US Physicians with Recent Experience Managing Hospitalized Older Adults: an Observational Study
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 19, 2020 Category: Internal Medicine Source Type: research

Does Mental Health Care Integration Affect Primary Care Clinician Burnout? Results from a Longitudinal Veterans Affairs Survey
ABSTRACTBackgroundBurnout among primary care clinicians (PCPs) is associated with negative health and productivity consequences. The Veterans Health Administration (VA) embedded mental health specialists and care managers in primary care to manage common psychiatric diseases. While challenging to implement, mental health integration is a team-based care model thought to improve clinician well-being.ObjectiveTo examine the relationships between PCP-reported burnout (and secondarily, job satisfaction) and mental health integration at provider and clinic levelsDesignAnalysis of 286 cross-sectional surveys in 2012 (n =&...
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

Low Skepticism and Positive Attitudes About Advance Care Planning Among African Americans: a National, Mixed Methods Cohort Study
ConclusionsSkepticism about ACP may contribute to low rates of ACP engagement in underserved African American communities. The positive attitudes uncovered in our study either negate previous findings or suggest reduced skepticism.Trial RegistrationThis study has been registered atclinicaltrials.gov (NCT03456921) (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

The Doctor-Public Relationship: How Physicians Can Communicate to Foster Resilience and Promote Mental Health During COVID-19
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

Trends in Industry Payments to Physicians for Antihyperglycemic Therapies Between 2014 and 2018
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

Diabetes Phenotyping Using the Electronic Health Record
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

Financial Burdens of Out-of-Pocket Prescription Drug Expenditures under High-Deductible Health Plans
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

Price Transparency for COVID-19 Testing Among Top US Hospitals
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults: Multicentered Cross-sectional Study
ConclusionsInfluenza and pneumococcal vaccine uptake were positively associated with patient experience of primary care in older adults. Consideration of patient experience, particularly longitudinality, coordination, comprehensiveness, and community orientation, could improve vaccine uptake. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 16, 2020 Category: Internal Medicine Source Type: research

Are Social Media Groups the Novel Physician Lounges to Combat COVID Times?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 16, 2020 Category: Internal Medicine Source Type: research

Health and Social Precarity Among Americans Receiving Unemployment Benefits During the COVID-19 Outbreak
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 16, 2020 Category: Internal Medicine Source Type: research

Direct-to-Consumer Drug Advertisement and Prescribing Practices: Evidence Review and Practical Guidance for Clinicians
AbstractDirect to consumer advertising (DTCA) of prescription drugs has increased dramatically in the past two decades. The effect of this increase in advertising on the frequency of inappropriate prescribing is poorly understood, as are the factors that may underly inappropriate prescribing. A review of existing observational and experimental studies that address advertising-related prescription requests and contain some measure of prescription appropriateness demonstrate that DTCA increases prescription requests, increases the likelihood of prescription, and increases both appropriate and inappropriate prescribing. Patie...
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Engaging Women with Limited Health Literacy in Mammography Decision-Making: Perspectives of Patients and Primary Care Providers
ConclusionBoth patients and PCPs perceived a need for tools to relay technical and process knowledge about mammography prior to clinical encounters to address the scope of information that patients with limited health literacy desired. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Specific Disease Knowledge as Predictor of Susceptibility to Availability Bias in Diagnostic Reasoning: a Randomized Controlled Experiment
ConclusionsKnowledge of features that discriminate between look-alike diseases reduced susceptibility to bias in a simulated setting. Reflecting further may be required to overcome bias, but succeeding depends on having the appropriate knowledge. Future research should examine whether the findings apply to real practice and to more experienced physicians. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Delta Studies: Expanding the Concept of Deviance Studies to Design More Effective Improvement Interventions
ConclusionsThe delta study concept is a promising mixed methods innovation to efficiently and effectively identify improvement strategies and other factors that have actually produced change in real-world settings. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Using Lean-Facilitation to Improve Quality of Hepatitis C Testing in Primary Care
ConclusionsHigh-reach and relatively low effort, but persistent intervention led to significant improvement in guideline-concordant HCV testing rates which were sustained.Trial RegistrationClinicalTrials.gov Identifier: NCT02936648 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

The Effect of Healthcare Provider Availability on Spine Spending
ConclusionsProvider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect healthcare spending. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Prescription Opioid Dispensing Patterns Prior to Heroin Overdose in a State Medicaid Program: a Case-Control Study
AbstractBackgroundA large proportion of individuals who use heroin report initiating opioid use with prescription opioids. However, patterns of prescription opioid use preceding heroin-related overdose have not been described.ObjectiveTo describe prescription opioid use in the year preceding heroin overdose.DesignCase-control study comparing prescription opioid use with a heroin-involved overdose, non-heroin-involved opioid overdose, and non-overdose controls from 2015 to 2017.ParticipantsOregon Medicaid beneficiaries with linked administrative claims, vital statistics, and prescription drug monitoring program data.Main Me...
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Provider Response to Critical Action Values for Hypoglycemia in the Ambulatory Setting: a Retrospective Cohort Study
AbstractBackgroundThe blood glucose level triggering a critical action value (CAV) for hypoglycemia is not standardized, and associated outcomes are unknown.ObjectiveTo evaluate the clinical consequences of, and provider responses to, CAVs for hypoglycemia.DesignRetrospective cohort study at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center between April 1, 2013, and January 31, 2017.ParticipantsPatients with an ambulatory serum glucose
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

COVID-19-Associated Deaths in San Francisco: the Important Role of Dementia and Atypical Presentations in Long-term Care Facilities
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Oral Anticoagulant Use in a Racial and Ethnically Diverse Population with Atrial Fibrillation
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Quality of Care for Women with Urinary Incontinence in the Veterans Health Administration
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Delivering Complex Care: Designing for Patients and Physicians
AbstractThe management of high-utilizing patients is an area of active research with broad implications for the healthcare system. There are significant operational challenges to designing primary care models for these medically complex, high-needs patients. Although it is crucial to provide a high degree of continuity of care for this population, managing a cohort of these patients can lead to provider over-work and attrition. This may be magnified by the lack of training dedicated to addressing the unique care needs of these patients. While academic medical centers would seem well suited to care for individuals with mult...
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Performance of Temporal Artery Temperature Measurement in Ruling Out Fever: Implications for COVID-19 Screening
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Charges of COVID-19 Diagnostic Testing and Antibody Testing Across Facility Types and States
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

“Racial Bias…I’m Not Sure if It Has Affected My Practice”: a Qualitative Exploration of Racial Bias in Team-Based Primary Care
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Psychological Distress and Access to Mental Health Services Among Cancer Survivors: a National Health Interview Survey Analysis
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Unintended Consequences
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 15, 2020 Category: Internal Medicine Source Type: research

Elderberry Extract Outpatient Influenza Treatment for Emergency Room Patients Ages 5 and Above: a Randomized, Double-Blind, Placebo-Controlled Trial
ConclusionsWe found no evidence that elderberry benefits the duration or severity of influenza. Post hoc analysis suggested primary outcomes with elderberry taken alone (without oseltamivir) were 2  days worse than with placebo taken alone. Our results contradict previous studies and demonstrate the need for further studies.Trial RegistrationNCT03410862 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

“Health Is on the Back Burner:” Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs
ConclusionsFindings regarding the multilevel barriers and facilitators to accessing primary care among PWID identify potential targets for programmatic interventions to improve primary care utilization in this population. Based on these findings, we make recommendations for improving the engagement of PWID in primary care as a means to advance individual and public health outcomes. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 11, 2020 Category: Internal Medicine Source Type: research

Patients ’ and Caregivers’ Experiences with the Multi-Payer Advanced Primary Care Practice Demonstration
ConclusionsMost participants had positive experiences with their care. Opportunities exist, however, to improve care for Medicaid and dually eligible beneficiaries, and enhance patient awareness of and involvement in PCMH practice transformation. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 11, 2020 Category: Internal Medicine Source Type: research

Concerns of Primary Care Clinicians Practicing in an Integrated Health System: a Qualitative Study
ConclusionPCCs in integrated health systems feel many of the same pressures as their counterparts in non-integrated settings, but they are also confronted with unique stressors related to these systems ’ organizational features that restrict clinicians’ autonomy. An understanding of these concerns can guide efforts to improve the well-being of PCCs in existing integrated health systems, as well as in practices on their way to integration. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 11, 2020 Category: Internal Medicine Source Type: research

Implementation Strategies for Frontline Healthcare Professionals: People, Process Mapping, and Problem Solving
AbstractImplementation science is focused on developing and evaluating methods to reduce gaps between research and practice. As healthcare organizations become increasingly accountable for equity, quality, and value, attention has been directed to identifying specific implementation strategies that can accelerate the adoption of evidence-based therapies into clinical practice. In this perspective, we offer three simple, practical strategies that can be used by frontline healthcare providers who are involved in on-the-ground implementation: people (stakeholder) engagement, process mapping, and problem solving. As a use case...
Source: Journal of General Internal Medicine - September 11, 2020 Category: Internal Medicine Source Type: research

Using Implementation Science-Guided Pilot Studies to Assess and Improve the Informativeness of Clinical Trials
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 11, 2020 Category: Internal Medicine Source Type: research

Trends and Disparities in Functional Impairment among US Adults Age 55 –64, 2002 to 2016
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 11, 2020 Category: Internal Medicine Source Type: research

Home Sick with Coronavirus Symptoms: a National Study, April –May 2020
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 10, 2020 Category: Internal Medicine Source Type: research

Primary Care Clinicians ’ Beliefs and Strategies for Managing Chronic Pain in an Era of a National Opioid Epidemic
ConclusionsPCC beliefs about opioid therapy generally align with the clinical evidence, but may have some important gaps. These findings suggest the potential value of interventions that include improved access to research findings; organizational changes to support PCCs in spending time with patients to develop rapport and trust, elicit information about pain, and manage patient expectations; and the need for innovative clinical cognitive support. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Enhancing Usability of Appointment Reminders: Qualitative Interviews of Patients Receiving Care in the Veterans Health Administration
ConclusionsAppointment reminders are vital to prevent no-shows, but their usability is not optimized for patients. There is potential for healthcare systems to modify several aspects of the content, timing, and delivery of appointment reminders to be more effective and patient-centered. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Physician Factors Associated with Inappropriate Vitamin B12 Prescribing in Ontario, Canada
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Behind the Mask
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Estimating Discounts for Top Spending Drugs in Medicare Part D
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Cardiac Metastases from Renal Cell Carcinoma
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings
AbstractBackgroundIntegrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams ’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation.ObjectivesDevelop a QI training program ( “Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA).DesignThis was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to part...
Source: Journal of General Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Long-Term Implications of Post-ACA Health Reform on State Health Care Policy
AbstractIn the midst of the COVID-19 outbreak, health care reform has again taken a major role in the 2020 election, with Democrats weighing Medicare for All against extensions of the Affordable Care Act, while Republicans quietly seem to favor proposals that would eliminate much of the ACA and cut Medicaid. Although states play a major role in health care funding and administration, public and scholarly debates over these proposals have generally not addressed the potential disruption that reform proposals might create for the current state role in health care. We examine how potential reforms influence state-federal rela...
Source: Journal of General Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India
ConclusionsEmpowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Effect of Outpatient Note Templates on Note Quality: NOTE (Notation Optimization through Template Engineering) Randomized Clinical Trial
AbstractBackgroundThis is the first randomized controlled trial evaluating the impact of note template design on note quality using a simulated patient encounter and a validated assessment tool.ObjectiveTo compare note quality between two different templates using a novel randomized clinical simulation process.DesignA randomized non-blinded controlled trial of a standard note template versus redesigned template.ParticipantsPGY 1-3 IM residents.InterventionsResidents documented the simulated patient encounter using one of two templates. The standard template was modeled after the usual outpatient progress note. The new temp...
Source: Journal of General Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Developing a Novel Resilience Curriculum for Internal Medicine Interns Using a Survey-Based Needs Assessment
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Implementation of a Behavioral Economics Electronic Health Record (BE-EHR) Module to Reduce Overtreatment of Diabetes in Older Adults
ConclusionsThe BE-EHR module shows promise for promoting the AGS CW guideline and improving diabetes management in older adults. A randomized controlled trial will commence to test the effectiveness of the intervention across 66 NYULH clinics.NIH Trial Registry NumberNCT03409523 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 3, 2020 Category: Internal Medicine Source Type: research

Spreading Addictions Care Across Oregon ’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program
ConclusionsA statewide, interprofessional SUD hospital care ECHO was feasible and acceptable. Findings may be useful to health systems, states, and regions looking to expand hospital-based addictions care. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 3, 2020 Category: Internal Medicine Source Type: research

Comparison of Discounted and Undiscounted Cash Prices for Cardiovascular Medications by Type of US Community Pharmacy
ConclusionsGoodRx-discounted cash prices of generic CV medications were significantly lower than undiscounted cash prices at supermarket, mass  merchandiser, and national chain pharmacies. Analytical pharmacy cash prices too were significantly lower than traditional pharmacy undiscounted cash prices. GoodRx-discounted prices for brand-name CV medications did not differ significantly from undiscounted cash prices and between pharmacy types . (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 3, 2020 Category: Internal Medicine Source Type: research