Journal of General Internal Medicine最新文献

{"title":"Associations of Medicare Advantage Enrollment Duration with Health Insurance Literacy and Access to and Affordability of Health Care.","authors":"Elizabeth Staton, Sungchul Park","doi":"10.1007/s11606-025-09628-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09628-x","url":null,"abstract":"<p><strong>Background: </strong>Health insurance literacy is crucial for making informed decisions about insurance plans, particularly in the context of the complex structure of Medicare Advantage (MA). Longer MA enrollment has the potential to improve health insurance literacy, which may, in turn, enhance access to and affordability of care. However, the extent of this relationship remains poorly understood.</p><p><strong>Objective: </strong>To examine the association of the duration of MA enrollment with health insurance literacy as well as access to and affordability of care.</p><p><strong>Design: </strong>Cross-sectional study within the MA setting.</p><p><strong>Participants: </strong>13,103 Medicare Advantage enrollees from the 2017-2020 Medicare Current Beneficiary Survey.</p><p><strong>Main measures: </strong>Health insurance literacy, access to care, and affordability of care.</p><p><strong>Key results: </strong>Compared to those enrolled in MA for 1-2 years, those with 3-5, 6-10, and ≥11 years of enrollment were more likely to report better understanding and knowledge of Medicare (adjusted differences ranging from 3.44 [p=0.011] to 6.53 [p<0.001] percentage points). Additionally, they were less likely to report trouble getting needed care (1.85 [p=0.007], 2.68 [p < 0.001], 2.08 [p=0.01] percentage points for 3-5, 6-10, and ≥11 years of enrollment). More pronounced differences were observed in care affordability: delaying care due to cost decreased by -1.36 (p=0.13), 2.59 (p=0.003), 2.39 (p=0.04) percentage points while having problems paying medical bills decreased by 3.48 (p<0.001), 2.76 (p<0.001), 2.93 (p=0.003) percentage points. However, these associations did not necessarily increase with enrollment beyond 3-5 years.</p><p><strong>Conclusions: </strong>Our findings indicate that longer MA enrollment is associated with higher health insurance literacy and better access to and affordability of care. However, this association appears to plateau after the first few years of enrollment. These results underscore the importance of implementing targeted programs to enhance health insurance literacy among those newly enrolled in MA, with the goal of improving access to and affordability of care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119835","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":"Lung Cancer Screening Offers and Low-Dose Computed Tomography Completion Among Veterans Experiencing Homelessness.","authors":"Jill S Roncarati, Thomas Byrne, Stefan G Kertesz, A Rani Elwy, Chris X Xu, Camilla B Pimentel, Renda Soylemez Wiener","doi":"10.1007/s11606-025-09622-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09622-3","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110825","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":"The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care.","authors":"Anthony J Lisi, Lori A Bastian, Cynthia A Brandt, Brian C Coleman, Brenda Fenton, Joseph T King, Joseph L Goulet","doi":"10.1007/s11606-025-09556-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09556-w","url":null,"abstract":"<p><strong>Background: </strong>Key nonpharmacologic therapies, including those routinely provided by chiropractors, are recommended first-line treatments for low back pain (LBP). Little is known on whether such care provided in the Veterans Health Administration (VA) has a downstream effect on the use of other healthcare services, including opioid prescriptions.</p><p><strong>Objective: </strong>To evaluate the impact of chiropractic care on receipt of opioid prescriptions within 365 days of an incident primary care provider (PCP) visit for LBP among opioid-naïve VA patients.</p><p><strong>Design: </strong>Cross-sectional analysis with longitudinal follow-up.</p><p><strong>Participants: </strong>Patients had an LBP visit with a VA PCP between 10/1/2015 and 9/30/2020, without any VA LBP visit in the preceding 18 months, and then 2 subsequent VA LBP visits in the following 12 months.</p><p><strong>Main measures: </strong>VA electronic health record data including outpatient visits, prescriptions, and comorbid diagnoses.</p><p><strong>Key results: </strong>A total of 128,377 patients met study criteria. The hazard ratio for opioid prescription in a propensity-matched sample was 0.77 (95% CI 0.71-0.83), indicating a significantly lower risk for receipt of an opioid prescription among chiropractic care users in the 365-day follow-up adjusting for potential confounders. The cumulative incidence of opioid prescriptions was 13.0% for chiropractic care users and 16.8% for non-users and the number needed to treat was 27.</p><p><strong>Conclusions: </strong>The results of this study show that nonpharmacologic chiropractic care can be an important component of opioid sparing strategies for VHA patients with LBP.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110909","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":"\"They Don't Just Need a Handshake or a Handoff, They Need a Hug\": A Qualitative Assessment of the Care Transition Experience of Patients with Substance Use Disorders After Hospital Discharge.","authors":"Michael A Incze, Tatum Anderson, Annika M Hansen, Kathryn Szczotka, Laura Stolebarger, Stephanie Tuckett, Shanaya Fox, Carolyn Bell, Patrick Galyean, Danielle Babbel, Susan Zickmund","doi":"10.1007/s11606-025-09614-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09614-3","url":null,"abstract":"<p><strong>Background: </strong>Hospitalizations are common among people with substance use disorders (SUD). Transitioning to follow-up medical and SUD care after discharge is a complex process affected by numerous medical, environmental, and psychosocial factors. Little is known about the experiences of patients with SUD during post-hospitalization care transitions.</p><p><strong>Objective: </strong>We sought to better understand the care transition experiences of people with SUD in the immediate post-hospitalization period.</p><p><strong>Design: </strong>We conducted a qualitative study at a single academic hospital site.</p><p><strong>Participants: </strong>We interviewed 25 recently hospitalized individuals with a SUD.</p><p><strong>Approach: </strong>Participants were recruited during their hospitalization, and semi-structured interviews were completed via telephone 1-3 weeks after hospital discharge. Interviews were transcribed verbatim and coded. Thematic analysis was performed to inductively extract key themes from coded transcripts.</p><p><strong>Key results: </strong>We identified six themes pertaining to post-hospitalization care transition experiences: (1) the timing and circumstances of hospital discharge were often unpredictable, which could be destabilizing for patients; (2) careful planning and thorough communication by hospital care teams at discharge were valued by patients but happened inconsistently; (3) substance use disorder treatment was desired and offered frequently via a spectrum of active and passive approaches; (4) patients faced multifarious challenges to following through with a care plan after discharge; (5) community supports and a sense of connection are key facilitators of SUD and medical care linkage after hospital discharge; and (6) proactive outreach, individualized care plans, and continuity of care are valued during post-hospitalization care transitions.</p><p><strong>Conclusion: </strong>Our themes suggest several distinct and actionable steps to improve post-hospitalization care transitions based on the perspectives of people with SUD who were actively transitioning care. In the hospital, SUD treatment initiation, proactive planning around discharge, and predictability were valued. In the outpatient setting, a supportive community, assistance with basic amenities, and post-discharge outreach were valued.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110775","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":"Early Implementation of a Regional Telehealth Contingency Staffing Program and Primary Care Quality in the Veterans Health Administration: Evidence from the Clinical Resource Hub program.","authors":"Chelle L Wheat, Sara E Kath, Karin M Nelson, Idamay Curtis, Ashok Reddy","doi":"10.1007/s11606-025-09615-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09615-2","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH) program to address primary care staffing deficits and improve access.</p><p><strong>Objective: </strong>To determine if the quality of primary care at clinics that use CRH services was similar to that of clinics that did not. Secondarily, to examine this association for clinics that serve a high proportion of minority Veterans.</p><p><strong>Design: </strong>A quasi-experimental study using VHA administrative data from October 2017 through September 2021. We applied interrupted time series models to estimate changes in primary care quality measures associated with CRH utilization. Results are reported as percentages.</p><p><strong>Participants: </strong>National cohort of 107 propensity-matched VHA clinics that did and did not use CRH primary care services INTERVENTION(S): CRH primary care services MAIN MEASURE(S): Chronic disease quality measures KEY RESULTS: For diabetes quality measures, we found similar results between CRH-utilizing clinics and their controls, including annual HbA1c screening (0.0% percentage difference (-1.0%, 1.0%), p = 0.640), poor HbA1c control (-1.0% (-1.0%, 0.0%), p=0.111), control of blood pressure for Veterans with diabetes (1.0% (-0.0%, 3.0%), p=0.095), statin therapy for Veterans with diabetes (1.0% (0.0%, 1.0%), p=0.003), statin adherence for Veterans with diabetes (0.0% (-1.0%, 0.0%), p=0.292), and nephropathy screening (1.0% (0.0%, 1.0%), p=0.010). There were no differences between clinic groups for control of blood pressure (1.0% (-1.0%, 2.0%), p=0.382). For cardiovascular quality measures, including statin therapy for Veterans with cardiovascular disease (0.0% (-1.0%, 2.0%), p=0.348), and statin adherence for Veterans with cardiovascular disease (-1.0% (-3.0%, 1.0%), p=0.467), we found no differences between clinic groups. Similar results were found among clinics that serve a high proportion of minority Veterans.</p><p><strong>Conclusions: </strong>We found that quality measures at CRH-utilizing clinics are similar to matched comparator clinics. These findings demonstrate that telehealth interventions, like CRH, can improve access to primary health care in a variety of settings, without impacting the quality of primary care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110779","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":"Risk of New Headaches Following GLP-1RA Initiation in Older Adults with Type 2 Diabetes: A Target Trial Emulation.","authors":"Hao Dai, Grant D Scheiffele, Huilin Tang, William T Donahoo, Sarah C Westen, Jiang Bian, Jingchuan Guo","doi":"10.1007/s11606-025-09612-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09612-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110896","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":"The Rules of Being a Patient.","authors":"Leah Ratner, Noor Elshaar","doi":"10.1007/s11606-025-09609-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09609-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110937","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":"Floodgates.","authors":"Sarah S Fittro","doi":"10.1007/s11606-025-09563-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09563-x","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110817","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":"The Use of Complementary Health Approaches Among U.S. Veterans from 2002 to 2022: a Prevalence and Sex-Stratified Analysis.","authors":"McKenzie Watson, Zhi Chen, Kaushal B Nanavati, Jamie L Romeiser","doi":"10.1007/s11606-025-09620-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09620-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110940","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":"Should Legal Status Determine Mortality? The Experience of Undocumented Individuals Denied a Curative Stem Cell Transplant Because of Uninsurance.","authors":"Maylyn Martinez, Milda Saunders, Lenny López","doi":"10.1007/s11606-025-09603-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09603-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110897","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}