This Week in Family Medicine — Jul 5, 2026

Welcome to This Week in Family Medicine. This week we're covering 8 notable papers spanning cardiometabolic risk stratification, expanding access through alternative preventive pathways, and improving care coordination for complex and vulnerable populations. Let's dive in.

We begin with new ways to leverage routine electronic health record data to identify high-risk clinical phenotypes and improve cancer screening in patients with diabetes. In a cross-sectional study published in BMC Primary Care, researchers utilized a statistical method called cluster analysis on routinely collected primary care variables to identify distinct clinical phenotypes of type 2 diabetes and evaluate their association with microvascular complications [3]. Analyzing data from 674 individuals in Spain, the researchers identified three clinically interpretable phenotypes: controlled, metabolic, and hypertensive. The metabolic phenotype, which was characterized by higher body mass index and poorer glycemic control, was strongly associated with microvascular complications. Specifically, compared to the controlled group, patients in the metabolic cluster had more than four times the odds of having diabetic retinopathy and more than double the odds of having diabetic nephropathy. In contrast, the hypertensive phenotype showed a more selective association, with more than double the odds of retinopathy but no statistically significant association with nephropathy. Although this cross-sectional design cannot establish causality, it suggests that standard primary care data can help us move beyond isolated clinical variables to identify patient subgroups who may require more intensive surveillance for microvascular complications.

In a related effort to stratify risk in patients with diabetes, a study published in the British Journal of General Practice evaluated the Enriching New-Onset Diabetes for Pancreatic Cancer, or ENDPAC, algorithm [1]. Originally developed in the United States, this algorithm uses age at diabetes onset, weight change, and glycemic control to identify patients with new-onset diabetes who are at an increased risk of pancreatic cancer, a disease with notoriously low survival rates due to late diagnosis. In this external validation study using a national primary care sentinel network in England, researchers analyzed data from over 70,000 adults aged 50 and older with new-onset diabetes. Over the study period, 185 individuals, or about one-quarter of one percent of the cohort, developed pancreatic cancer. The ENDPAC algorithm demonstrated moderate discrimination, with an area under the curve of 0.733. Using an optimal cutoff score of three or higher, the algorithm classified nearly 28% of the population as high-risk, yielding a sensitivity of roughly 63%, a specificity of 72%, and a very high negative predictive value of 99.9%. However, the positive predictive value was extremely low at just 0.6%. While these numbers mean the tool cannot be used in isolation for diagnosis, integrating ENDPAC into routine primary care electronic health records could provide a scalable, low-cost, automated risk-stratification step to help identify which new-onset diabetes patients should enter a sequential diagnostic pathway for pancreatic cancer.

Next, we turn to innovative delivery models designed to lower barriers to preventive and acute care. Cervical cancer remains a significant public health challenge in the United States, where half of the women who develop the disease have never had a cervical cancer screen. Self-sampled primary human papillomavirus, or HPV, testing represents a highly acceptable, equivalent alternative to the traditional, invasive speculum exam. A national survey of 744 family medicine educators published in the Journal of the American Board of Family Medicine evaluated their current knowledge, attitudes, and behaviors regarding this screening modality [2]. The results were highly encouraging: after completing the survey, which was designed using Question-Behavior Theory, over 90% of family medicine educators expressed an intention to offer self-sampling to their patients. Remarkably, among those who initially did not intend to offer self-sampling, 88% changed their minds by the end of the survey. The study also revealed some important demographic differences; female respondents were nearly three times more likely to intend to offer self-sampling than male respondents. Furthermore, baseline knowledge regarding the advantages of primary HPV screening was significantly lower among underrepresented minority Hispanic respondents, at 52% correct compared to 80% among white respondents. This highlights a critical need for targeted educational interventions among clinicians to ensure equitable implementation of this practice-changing screening tool.

Expanding access to care for children is another major priority, and school-based health centers have emerged as a vital resource for reaching underserved populations. A retrospective cross-sectional study published in the Journal of the American Board of Family Medicine analyzed electronic health record data from nearly 180,000 children utilizing 180 school-based health centers across 14 United States states [8]. The researchers found that over three-quarters of these children received their ambulatory care exclusively at these school-based centers. This exclusive-use group was disproportionately low-income, with nearly half living below 138% of the federal poverty line, and over 45% identifying as Hispanic. Compared to children who utilized both school-based and traditional community health centers, those who relied solely on school-based centers were older and far more likely to be uninsured, with an uninsured rate of over 13% compared to less than 3% in the dual-use group. While the exclusive school-based users had fewer total yearly visits, fewer well-child visits, and fewer influenza vaccinations, a significant portion still received vital preventive care, with one-third receiving well-child care and nearly a quarter receiving influenza vaccinations exclusively at school. Preschool-aged children, in particular, received the most preventive services in these settings. These findings underscore the immense potential of school-based health centers to address pediatric health inequities, provided they are adequately resourced and integrated with broader community health networks.

For acute, minor conditions in adults, alternative pathways are also being deployed to alleviate primary care backlogs. In England, the national "Pharmacy First" community pharmacy service was launched in January 2024 to allow patients with minor ailments to be managed directly by pharmacists, who are then required to share consultation details with the patient's general practice. Observations from a study published in the British Journal of General Practice used the OpenSAFELY platform to analyze over 400,000 Pharmacy First consultations recorded in general practice records during the service's first year [5]. The most common conditions managed were acute pharyngitis, making up nearly 29% of consultations, and uncomplicated urinary tract infections, accounting for 28%. The service was utilized more frequently by females, younger adults, and individuals living in more deprived areas compared to the general population. However, the study identified a significant challenge: by January 2025, only about 36% of the recorded consultations in general practice files contained structured coding for a clinical condition, medication, or both. This high level of variation in structured recording limits the ability of researchers and policymakers to evaluate the clinical safety, prescribing habits, and overall effectiveness of the Pharmacy First service, emphasizing the need for more standardized communication interfaces between community pharmacies and general practices.

Finally, we turn to the systemic gaps in caring for patients with complex medical and social needs, starting with individuals who have intellectual or learning disabilities. Two studies published in the British Journal of General Practice highlight the ongoing challenges of identifying and managing care for this vulnerable population in England. The first study analyzed national data on the learning disability annual health check scheme from 2022 to 2025 [6]. While the number of individuals on learning disability registers increased during this period, the overall registry size still represents only a third to a quarter of estimated true prevalence, meaning a vast majority of these patients remain unidentified in primary care records. Furthermore, while the uptake of annual health checks reached nearly 81% for adults, it lagged behind at roughly 72% for adolescents aged 14 to 17. The second study, a population-based cohort analysis spanning 2015 to 2023, examined rates of new registration among young people aged 14 to 24 following the introduction of national targets in the 2019 NHS Long Term Plan [7]. The researchers observed a temporary spike in new registrations during 2020 and 2021, which peaked at nearly 16 per 10,000 person-years in males and over 8 per 10,000 in females, but these rates returned to pre-2019 baseline levels by 2023. Together, these papers demonstrate that while policy targets can drive short-term improvements, sustained effort and systematic practice-level coding are required to ensure that young people with learning disabilities are identified and supported as they transition to adult services.

For older adults managing multiple chronic conditions, improving care coordination requires us to better understand their own communication priorities. A study published in the Journal of the American Board of Family Medicine analyzed visit guides from 451 older adults aged 50 or older who were taking five or more medications across both safety-net and private family medicine clinics [4]. When given a structured guide of questions and concerns to discuss with their clinicians, the top topics of interest to patients were diet, selected by over 20% of participants, taking fewer medications, chosen by over 15%, and understanding their medical conditions, selected by nearly 15%. Regarding medication-specific concerns, 11% reported stopping or skipping medications due to cost, side effects, or other reasons, while 8% expressed concerns about receiving medications from multiple doctors. These findings offer valuable insight into what older, multimorbid patients actually want to discuss during brief primary care encounters. Utilizing structured question prompt lists in our clinics can help bridge the gap between clinical agendas and patient priorities, facilitating more engaging and effective shared decision-making.

If you only have time for one paper this week, make it the study on primary HPV self-sampling among family medicine educators [2]. This paper highlights an imminent shift in cervical cancer screening, showing overwhelming support for a self-sampling option that could dramatically reduce screening disparities in our clinics.

Here are the key takeaways from this week in Family Medicine. First, consider utilizing routine clinical variables like body mass index, glycemic control, and blood pressure to identify high-risk metabolic phenotypes in patients with type 2 diabetes, as these individuals have significantly higher odds of developing both retinopathy and nephropathy [3]. Second, prepare your practice for the integration of self-sampled primary HPV screening, which has strong backing from family medicine educators and the potential to reach patients who historically avoid speculum exams [2]. Third, actively review and update your practice's learning disability registers, paying special attention to adolescents aged 14 to 17 to ensure they are receiving their annual health checks during the critical transition to adulthood [6, 7]. Finally, when caring for older patients with multimorbidity and polypharmacy, routinely address their top self-reported priorities, which include dietary advice, opportunities for deprescribing, and financial or side-effect-related barriers to medication adherence [4].

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.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.