Journal of General Internal Medicine最新文献

{"title":"From the Editors' Desk: Affinity Groups for Associate Editors.","authors":"Michael Elnicki, Lenny Lopez, Joseph Conigliaro","doi":"10.1007/s11606-024-09214-7","DOIUrl":"10.1007/s11606-024-09214-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668173","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 US Organ Transplantation System: HRSA's Modernization Initiative.","authors":"Eli Y Adashi, Daniel P O'Mahony","doi":"10.1007/s11606-024-09210-x","DOIUrl":"10.1007/s11606-024-09210-x","url":null,"abstract":"<p><p>The 1984 National Organ Transplant Act (NOTA) saw to the establishment of a national Organ Procurement and Transplantation Network (OPTN). As envisaged by the law's congressional sponsors, the Secretary of the US Department of Health and Human Services (HHS) was to institute a \"central registry linking donors and potential recipients.\" In addition, the Secretary was to see to the institution of a \"scientific registry of organ recipients\" as well as \"designate and maintain an identifiable unit in the Public Health Service to coordinate Federal organ transplant programs and policies.\" Forty years later, over 103,000 patients remain on the organ transplant waiting list for an average of 3-5 years during which time 17 die every day. It is against this backdrop that the Senate Committee on Finance (SCF) launched a sustained inquiry in 2020 with an eye towards assessing the status quo and potential remedies thereof. A Health Resources & Services Administration (HRSA) Modernization Initiative followed suit in March 2023. In this Perspective, we review the state of OPTN, discuss its recent oversight by the SCF, and describe its future reform as conceived and enunciated by HRSA.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668187","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":"Evaluation of a Tailored Patient Navigation Program for Improving Multitarget Stool DNA Test Adherence.","authors":"Edward Cytryn, Zachary Stauber, Kayla Jaeckel, Nikita Barai, Pascale White, Christina P Wang, Mary Fishman, Juan P Wisnivesky, Lina H Jandorf, Steve H Itzkowitz, Kyle M Koster","doi":"10.1007/s11606-024-09201-y","DOIUrl":"10.1007/s11606-024-09201-y","url":null,"abstract":"<p><strong>Background: </strong>Multitarget stool DNA (mt-sDNA) is an increasingly utilized noninvasive option for colorectal cancer screening; however, its impact is limited by imperfect test adherence. Tailored patient navigation (TPN) improves adherence for other cancer screening tests, but its role in mt-sDNA is not known.</p><p><strong>Aim: </strong>Determine whether TPN improves mt-sDNA completion and reduces sample could not be processed (SCNBP) result rates.</p><p><strong>Setting: </strong>A large, urban, academic primary care clinic serving a medically vulnerable population.</p><p><strong>Participants: </strong>All patients who received mt-sDNA order in 2022 and 2023.</p><p><strong>Program description: </strong>A patient navigator outreached all patients ordered mt-sDNA to support test completion during the 12-month intervention period in 2023.</p><p><strong>Program evaluation: </strong>Rates of mt-sDNA completion within 90 days and SCNBP results were compared between the 12-month intervention and pre-intervention periods using generalized estimating equations. A total of 2694 patients received 3297 orders during the study. TPN was significantly associated with improved rates of 90-day mt-sDNA completion (51% vs. 39%, OR 1.67, p < .001) and SCNBP results (4% vs. 5%, OR 0.55, p < .001).</p><p><strong>Discussion: </strong>Tailored patient navigation was associated with improved rates of mt-sDNA completion and SCNBP results despite built-in navigation services provided by the manufacturer. TPN for mt-sDNA is a promising strategy for enhancing colorectal cancer screening uptake.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668171","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":"Telemedicine use in Primary Care Associated with More Timely Access Without Unintended Subsequent Utilization for People with Dementia.","authors":"Julia Adler-Milstein, Anjali Gopalan, Jie Huang, Christopher Toretsky, Mary Reed","doi":"10.1007/s11606-024-09211-w","DOIUrl":"10.1007/s11606-024-09211-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668184","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":"Effectiveness of a Novel Global Telemedicine Curriculum for Medical Students.","authors":"Pranav Doshi, Anna K Donovan, Erin J Kim, Meghan Moretti, Stephen Y Chan, Peter J Veldkamp, Erin M Schikowski","doi":"10.1007/s11606-024-09190-y","DOIUrl":"10.1007/s11606-024-09190-y","url":null,"abstract":"<p><strong>Background: </strong>The University of Pittsburgh School of Medicine collaborated with The Addis Clinic to create a global telemedicine elective for fourth-year medical students during the COVID-19 pandemic. The elective aimed to promote cross-cultural understanding by providing unique, hands-on telemedicine experience.</p><p><strong>Aim: </strong>To assess the effectiveness of the telemedicine elective, four of five medical students and 11 of 12 Kenyan clinical officers completed one-on-one interviews and surveys.</p><p><strong>Setting: </strong>Students and global health faculty connected virtually with patients and clinical officers from several rural clinics in Kenya during the 4-week elective.</p><p><strong>Participants: </strong>Per elective month, participants of the course included two fourth-year medical students and five Kenyan clinical officers.</p><p><strong>Program description: </strong>A medical school elective designed in collaboration with The Addis Clinic, using WhatsApp and Telemedicus platform, in which each medical student virtually assisted a team of Kenyan clinical officers with a variety of active patient cases.</p><p><strong>Program evaluation: </strong>Qualitative analysis of interviews with medical students and Kenyan clinical officers yielded themes of increased competency with clinical decision-making and culturally appropriate care delivery.</p><p><strong>Discussion: </strong>Implementation of a unique global telemedicine elective was feasible and well received by both medical students and clinical officers in Kenya. The elective can be implemented at other institutions with faculty experienced in global health who would like to partner with The Addis Clinic.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668136","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":"Responsibilities of Medical Professionals Amidst Geopolitical Conflict.","authors":"Cassondra L Feldman, Nicole Z Spence","doi":"10.1007/s11606-024-09189-5","DOIUrl":"10.1007/s11606-024-09189-5","url":null,"abstract":"<p><p>The ethical responsibilities of healthcare professionals amidst geopolitical conflict, particularly regarding their impact on patient care and healthcare delivery, present a significant challenge, especially during current strife. With the rise of national and international discord and debate, and the close relationship between war and healthcare, healthcare organizations are increasingly pressured to comment, which can reflect societal engagement, but also pose demands for maintaining professionalism. This article discusses the need for healthcare practitioners to navigate their roles in advocacy without compromising patient care, emphasizing the importance of self-reflection, adherence to ethical standards, and effective communication. We also address the implications of politicization within healthcare settings, offering strategies to uphold professional integrity and prioritize patient-centered care amidst the complexities of geopolitical tensions. While the premise of this paper was prompted by geopolitical conflict, the principles emphasized are broadly applicable to an array of controversial issues. By fostering a culture of inclusivity and respect, healthcare professionals can mitigate the risks associated with politicization and ensure a commitment to the fundamental principle of \"do no harm.\"</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668181","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":"Associations Between State Policies Facilitating Telehealth and Buprenorphine Episode Initiation and Duration Early in the COVID Pandemic : State Telehealth Policies and Buprenorphine.","authors":"Bradley D Stein, Brendan K Saloner, Flora Sheng, Mark Sorbero, Andrew W Dick, Adam J Gordon","doi":"10.1007/s11606-024-09188-6","DOIUrl":"https://doi.org/10.1007/s11606-024-09188-6","url":null,"abstract":"<p><strong>Importance: </strong>State policies facilitating telehealth implemented early in COVID may support buprenorphine treatment of opioid use disorder. However, little empirical information is available about those policies' effects.</p><p><strong>Objective: </strong>Examine association between state policies that may facilitate telehealth use and buprenorphine treatment.</p><p><strong>Design, setting, participants: </strong>Retrospective cohort study using 2019-2020 national pharmacy data on dispensed buprenorphine prescriptions.</p><p><strong>Exposures: </strong>State policies implemented after March 3, 2020, public health emergency declaration requiring private insurers' telehealth reimbursement to be commensurate with in-person service reimbursement, authorizing Medicaid reimbursement for audio-only telehealth, allowing physicians to provide cross-state telehealth services, and allowing psychologists to provide cross-state telehealth services.</p><p><strong>Main outcomes and measures: </strong>(a) Duration of treatment episodes started between March 1 and March 13 in both 2019 and 2020, and (b) daily numbers of new buprenorphine treatment episodes from March 13 through December 31 in each year.</p><p><strong>Key results: </strong>We found little change in the number of new buprenorphine treatment episodes started in 2020 compared to 2019 and an increase in treatment duration of 10.3 days (95%CI 8.3 to 12.2 days) for episodes started in March 2020 before the public health emergency declaration compared to the comparable 2019 period. States implementing a telehealth parity policy in 2020 had 7.3% (95%CI - 13.3% to - 0.4%) fewer new buprenorphine treatment episodes. States joining the psychologist interstate compact in 2020 after the public health emergency declaration had treatment episodes 7.97 days longer (95%CI 0.78 to 15.16) than other states. None of the other policies examined was associated with changes in new treatment episodes or treatment duration.</p><p><strong>Conclusions and relevance: </strong>Policies undertaken during the pandemic we examined were associated with few significant changes in buprenorphine treatment initiation and duration. Findings suggest realizing the benefits of telehealth and other policy changes for buprenorphine may require more extensive implementation and infrastructure support.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621522","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":"Efficacy of Interventions Intended to Increase Lung Cancer Screening Rates: A Systematic Review and Meta-analysis.","authors":"Shina Satoh, Manav Shah, Mitchell Sungelo, Louise Falzon, Alex Makhnevich, Brett Bade, Elizabeth Cohn, Suhail Raoof, Jesse Chusid, Martin Lesser, Karina Davidson, Gerard A Silvestri, Stuart L Cohen","doi":"10.1007/s11606-024-09097-8","DOIUrl":"https://doi.org/10.1007/s11606-024-09097-8","url":null,"abstract":"<p><strong>Background: </strong>Few eligible patients in the United States participate in lung cancer screening (LCS) with low-dose computed tomography (LDCT).</p><p><strong>Objective: </strong>What is the efficacy of interventions to increase LCS participation?</p><p><strong>Design: </strong>We performed a systematic review following a prespecified protocol registered in PROSPERO (CRD42021283984). In June/July of 2021, we searched Ovid MEDLINE, Embase, Cochrane, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Epistemonikos from 1946 to October 2021 to identify studies evaluating interventions to increase LCS participation.</p><p><strong>Participants: </strong>Thirteen of 2761 studies met inclusion criteria for data extraction. Of these, six had results available (five RCTs and one prospective observational study). The studies had predominantly White and non-Hispanic participants.</p><p><strong>Main measures: </strong>An intention-to-treat analysis was used to calculate each study's relative risk (RR) to increase LCS. Effect sizes were pooled using a random-effects model with a subgroup analysis for multi- versus single-step interventions. Risk of bias was evaluated with the revised Cochrane risk-of-bias tool (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I).</p><p><strong>Key results: </strong>Overall, the proportion of screening LDCTs performed did not improve in the intervention group relative to the comparator group (RR [95% CI] of 1.30 [0.74, 2.29]), and meta-analysis indicated high heterogeneity of studies (I² = 91%). Subgroup analysis suggests that interventions targeting multiple barriers may increase LCS participation (RR [95% CI] for multistep vs single-step; 2.68 [1.77, 4.05] vs 0.99 [0.89, 1.10], P < 0.01). Quality assessment revealed that three of five RCTs showed some concerns or high risk of bias.</p><p><strong>Conclusion: </strong>Evidence on efficacy of interventions to increase LCS participation is limited due to a small number of prospective studies performed in non-diverse populations with critical risk of bias. Further, overall, studied interventions did not improve lung cancer screening participation, though interventions targeting multiple barriers may have some benefit.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621449","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":"Referrals and Black-White Coronary Heart Disease Treatment Disparities: A Qualitative Study of Primary Care Physician Perspectives.","authors":"Nabeel Qureshi, Sandra Berry, Cheryl L Damberg, Ben Gibson, Ioana Popescu","doi":"10.1007/s11606-024-09175-x","DOIUrl":"https://doi.org/10.1007/s11606-024-09175-x","url":null,"abstract":"<p><strong>Background: </strong>Black-White coronary heart disease (CHD) treatment disparities are well documented, especially regarding the use of high-quality hospitals. Physician referral networks may play a role.</p><p><strong>Objective: </strong>To understand how primary care physicians (PCPs) make specialty referrals for CHD treatment and how referrals may contribute to treatment disparities.</p><p><strong>Design: </strong>Qualitative study using semi-structured interviews and focus group discussions.</p><p><strong>Participants: </strong>We purposively recruited 45 PCPs (50 invited, 90% response rate) in three metro areas with high Black-White segregation of cardiac care networks (New York City; Chicago; Atlanta).</p><p><strong>Approach: </strong>We developed the focus group discussion guide from interviews and current literature. We conducted two focus groups per metro area via Zoom. Two expert team members independently coded the transcripts using inductive techniques and analyzed focus group content and themes using Dedoose.</p><p><strong>Key results: </strong>Most participants were male (62.2%), White (57.8%), and practiced for at least 23 years. We identified several recurrent themes for factors influencing cardiology referrals. The most frequently mentioned themes were heavy reliance on professional networks, specialist availability, timeliness, communication style, patient geographic and economic constraints, and patient preferences. PCPs used anecdotal and not data-driven evidence to assess hospital quality and viewed Black-White differences in high-quality hospital use as due to patient economic status and preferences or differences in hospital access and provider referral bias.</p><p><strong>Conclusion: </strong>PCPs' referral decisions for CHD treatment are primarily driven by access to specific professional networks and the socioeconomic circumstances of their patients. Nevertheless, PCPs strive to make the best available decisions, leaning into their networks and honoring patient preferences. While PCPs acknowledged existing disparities, they attributed them to patient and system factors rather than provider referral bias. Mitigating disparities will require interventions to improve minority-serving providers' formal and informal connections with high-quality specialists and hospitals, address patient socioeconomic constraints, and train providers to recognize their potential biases and misconceptions.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621785","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":"Recommendations for Clinicians, Technologists, and Healthcare Organizations on the Use of Generative Artificial Intelligence in Medicine: A Position Statement from the Society of General Internal Medicine.","authors":"Byron Crowe, Shreya Shah, Derek Teng, Stephen P Ma, Matthew DeCamp, Eric I Rosenberg, Jorge A Rodriguez, Benjamin X Collins, Kathryn Huber, Kyle Karches, Shana Zucker, Eun Ji Kim, Lisa Rotenstein, Adam Rodman, Danielle Jones, Ilana B Richman, Tracey L Henry, Diane Somlo, Samantha I Pitts, Jonathan H Chen, Rebecca G Mishuris","doi":"10.1007/s11606-024-09102-0","DOIUrl":"https://doi.org/10.1007/s11606-024-09102-0","url":null,"abstract":"<p><p>Generative artificial intelligence (generative AI) is a new technology with potentially broad applications across important domains of healthcare, but serious questions remain about how to balance the promise of generative AI against unintended consequences from adoption of these tools. In this position statement, we provide recommendations on behalf of the Society of General Internal Medicine on how clinicians, technologists, and healthcare organizations can approach the use of these tools. We focus on three major domains of medical practice where clinicians and technology experts believe generative AI will have substantial immediate and long-term impacts: clinical decision-making, health systems optimization, and the patient-physician relationship. Additionally, we highlight our most important generative AI ethics and equity considerations for these stakeholders. For clinicians, we recommend approaching generative AI similarly to other important biomedical advancements, critically appraising its evidence and utility and incorporating it thoughtfully into practice. For technologists developing generative AI for healthcare applications, we recommend a major frameshift in thinking away from the expectation that clinicians will \"supervise\" generative AI. Rather, these organizations and individuals should hold themselves and their technologies to the same set of high standards expected of the clinical workforce and strive to design high-performing, well-studied tools that improve care and foster the therapeutic relationship, not simply those that improve efficiency or market share. We further recommend deep and ongoing partnerships with clinicians and patients as necessary collaborators in this work. And for healthcare organizations, we recommend pursuing a combination of both incremental and transformative change with generative AI, directing resources toward both endeavors, and avoiding the urge to rapidly displace the human clinical workforce with generative AI. We affirm that the practice of medicine remains a fundamentally human endeavor which should be enhanced by technology, not displaced by it.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621714","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}