide, accounting for over 17% of the total. Anxiety disorders and major depressive disorder are the largest contributors. These numbers underscore the massive and growing public health crisis that presents daily in primary care offices.

Connecting burden to cost, a study in *The Lancet Global Health* analyzed the real-world costs of strengthening small and sick newborn care in four sub-Saharan African countries [9]. The analysis found that governments were the primary funders of human resources, which was the largest cost driver. Meanwhile, implementation partners like the NEST360 alliance primarily funded data systems and medical devices. However, when benchmarking the measured costs against what is modeled to be necessary for high-quality care, the study found a major gap. In Tanzania, for example, current investments would need to triple to reach the government's own targets. This study provides a concrete example of the immense resource gap that exists between current spending and what is truly needed to achieve global health goals like improving newborn survival.

Lastly, a paper in the *BMJ* provides a tool to help us better interpret the research we rely on [4]. This consensus statement introduces the CRT-Estimands Framework, which is an extension of existing international guidelines. Its purpose is to help researchers be more precise when defining the research question, or estimand, in cluster randomized trials. These are trials where groups of people, like clinics or villages, are randomized instead of individuals. This framework matters to practicing clinicians because many public health and primary care interventions are tested using this study design. By encouraging researchers to be clearer about exactly what they are measuring, the framework helps clinicians on the other end better assess a trial's relevance and applicability to their own patients and practice setting.

If you only have time for one paper this week, make it the B-Well trials on bepirovirsen for chronic Hepatitis B in *The New England Journal of Medicine* [1]. This is one of the first therapies to show a significant rate of functional cure, moving beyond lifelong suppression and representing a potential paradigm shift in how we manage this common chronic infection.

Here are the key takeaways from this week in Family Medicine. First: The administrative burden in family medicine is measurably increasing, with a significant rise in referrals and lab orders per patient visit over the last decade. Simultaneously, we're caring for increasingly complex patients, such as older adults with cognitive impairment living alone, who require more time and support. Second: Population-based screening for pre-symptomatic Type 1 diabetes in children appears effective at identifying cases, with progression risk being similar regardless of family history. This may support broader screening efforts as disease-modifying therapies become available. Third: For patients with chronic Hepatitis B on stable NA therapy, a 24-week course of bepirovirsen led to a functional cure in about one in five patients, a significant advance over placebo. Clinicians should keep an eye on this new therapeutic class. Fourth: The global burden of mental health disorders continues to grow, and they now represent the leading cause of disability worldwide. This reinforces the central role of primary care in identifying and managing these conditions. And finally: Effective medicine optimization for diverse older populations requires more than a simple review; it demands culturally sensitive, relationship-based care that accounts for patient beliefs, family involvement, and language barriers.

That's your roundup for This Week in Family Medicine. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.