Journal of General Internal Medicine最新文献

{"title":"Impact of a Novel Curriculum on Internal Medicine Residents' Management of Outpatient Hypertensive Urgencies.","authors":"Natasha Cigarroa, Donna M Windish, Benjamin D Gallagher","doi":"10.1007/s11606-024-09272-x","DOIUrl":"10.1007/s11606-024-09272-x","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1938-1939"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators to Implementing Food is Medicine for the Management of Type 2 Diabetes in China.","authors":"Yuze Xin, Hongru Sun, Shuangjie Peng, Xuejun Yin, Anqi Ge, Xinyan Liu, Tengyi Wang, Jingxue Sun, Yanmeizhi Wu, Kristy Law, Kathy Trieu, Jason H Y Wu, Hong Qiao, Maoyi Tian","doi":"10.1007/s11606-024-09251-2","DOIUrl":"10.1007/s11606-024-09251-2","url":null,"abstract":"<p><strong>Background: </strong>'Food is Medicine', a rapidly growing innovative intervention, has been shown to improve the management of type 2 diabetes mellitus (T2DM). However, due to the unique characteristics of Chinese dietary culture, it remains unclear whether such intervention measures can be implemented in China.</p><p><strong>Objective: </strong>To identify the potential barriers and facilitators to implementing 'Food is Medicine' intervention for the management of people living with T2DM in three Chinese provinces.</p><p><strong>Design: </strong>Face-to-face semi-structured individual in-depth interview and focus group discussions in Heilongjiang, Hubei and Ningxia provinces in China.</p><p><strong>Participant: </strong>People living with T2DM.</p><p><strong>Approach: </strong>Both inductive and deductive methods were used to analyse the interview data, guided by the COM-B framework.</p><p><strong>Key results: </strong>A total of 97 individuals participated in the study. Participants were concerned about the prices of buying prescribed meals, if not fully subsidised by healthcare system. Other barriers included the potential challenge to adhering to prescribed meals for long periods if the variety was limited, the difficulties in delivering fresh food or meals to remote areas and the lack of knowledge of healthy diets among the people living with T2DM and their relatives. In contrast, clinicians' confidence in the effectiveness of food and meal prescription, the opportunities to collaborate with community canteens on producing prescribed foods, and the convenience of preparing food for people with T2DM were identified as the main enablers.</p><p><strong>Conclusions: </strong>There are presently several potential barriers to future implementing 'Food is Medicine' to manage people living with T2DM. But there are also clear opportunities to develop a context-tailored 'Food is Medicine' intervention in China.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1701-1710"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians.","authors":"Priya N Jain, Christopher J King, Kiana Johnson, Robert L Fogerty, Venkata G Andukuri, Kshitij Thakur, Remus Popa, Kencee K Graves","doi":"10.1007/s11606-024-09343-z","DOIUrl":"10.1007/s11606-024-09343-z","url":null,"abstract":"<p><strong>Purpose: </strong>Physicians are estimated to be responsible for more than 50% of national healthcare costs and hold the greatest potential to improve value by orchestrating quality-driven programs to reduce unnecessary practices and variability. A physician's ability to practice cost-conscious care has been linked to their training, underscoring the importance of integrating cost-conscious practice into training.</p><p><strong>Methods: </strong>The High Value Practice Academic Alliance was formed to help advance the value-improvement work of individual institutions through a national organization. We developed a curriculum and mentorship model for trainees throughout the country titled the Future Leaders Program (FLP). Upon entry to FLP, GME physicians completed a baseline self-assessment of their knowledge about costs, payment, and value in healthcare. Over 1 year, these physicians participated in structured educational activities related to high-value care (HVC), received mentorship focused on leading a value-based quality improvement (QI) project, and then completed a second self-assessment upon completion of the program.</p><p><strong>Results: </strong>Over four academic years (AY17-18 through AY20-21), we had 161 respondents. Most participants report some prior education in healthcare value; however, many had never participated in a QI project. Participants showed variability in their knowledge. After completion of the program, paired sample t-tests demonstrated significant differences in the subscale scores for value knowledge (M =  - 0.63, SD = 0.93), attitudes (M =  - 0.46, SD = 0.45), and skills (M =  - 0.40, SD = 0.71) indicating that participating in a value-focused QI project improved value knowledge, t(160) =  - 9.66, p < .001; attitudes towards high-value care teaching, t(160) =  - 12.48, p < .001; and high-value care practice frequency, t(160) =  - 6.93, p < .001.</p><p><strong>Conclusions: </strong>Skills and knowledge are significantly improved after completion of our program, demonstrating that a free, web-based curriculum and tiered mentoring program can be effective in teaching HVC skills and preparing physicians to lead this work.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1776-1781"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Neighborhood Socioeconomic Deprivation on Effectiveness of an Intensive Lifestyle Intervention.","authors":"Mamadou Sy, Scott Pilla, Wendy Bennett, Hsin-Chieh Yeh, Kesha Baptiste-Roberts, Tiffany L Gary-Webb, Dhananjay Vaidya, Jeanne M Clark","doi":"10.1007/s11606-024-09232-5","DOIUrl":"10.1007/s11606-024-09232-5","url":null,"abstract":"<p><strong>Objective: </strong>To assess the influence of neighborhood socioeconomic deprivation on the effectiveness of an intensive lifestyle intervention (ILI) in the Look AHEAD trial.</p><p><strong>Research design and methods: </strong>Look AHEAD randomized adults with overweight/obesity and type 2 diabetes to ILI for weight loss, or Diabetes Support and Education (DSE). We linked participant data from four study sites to the 2000 United States Census to generate a neighborhood socioeconomic deprivation score. We analyzed the effect of neighborhood deprivation in tertiles on various clinical outcomes including weight and HbA1c changes over 4 years using a mixed-effects linear model with random intercept and an interaction term between deprivation tertile and study arm over 4 years.</p><p><strong>Results: </strong>Among 1213 participants at baseline, the mean age was 60 years, 41% were male, and 65% identified as White, 26% as Black, and 4% as Hispanic. Most participants had a college degree (84%) and reported an annual income over $40,000 (75%). The deprivation score ranged from -12.04 to -2.61 in the most deprived tertile and 2.01 to 18.69 in the least deprived tertile (the lower the score, the higher the deprivation). There were no statistically significant treatment differences by deprivation score in weight or HbA1c changes over the 4-year period.</p><p><strong>Conclusions: </strong>In this clinical trial population, an intensive lifestyle intervention was equally effective across levels of neighborhood socioeconomic deprivation. However, these findings may not extend to individuals with the lowest income and educational attainment who are not typically represented in clinical trials and for whom more research is needed.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1728-1734"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More on Food as Medicine: Critical Need for Effective Interventions.","authors":"D Michael Elnicki, Lenny Lopez, Joseph Conigliaro","doi":"10.1007/s11606-025-09469-8","DOIUrl":"10.1007/s11606-025-09469-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1699-1700"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Medical Debt and Vaccine Uptake in the USA, 2021-2022.","authors":"Kathryn E W Himmelstein, Amir M Mohareb","doi":"10.1007/s11606-024-09183-x","DOIUrl":"10.1007/s11606-024-09183-x","url":null,"abstract":"<p><strong>Background: </strong>Many individuals do not receive recommended vaccines, increasing infectious disease morbidity and mortality. It is unknown whether the financial practices of US healthcare institutions contribute to vaccine hesitancy.</p><p><strong>Objective: </strong>To determine whether medical debt is associated with low vaccine uptake.</p><p><strong>Design: </strong>Cross-sectional analysis of the association between medical debt and vaccine receipt.</p><p><strong>Subjects: </strong>56,373 adult participants in the 2021-2022 National Health Interview Survey.</p><p><strong>Interventions: </strong>Presence of medical debt at the time of survey administration.</p><p><strong>Main measures: </strong>We used logistic regression models to assess whether medical debt was associated with recent vaccine receipt, adjusting for sociodemographic, health, and access-to-care variables. We performed a sensitivity analysis restricted to individuals with health insurance and conducted a falsification test of the hypothesis that current medical debt would not be associated with remote prior vaccination (i.e., > 1 year prior, likely before debt acquisition).</p><p><strong>Key results: </strong>Individuals with medical debt were less likely than those without such debt to receive any recent vaccine (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.76-0.91), including influenza vaccination (aOR 0.83, 95% CI 0.75-0.91) or COVID-19 vaccination (aOR 0.79, 95% CI 0.69-0.91). Analyses limited to insured individuals had similar findings (aOR for any recent vaccination 0.79, 95% CI 0.72-0.88). In the falsification test, current medical debt was not associated with remote prior vaccination (aOR 1.04, 95% CI 0.93-1.16).</p><p><strong>Conclusions: </strong>Current medical debt is associated with lower likelihood of recent vaccine receipt in both insured and uninsured individuals. Policies that minimize medical debt may improve vaccine coverage.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1851-1858"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered Frameworks.","authors":"Christopher Joshi, Sehrish Malik, Wei Wang, Kei Ouchi","doi":"10.1007/s11606-024-09243-2","DOIUrl":"10.1007/s11606-024-09243-2","url":null,"abstract":"<p><strong>Background: </strong>Helping patients make decisions about their preferences for cardiopulmonary resuscitation (i.e., code status) is an important way to respect patient autonomy in the hospital. There is a gap in understanding which framework of discussion patients prefer for this decision-making.</p><p><strong>Objective: </strong>To determine which of two frameworks to code status discussions-information-centered or patient values-centered-make patients feel more heard and understood about their preferences regarding cardiopulmonary resuscitation (CPR).</p><p><strong>Design: </strong>Prospective, randomized study comparing two different frameworks to CPR discussion.</p><p><strong>Participants: </strong>We enrolled adult patients with one or more serious illnesses who were recently discharged from an urban, tertiary care, academic medical center in Boston, MA.</p><p><strong>Interventions: </strong>Subjects were randomized to receive either the information-centered framework, in which their likelihood of recovery following CPR was shared, or the patient values-centered framework, in which their personal values were elicited and used to make a recommendation.</p><p><strong>Main measures: </strong>Subject-reported heard and understood rating with regard to their preferences for CPR.</p><p><strong>Key results: </strong>Of the 46 subjects enrolled, 25 (54.3%) were male, 42 (91.3%) were White, and 3 (6.5%) were Black. Mean age was 66.4 ± 11.8 years. Subjects reported feeling more \"heard and understood\" about their preferences for CPR with the patient values-centered framework compared with after the information-centered framework (p = 0.033). When asked, 89% of subjects \"definitely\" or \"probably\" wanted to hear their doctor's personalized recommendation about CPR (p < 0.001).</p><p><strong>Conclusion: </strong>Patients, in line with palliative care experts, largely support a patient values-centered framework to CPR, including a recommendation made by the clinician based on the patient's expressed values.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1829-1835"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing Micronutrient Deficiencies for Modern times: A Review.","authors":"Azadeh Lankarani-Fard, Maria Romanova, Zhaoping Li","doi":"10.1007/s11606-025-09481-y","DOIUrl":"10.1007/s11606-025-09481-y","url":null,"abstract":"<p><p>Micronutrient deficiencies are often discounted in as an entity of the past when access to quality nutrition was scarce. However modern-day conditions such as hemodialysis, complex medication interactions, parenteral nutrition, gastrointestinal resections, institutional living, and substance use can place patients at risk. The metabolic demands of critical illness during prolonged hospitalization may provide added stressors. Food insecurity with reliance on inexpensive calorie-rich, nutrient poor diet may lead to deficiency without overt evidence of malnutrition. Moreover, clinical presentation may be subtle and easily attributed to other diagnoses. Increased awareness of current risk factors is essential for detection and treatment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1735-1741"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unbanked Status Among Individuals with Diabetes: Exploring Reasons, Correlates, and Implications for Financial and Health Outcomes.","authors":"Minal R Patel","doi":"10.1007/s11606-024-09245-0","DOIUrl":"10.1007/s11606-024-09245-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1933-1935"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional Evaluation of State-Level Protections, Medical Debt, and Deferred Care Among Sexual and Gender Minority People.","authors":"Emily Lupton Lupez, Steffie Woolhandler, David U Himmelstein, Samuel Dickman, Elizabeth Schrier, Lenore S Azaroff, Chris Cai, Danny McCormick","doi":"10.1007/s11606-024-09258-9","DOIUrl":"10.1007/s11606-024-09258-9","url":null,"abstract":"<p><strong>Background: </strong>Millions of Americans have medical debt and/or defer care due to cost. Few studies have examined the association of such health-related financial problems with sexual orientation or gender identity, and whether state-level policies protecting sexual and gender minority (SGM) people affect disparities in such problems.</p><p><strong>Objective: </strong>To examine the relationships between SGM status, state-level SGM protections, and health-related financial problems.</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Participants: </strong>Nationally-representative sample of U.S. adults in the 2021 National Financial Capability Study.</p><p><strong>Main measures: </strong>Prevalence of medical debt and/or deferred care; adjusted odds ratios (aORs) by SGM status and residence in a state with fewer SGM protections.</p><p><strong>Key results: </strong>Of 25,170 survey respondents, 3.7% were gay/bisexual men, 4.3% lesbian/bisexual women, and 0.6% transgender people. Among lesbian/bisexual women, 39.4% had medical debt, the highest proportion of any group. Accounting for sociodemographic and personal-financial factors, women and all lesbian/gay/bisexual persons (vs. straight men) more often experienced medical debt (aOR [95% CI]: straight women 1.28 [1.16, 1.41], gay/bisexual men 1.55 [1.23, 1.94], lesbian/bisexual women 1.80 [1.50, 2.10]) or deferred care (e.g., 1.80 [1.51, 2.16] for lesbian/bisexual women). Transgender people vs. cisgender men were more likely to defer care (aOR = 2.58 [1.54, 4.30]). Living in a state with fewer SGM protections was associated with higher rates of health-related financial problems for most groups, especially cisgender women and lesbian/bisexual women.</p><p><strong>Conclusions: </strong>Lesbian/gay/bisexual, female, and transgender adults experience more health-related financial problems, especially in states lacking SGM protections, underlining the importance of universal, comprehensive insurance coverage (including for services unique to SGM people), ending bans on gender-affirming care, and closing the male-female pay gap.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1859-1868"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}