Association Between Cost-Saving Prescription Policy Changes and Adherence to Chronic Disease Medications: an Observational Study
AbstractBackgroundPharmacy benefit design is one tool for improving access and adherence to medications for the management of chronic disease.ObjectiveWe assessed the effects of pharmacy benefit design programs, including a change in pharmacy benefit manager (PBM), institution of a prescription out-of-pocket maximum, and a mandated switch to 90 days ’ medication supply, on adherence to chronic disease medications over time.DesignWe used a difference-in-differences design to assess changes in adherence to chronic disease medications after the transition to new prescription policies.SubjectsWe utilized claims data from...
Source: Journal of General Internal Medicine - July 30, 2021 Category: Internal Medicine Source Type: research

Post-Identification Approaches to Addressing Health-Related Social Needs in Primary Care: A Qualitative Study
ConclusionsThis study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 30, 2021 Category: Internal Medicine Source Type: research

Sociodemographics, Social Vulnerabilities, and Health Factors Associated with Telemedicine Unreadiness Among US Adults
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 30, 2021 Category: Internal Medicine Source Type: research

Association Between High Deductible Health Plans and Cost-Related Non-adherence to Medications Among Americans with Diabetes: an Observational Study
ConclusionHDHPs are associated with greater CRN among people with diabetes, particularly those prescribed insulin. For people with diabetes, enrollment in non-HDHPs might reduce CRN to prescribed medications. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 29, 2021 Category: Internal Medicine Source Type: research

Identifying and Prioritizing Workplace Climate Predictors of Burnout Among VHA Primary Care Physicians
ConclusionIdentifying the relative importance of workplace climate is important for the allocation of health organization resources to mitigate and prevent burnout within the PCP workplace. In a context of limited resources, efforts to reduce perceived workload and improve organization satisfaction may represent the biggest leverage points for health organizations to address physician burnout. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 29, 2021 Category: Internal Medicine Source Type: research

Development of a Primary Care Transitions Clinic in an Academic Medical Center
DiscussionA primary care transitions clinic can provide accessible, attentive care post-discharge with positive effects on healthcare utilization. Availability of a multidisciplinary team that can see patients for repeated visits until establishment of PCP care was a key success factor for the transitions clinic. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 29, 2021 Category: Internal Medicine Source Type: research

“I was not able to keep myself away from tending to her immediate needs”: Primary Care Physicians’ Perspectives of Serious Illness Conversations at Community Health Centers
ConclusionsPhysicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 29, 2021 Category: Internal Medicine Source Type: research

Predicting Life Expectancy to Target Cancer Screening Using Electronic Health Record Clinical Data
ConclusionsWe developed a life expectancy calculator using VA EHR data with excellent discrimination and calibration. Automated life expectancy prediction using EHR data may improve guideline-concordant breast and colorectal cancer screening by identifying patients with a life expectancy>10 years. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 29, 2021 Category: Internal Medicine Source Type: research

Tips for Busy Clinicians to Gauge Conclusions from Clinical Trials
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 29, 2021 Category: Internal Medicine Source Type: research

Bundled Payment Episodes Initiated by Physician Group Practices: Medicare Beneficiary Perceptions of Care Quality
AbstractBackgroundThe Bundled Payments for Care Improvement (BPCI) initiative incentivizes participating providers to reduce total Medicare payments for an episode of care. However, there are concerns that reducing payments could reduce quality of care.ObjectiveTo assess the association of BPCI with patient-reported functional status and care experiences.DesignWe surveyed a stratified random sample of Medicare beneficiaries with BPCI episodes attributed to participating physician group practices, and matched comparison beneficiaries, after hospitalization for one of the 18 highest volume clinical episodes. The sample inclu...
Source: Journal of General Internal Medicine - July 28, 2021 Category: Internal Medicine Source Type: research

Do You Still Wear a Black Dress to a Zoom Funeral?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 28, 2021 Category: Internal Medicine Source Type: research

Physical Therapy Is Better than Glucocorticoid Injections for Osteoarthritis of the Knee
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 28, 2021 Category: Internal Medicine Source Type: research

The COVID-19 Pandemic and Mental Health Symptoms Among US Adults
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2021 Category: Internal Medicine Source Type: research

Abstracts from the 2021 Annual Meeting of the Society of General Internal Medicine
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 23, 2021 Category: Internal Medicine Source Type: research

COVID-19 in the California State Prison System: an Observational Study of Decarceration, Ongoing Risks, and Risk Factors
ConclusionDespite reductions in room occupancy and mixing, California prisons still house many medically vulnerable residents in risky settings. Reducing risks further requires a combination of strategies, including rehousing, decarceration, and vaccination. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 21, 2021 Category: Internal Medicine Source Type: research

Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry
ConclusionsIn hospitalized patients with COVID-19, a pDd value greater than 3.0 μg/ml can be considered to screen VTE and to consider full-dose anticoagulation. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 21, 2021 Category: Internal Medicine Source Type: research

A Race to the End: Family Caregivers ’ Experience of Medical Assistance in Dying (MAiD)—a Qualitative Study
ConclusionsThe “race to the end” theoretical model contributes new knowledge and understanding that can inform the development of tailored support services for caregivers, the impact of legislative changes on this population, and future research examining decision-making near end of life and the caregiver expe rience. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 21, 2021 Category: Internal Medicine Source Type: research

Teaching Telehealth During a Pandemic and Beyond: an Intern ’s Survival Guide for Virtual Medicine
DiscussionUsing experiential learning, we identified strategies which increased the confidence of internal medicine trainees in conducting telemedicine visits. Further research is needed to validate our findings across different practice settings. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 21, 2021 Category: Internal Medicine Source Type: research

Delayed Hypersensitivity Reactions Following First Dose of the SARS-CoV2 mRNA Vaccines
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 21, 2021 Category: Internal Medicine Source Type: research

Promoting Women in Academic Medicine during COVID-19 and Beyond
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 21, 2021 Category: Internal Medicine Source Type: research

Mobile Health for Arrhythmia Diagnosis and Management
AbstractPalpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent commercial availability of smartphone-based devices and wearable technologies with arrhythmia detection capabilities has revolutionized the diagnosis and management of these common medical issues, as it has placed the power of arrhythmia detection into the hands of the patient. Numerous mobile health (mHealth) devices that can detect, record, and automatically interpret irregularities in heart rhythm and abrupt changes in heart rate using photoplethysmogr...
Source: Journal of General Internal Medicine - July 19, 2021 Category: Internal Medicine Source Type: research

Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration
ConclusionsOne-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10 –17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disp arities in treatment receipt or cessation by race, rurality, and psychiatric conditions. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 19, 2021 Category: Internal Medicine Source Type: research

The Association of Readmission Reduction Activities with Primary Care Practice Readmission Rates
AbstractBackgroundA great deal of research has focused on how hospitals influence readmission rates. While hospitals play a vital role in reducing readmissions, a significant portion of the work also falls to primary care practices. Despite this critical role of primary care, little empirical evidence has shown what primary care characteristics or activities are associated with reductions in hospital admissions.ObjectiveTo examine the relationship between practices ’ readmission reduction activities and their readmission rates.Design, Setting, and ParticipantsA retrospective study of 1,788 practices who responded to ...
Source: Journal of General Internal Medicine - July 13, 2021 Category: Internal Medicine Source Type: research

Do Formulation and Dose of Long-Term Opioid Therapy Contribute to Risk of Adverse Events among Older Adults?
ConclusionsOlder adults receiving medically prescribed opioids at higher doses and those using LA and combination of LA and SA opioids are at increased risks for opioid-related adverse events, highlighting the need for close patient supervision. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 13, 2021 Category: Internal Medicine Source Type: research

Impact of 2012 Prostate Cancer Screening Statement
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 13, 2021 Category: Internal Medicine Source Type: research

Mask Work —Translating Lessons Learned in Drama School to Conversations on the Medical Wards
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 13, 2021 Category: Internal Medicine Source Type: research

The Costs of Delayed Generic Drug Entry: Evidence from a Controversial Prostate Cancer Drug Patent
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 13, 2021 Category: Internal Medicine Source Type: research

Associations Between Gender and Racial Patient-Physician Concordance and Visit Outcomes Among Hypertensive Patients in Primary Care
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 13, 2021 Category: Internal Medicine Source Type: research

Identifying and Addressing Barriers to Transgender Healthcare: Where We Are and What We Need to Do About It
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 12, 2021 Category: Internal Medicine Source Type: research

Using incident reporting to understand and characterize sexual harassment of physicians by patients
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 12, 2021 Category: Internal Medicine Source Type: research

Tissue, Teamwork, and Timing: an Exercise in Clinical Reasoning
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 9, 2021 Category: Internal Medicine Source Type: research

Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer ’s Disease: a Systematic Review and Meta-Analysis
ConclusionAF increases the risk of cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer ’s disease. Future studies should employ interventions that may delay or even prevent cognitive decline in AF patients. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 9, 2021 Category: Internal Medicine Source Type: research

The Importance of Glucose Optimization Prior to FDG-PET Imaging in the Diagnosis of Cardiac Sarcoidosis
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 9, 2021 Category: Internal Medicine Source Type: research

Reply Physician Tolerance of Uncertainty
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 9, 2021 Category: Internal Medicine Source Type: research

Provider Network Structure and Black-to-White Disparity Gaps for Medicare Patients with Diabetes: County-Level Analysis of Cost, Utilization, and Clinical Care
AbstractBackgroundPrior work has shown that provider network structures correlate with outcomes such as patient costs, utilization, and care. However, it remains unknown whether certain provider networks are associated with reduced disparity gaps.MethodsWe study the population of Medicare beneficiaries with diabetes who were continuously enrolled in Medicare FFS in 2016. Using multivariable regression analysis of county-level risk adjusted cost, hospitalization, emergency department visits, A1c testing, and preventable diabetes-related hospitalizations, we measure the effect that the relative network connectivity of primar...
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting
ConclusionsIn older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24  months. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Impact of a Dyadic Intervention on Family Supporter Involvement in Helping Adults Manage Type 2 Diabetes
ConclusionsA dyadic patient-supporter intervention led to increased family supporter involvement in diabetes self-management and increased use of positive support techniques, without increasing caregiver stress. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Socio-Demographic Health Determinants Are Associated with Poor Prognosis in Spanish Patients Hospitalized with COVID-19
ConclusionsSocial determinants such as residence in low-income areas and being born in Latin American countries were associated with increased odds of being admitted to an intensive care unit and of in-hospital mortality. There was considerable variation in outcomes between different Spanish centers. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Association Between Neighborhood-Level Poverty and Incident Atrial Fibrillation: a Retrospective Cohort Study
ConclusionIn adults without baseline cardiovascular disease managed in a large, integrated health system, intermediate neighborhood poverty was significantly associated with incident AF. Understanding neighborhood-level drivers of AF disparities will help achieve equitable care. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization
AbstractBackgroundThe Centers for Medicare& Medicaid Services launched the 4-year Comprehensive Primary Care Initiative (CPC Classic) in 2012 and its 5-year successor, CPC Plus (CPC+), in 2017 to test whether improving primary care delivery in five areas —and providing practices with financial and technical support—reduced spending and improved quality. This is the first study to examine long-term effects of a primary care practice transformation model.ObjectiveTo test whether long-term primary care transformation —the 4-year CPC Classic and the first 2 years of its successor, CPC+—reduced hospi...
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Changes in Prescribing by Provider Type Following a State Prescription Opioid Restriction Law
AbstractBackgroundMany states have implemented opioid days ’ supply restriction policies, leading to reductions in opioid prescribing. Although research within certain provider types exist, no study has evaluated a restriction policy by various provider types.ObjectiveTo evaluate changes in opioid utilization following a days ’ supply restriction policy stratified by provider type: surgery, emergency medicine, primary care, specialty care, and dentistry.DesignInterrupted time series (ITS)ParticipantsOpioid prescription claims of patients in a private health plan serving a large Florida employer from 1/1/2015 to...
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Generalists as Clinical Physiologists: Bringing Science Back to the Bedside
DiscussionAn immersive, hands-on faculty development course that integrated physiology with clinical decision-making increased participants ’ comfort level and self-rated ability to teach and incorporate physiology in their clinical work. We believe faculty development is one potential solution to the growing chasm between clinicians and scientists in general medicine. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

How Would Medicare for All Affect Physician Revenue?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Readability of Patient Discharge Instructions
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

A Survey of Aspirin Knowledge Among the General Public
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Differences Between For-profit and Non-profit Hospice Agencies in the US Medicare Population
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Economic Considerations for Hospital at Home Programs: Beyond the Pandemic
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

PSA Screening: a Kind of Russian Roulette?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Describing Death
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 8, 2021 Category: Internal Medicine Source Type: research

Evaluating the Effects of Opioid Prescribing Policies on Patient Outcomes in a Safety-net Primary Care Clinic
ConclusionsClinic-level opioid prescribing policies were associated with reduced dose, although the control clinic achieved similar reductions by the fourth post-policy year, and the policies may have been associated with increased non-prescribed opioid analgesic use. Clinicians should balance the urgency to reduce opioid prescribing with potential harms from rapid change. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - June 25, 2021 Category: Internal Medicine Source Type: research