Journal of General Internal Medicine最新文献

{"title":"Brick Walls and Broken Hearts: Physicians Draw how they Feel About Treating Pain and Addiction.","authors":"Lisa R Villarroel, Aram S Mardian, Cynthia O Townsend, Steven R Brown","doi":"10.1007/s11606-024-09205-8","DOIUrl":"10.1007/s11606-024-09205-8","url":null,"abstract":"<p><p>As part of a continuing medical education activity, primary care physicians in Arizona were asked to draw how they feel about treating patients with chronic pain and addiction. Their drawings, complete with cliffs, walls, torn-out hair, and connected hearts, make for a harrowing look at burnout, angst, and empathy among physicians who treat this subset of patients. Public health and exercise facilitators were troubled, leading them to publish this essay along with a selection of the drawings that depict the feelings of the physicians who feel ill-prepared to treat this patient population, which is only growing in number and needs.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1194-1196"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The Environment Fostered True Growth\": Harnessing Coaching on an Innovative Medicine Sub-internship.","authors":"Sydney Katz, Stephanie J Tang, Vishwas A Singh, Erika L Abramson, Alice J Tang","doi":"10.1007/s11606-024-08928-y","DOIUrl":"10.1007/s11606-024-08928-y","url":null,"abstract":"<p><strong>Background: </strong>Medicine sub-internships aim to prepare students for residency. However, the traditional sub-internship structure, with multiple learners at varied levels, poses obstacles to providing the clinical exposure, learning environment, and direct observation and feedback necessary to develop essential skills.</p><p><strong>Aim: </strong>Investigate the educational experience of learners on a coaching-centered sub-internship (CCSI) on a resident uncovered ward service.</p><p><strong>Setting and participants: </strong>From 2017 to 2022, 73 sub-interns and 39 hospitalists participated in the rotation at a community-based university-affiliated urban hospital.</p><p><strong>Program description: </strong>Sub-interns rotated on a CCSI with teams comprised of one attending, one physician assistant, and one student. Students cared for patients across the continuum of hospitalization with frequent coaching by trained attendings. Students engaged in workshops targeting clinical skills essential for internship.</p><p><strong>Program evaluation: </strong>Students (n = 67/73, 91.8% response rate) rated the quality of the course significantly higher on the CCSI than the traditional sub-internship rotation (mean [SD]) 4.87/5 [0.49] vs. 4.63/5 [0.61]; p < 0.001. Students and faculty found the CCSI fostered coaching, autonomy, accurate assessments, professional development, growth mindset, and readiness for internship.</p><p><strong>Discussion: </strong>Our model demonstrates that a CCSI can cultivate the skills and mindset to prepare students for internship. This coaching model can benefit students in other settings.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1018-1022"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articulating What Makes Sense: An Exercise in Clinical Reasoning.","authors":"Shruti Gupta, Daniel J Minter, Meredith Lora, Varun K Phadke","doi":"10.1007/s11606-025-09362-4","DOIUrl":"10.1007/s11606-025-09362-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1181-1185"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-level Factors to Build Confidence and Support in Active Surveillance for Low-Risk Prostate Cancer: A Qualitative Study.","authors":"Jason C Chen, Lalita Subramanian, Ted A Skolarus, Sarah T Hawley, Aaron Rankin, Michael D Fetters, Karla Witzke, Tudor Borza, Archana Radhakrishnan","doi":"10.1007/s11606-024-09345-x","DOIUrl":"10.1007/s11606-024-09345-x","url":null,"abstract":"<p><strong>Background: </strong>Active surveillance (AS) is the guideline-recommended treatment for low-risk prostate cancer and involves routine provider visits, lab tests, imaging, and prostate biopsies. Despite good uptake, adherence to AS, in terms of receiving recommended follow-up testing and remaining on AS in the absence of evidence of cancer progression, remains challenging.</p><p><strong>Objective: </strong>We sought to better understand urologist, primary care providers (PCPs), and patient experiences with AS care delivery to identify opportunities to improve adherence.</p><p><strong>Design: </strong>A qualitative study involving patients, PCPs, and urologists with experience of AS.</p><p><strong>Participants: </strong>PCPs (19), urologists (15), and patients (15) in Michigan.</p><p><strong>Approach: </strong>Participants were recruited through a statewide quality improvement collaborative. Semi-structured interviews were conducted virtually from June 2020 to April 2021. The Theoretical Domains Framework and the Behavior Change Wheel's Capability, Opportunity, and Motivation model guided interviews and coding. Thematic analysis was used to identify shared perspectives on AS care delivery.</p><p><strong>Results: </strong>Three main themes emerged from the PCP, urologist, and patient data collected related to AS care delivery that were needed to improve AS adherence: (1) building patient confidence in AS by leveraging provider roles and expertise and creating connection through communication across the care team and with patients; (2) building confidence in AS through psychosocial support by involving families and peers, and addressing anxiety and uncertainty; (3) building AS support within healthcare processes and electronic health record systems.</p><p><strong>Conclusion: </strong>These themes reflect opportunities for interventions at the care team, community (family and peers), and health system levels that could better support individualized care and overcome challenges to AS adherence through team-based approaches.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1107-1115"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caution Around Reinforcing Baseline-Shackling Practices.","authors":"Anna-Maria South, Lawrence A Haber, Justin Berk","doi":"10.1007/s11606-024-09330-4","DOIUrl":"10.1007/s11606-024-09330-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1204-1205"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-reported Health Service Utilization and Barriers to Care Among US Adults with a History of Post COVID-19 Condition.","authors":"Hiten Naik, Roy H Perlis, Karen C Tran, John A Staples","doi":"10.1007/s11606-024-09079-w","DOIUrl":"10.1007/s11606-024-09079-w","url":null,"abstract":"<p><strong>Background: </strong>Millions of US adults continue to experience symptoms of post COVID-19 condition (PCC). More data on health service utilization patterns and barriers to care in this population are needed to understand how to care for people with PCC.</p><p><strong>Objective: </strong>To evaluate health service utilization and barriers to medical care among individuals with a history of PCC compared with other US adults.</p><p><strong>Design: </strong>Data were analyzed from the 2022 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of the US population.</p><p><strong>Participants: </strong>US adults.</p><p><strong>Main measures: </strong>Health service utilization and the presence of financial and nonfinancial barriers to care in the preceding 12 months.</p><p><strong>Key results: </strong>There were 24,905 individuals included in the analysis, representing approximately 230 million US adults. The weighted prevalence of those with a history of PCC was 6.9% (95%CI, 6.5-7.3). Compared to other US adults, participants with a history of PCC were more likely to have had an urgent care visit (adjusted odds ratio (aOR) 1.52 [95%CI, 1.34-1.72]), emergency room visit (aOR 1.94 [95%CI 1.71-2.21]), hospitalization (aOR 1.48 [95%CI, 1.24-1.77]), rehabilitation services (aOR 1.35 [95%CI, 1.14-1.60]), home care (aOR 1.55 [95%CI, 1.66-2.26]), mental health counseling (aOR 1.39 [95%CI, 1.17-1.65]), and complementary and integrative medicine services (aOR 1.29 [95%CI, 1.13-1.49]). Furthermore, respondents with a history of PCC were more likely to report at least one financial barrier to care (aOR 1.71 [95%CI, 1.48-1.97]) and at least one nonfinancial barrier (aOR 1.77 [95%CI, 1.56-2.00]). A greater proportion of participants with a history of PCC reported a financial barrier and nonfinancial barrier than adults with most other chronic conditions captured by NHIS.</p><p><strong>Conclusions: </strong>Individuals with a history of PCC were more likely to use a variety of health services and report barriers to medical care. Health systems should consider developing accessible, multidisciplinary care pathways for this population.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1059-1069"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veteran Preferences and Willingness to Share Patient-Generated Health Data.","authors":"Timothy P Hogan, Bella Etingen, Mark S Zocchi, Felicia R Bixler, Nicholas McMahon, Jamie Patrianakos, Stephanie A Robinson, Terry Newton, Nilesh Shah, Kathleen L Frisbee, Stephanie L Shimada, Jessica M Lipschitz, Bridget M Smith","doi":"10.1007/s11606-024-09095-w","DOIUrl":"10.1007/s11606-024-09095-w","url":null,"abstract":"<p><strong>Background: </strong>Technologies, including mobile health applications (apps) and wearables, offer new potential for gathering patient-generated health data (PGHD) from patients; however, little is known about patient preferences for and willingness to collect and share PGHD with their providers and healthcare systems.</p><p><strong>Objective: </strong>Describe how patients use their PGHD and factors important to patients when deciding whether to share PGHD with a healthcare system.</p><p><strong>Design: </strong>Cross-sectional mailed longitudinal survey supplemented with administrative data within the Veterans Health Administration (VHA).</p><p><strong>Subjects: </strong>National sample of Veterans who use VHA healthcare.</p><p><strong>Main measures: </strong>Survey questions asked about demographics, willingness to use different devices to collect and share PGHD, what Veterans do with their PGHD, and factors important to Veterans when deciding whether to share PGHD with VHA. Administrative data provided information on Veteran health conditions. Multiple logistic regression models assessed factors associated with sharing PGHD with VHA.</p><p><strong>Key results: </strong>Overall, 47% of our analytic cohort (n = 383/807) indicated that they share PGHD collected through apps or digital health devices with VHA. In adjusted logistic regression models, Veterans who believed the following factors were Very Important (versus Somewhat/Not At All Important) had higher odds of sharing PGHD with VHA: if their doctor (OR = 1.4; 95%CI, 1.0-2.0) or other healthcare team members (OR = 1.4; 95%CI, 1.0-1.9) recommended they do so; and knowing that their healthcare team would look at the data (OR = 1.4; 95%CI, 1.0-2.0) or use the information to inform their healthcare (OR = 1.5; 95%CI, 1.1-2.1).</p><p><strong>Conclusions: </strong>Our data suggest that healthcare team members can influence patient sharing of PGHD, as can a patient's knowledge that PGHD will be used in clinical practice. Efforts to increase the number of patients who share PGHD with a healthcare system may benefit from buy-in among healthcare team members, who appear to play an influential role in patient decisions to share data.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1157-1165"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Medical Financial Hardship and Mortality Risk among US Adults.","authors":"Fangyuan Chen, Ryan D Nipp, Xuesong Han, Zhiyuan Zheng, K Robin Yabroff, Changchuan Jiang","doi":"10.1007/s11606-024-09135-5","DOIUrl":"10.1007/s11606-024-09135-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1211-1214"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Consensus on Strategies to Support Opioid Use Disorder Care Transitions Following Hospitalization: A Modified Delphi Process.","authors":"Noa Krawczyk, Megan Miller, Honora Englander, Bianca D Rivera, Daniel Schatz, Ji Chang, Magdalena Cerdá, Carolyn Berry, Jennifer McNeely","doi":"10.1007/s11606-024-09108-8","DOIUrl":"10.1007/s11606-024-09108-8","url":null,"abstract":"<p><strong>Background: </strong>Despite proliferation of acute-care interventions to initiate medications for opioid use disorder (MOUD), significant challenges remain to supporting care continuity following discharge. Research is needed to inform effective hospital strategies to support patient transitions to ongoing MOUD in the community.</p><p><strong>Objective: </strong>To inform a taxonomy of care transition strategies to support MOUD continuity from hospital to community-based settings and assess their perceived impact and feasibility among experts in the field.</p><p><strong>Design: </strong>A modified Delphi consensus process through three rounds of electronic surveys.</p><p><strong>Participants: </strong>Experts in hospital-based opioid use disorder (OUD) treatment, care transitions, and hospital-based addiction treatment.</p><p><strong>Main measures: </strong>Delphi participants rated the impact and feasibility of 14 OUD care transition strategies derived from a review of the scientific literature on a scale from 1 to 9 over three survey rounds. Panelists were invited to suggest additional care transition strategies. Agreement level was calculated based on proportion of ratings within three points of the median.</p><p><strong>Key results: </strong>Forty-five of 71 invited panelists participated in the survey. Agreement on impact was strong for 12 items and moderate for 10. Agreement on feasibility was strong for 11 items, moderate for 7, and poor for 4. Strategies with highest ratings on impact and feasibility included initiation of MOUD in-hospital and provision of buprenorphine prescriptions or medications before discharge. All original 14 strategies and 8 additional strategies proposed by panelists were considered medium- or high-impact and were incorporated into a final taxonomy of 22 OUD care transition strategies.</p><p><strong>Conclusions: </strong>Our study established expert consensus on impactful and feasible hospital strategies to support OUD care transitions from the hospital to community-based MOUD treatment, an area with little empirical research thus far. It is the hope that this taxonomy serves as a stepping-stone for future evaluations and clinical practice implementation toward improved MOUD continuity and health outcomes.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1048-1058"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathognomonic.","authors":"David T Zhu","doi":"10.1007/s11606-024-09299-0","DOIUrl":"10.1007/s11606-024-09299-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1200"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}