Journal of General Internal Medicine最新文献

{"title":"A Randomized Controlled Trial of a Culinary Medicine Intervention in a Virtual Teaching Kitchen for Primary Care Residents.","authors":"Nathan Isaac Wood, Maya Fussell, Erica Benghiat, Lora Silver, Max Goldstein, Amy Ralph, Lisa Mastroianni, Erica Spatz, Dana Small, Rosemarie Fisher, Donna Windish","doi":"10.1007/s11606-025-09652-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09652-x","url":null,"abstract":"<p><strong>Background: </strong>For decades, physicians have received inadequate nutrition education. \"Culinary medicine,\" an emerging pedagogy in medical education, seeks to address this by integrating hands-on cooking to enhance nutrition training. While cohort and cross-sectional studies have demonstrated culinary medicine's efficacy, no randomized controlled trials to date have been conducted among medical trainees.</p><p><strong>Objective: </strong>To evaluate the efficacy of a hands-on culinary medicine curriculum compared to didactics-only nutrition education.</p><p><strong>Design: </strong>Two versions of a nutrition education curriculum were developed: a culinary medicine curriculum (intervention) and a didactics-only curriculum (control). The curricula were assessed using a non-inferiority randomized controlled trial design.</p><p><strong>Participants: </strong>All active Yale Primary Care residents were randomized to receive either the intervention curriculum or the control curriculum.</p><p><strong>Main measures: </strong>Residents completed surveys at baseline, immediately post-session, and 8 weeks post-session assessing nutrition knowledge, attitudes regarding providing dietary counseling, and behavior in providing nutrition resources to patients.</p><p><strong>Key results: </strong>Nutrition knowledge increased from baseline to immediately post-session in both groups (control (mean percent correct 54% to 94%, P = 0.001), intervention (60% to 92%, P = 0.001)). Compared to the control group, the intervention group gained more confidence in counseling patients on a plant-forward diet (F = 5.44, P = 0.03). Residents in the intervention group reported providing nutrition resources to their patients significantly more frequently at 8 weeks post-session than at baseline (mean frequency per week 0.1 to 0.9, P = 0.002), a change that was not demonstrated among control group participants (0.1 to 0.5, P = 0.35).</p><p><strong>Conclusions: </strong>Both culinary medicine and didactics-only pedagogies can be effective approaches to teaching nutrition. Culinary medicine was found in this trial to be non-inferior to a didactics-only approach and may be superior in improving participants' confidence in providing dietary counseling to patients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497217","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":"Tobacco Use Patterns and Missed Opportunities for Cessation Treatment Among People Experiencing Homelessness.","authors":"Mark R Hawes, Ryan D Assaf, Jennafer A Birkmeyer, Morgan M Philbin, Maya Vijayaraghavan, Margot Kushel","doi":"10.1007/s11606-025-09654-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09654-9","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497227","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":"Adopting Self-Measured Blood Pressure Monitoring Among Underserved Communities (ASPIRE): A Pilot Randomized Controlled Trial.","authors":"Rasha Khatib, Nicole Glowacki, Iridian Guzman, Osondi Ozoani, John Brill, Julie C Lauffenburger, Alex Biskis, Melanie Gordon","doi":"10.1007/s11606-025-09646-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09646-9","url":null,"abstract":"<p><strong>Background: </strong>Addressing barriers to self-measured blood pressure (SMBP) engagement through tailored implementation strategies is critical for improving hypertension-related outcomes.</p><p><strong>Objective: </strong>To evaluate the feasibility of implementing the ASPIRE Clinical Integration Package, a multifaceted intervention designed to support SMBP adoption and engagement in under-resourced primary care settings.</p><p><strong>Design: </strong>This randomized trial was conducted in 2024 at one large primary care clinic serving racially and ethnically diverse populations.</p><p><strong>Participants: </strong>Patients were eligible if they had hypertension, were prescribed ≥1 blood pressure-lowering medication, and presented to the clinic with an elevated blood pressure reading.</p><p><strong>Approach: </strong>Patients were randomized to receive a free SMBP device (control; n=25) or a free SMBP device and the ASPIRE Clinical Integration Package (intervention; n=25) which included 6 components; 1. Cuff sizing, 2. Training on accurate readings, 3. ASPIRE log, 4. Reminders/support for sharing readings, 5. Social needs screening, 6. Clinic workflow for SMBP documentation. The primary outcomes included feasibility metrics (referral, recruitment, and retention) and fidelity described in terms of the proportion of patients who received each of the 6 ASPIRE components. Secondary outcomes included SMBP engagement (1+ reading documented in the electronic health record) and change in systolic blood pressure.</p><p><strong>Key results: </strong>In total, 50 patients were randomized and included in analyses. Referral (60.0%), recruitment (60.2%), and retention (90.0%) targets were met. Fidelity evaluation revealed that 100% of patients received components 1 - 4, 96% and 93% received components 5 and 6, respectively. At 6-months the difference in SMBP engagement was 52.0% (95% confidence interval [CI] 29.3%-74.7%) favoring the intervention arm, and the difference in change in systolic blood pressure was -11.9mmHg (95% CI -21.7, -2.1) favoring the intervention arm.</p><p><strong>Conclusions: </strong>The ASPIRE Clinical Integration Package demonstrates feasibility and acceptability in promoting SMBP adoption in under-resourced primary care settings. These findings lay the groundwork for a larger trial to assess effectiveness in improving hypertension control and reducing disparities.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT06175793.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497218","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":"Community-Engaged Qualitative Study on Supporting Transgender and Gender-Diverse Standardized Patients in Medical Simulation.","authors":"Steven Allon, Andrew Kittleson, Pepper Heifner, David Schlundt, Kemberlee Bonnet, Arna Banerjee, Christopher Terndrup","doi":"10.1007/s11606-025-09640-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09640-1","url":null,"abstract":"<p><strong>Background: </strong>Transgender and gender-diverse (TGD) individuals experience high rates of adverse physical and mental health outcomes, in part due to negative healthcare experiences that discourage healthcare utilization. Affirming practices by providers can mitigate this distress, but medical education to build these skills is limited. Medical simulation offers an opportunity to enhance affirming communication, but best practices in supporting TGD standardized patients (SPs) are lacking.</p><p><strong>Objective: </strong>This study sought to develop a preliminary guideline on recruitment, portrayal, and support of TGD SPs.</p><p><strong>Design: </strong>We utilized a modified Delphi technique to identify consensus guidelines for medical simulation programs incorporating TGD individuals as standardized actors in simulation scenarios.</p><p><strong>Participants: </strong>Fifty TGD community members and parents of TGD children in Middle Tennessee provided embodied knowledge.</p><p><strong>Approach: </strong>We administered a survey examining participants' perspectives on recruitment, casting, and supporting TGD SPs in medical simulations. Thematic analysis was used to derive guideline statements, which were refined using participant feedback over two additional survey rounds.</p><p><strong>Key results: </strong>Our sample consisted of 50 participants (96% TGD). We derived 44 guideline statements related to recruitment, casting, and supporting TGD SPs. Participants recommended recruitment of prospective TGD SPs through established venues holding trusted relationships with the TGD community, honestly conveying the benefits and drawbacks of this work. A gradient of acceptable casting decisions emerged, anchored by the gender identity of the simulated patient, to ensure shared lived experiences between an SP and their cast role. Participants offered strategies throughout simulation encounters to enhance TGD SPs' agency, facilitate psychological safety, and process emotions to improve simulation programs' support of TGD SPs.</p><p><strong>Conclusions: </strong>We utilized a modified Delphi technique with TGD community members to derive a consensus guideline to support TGD SPs. Our study addressed key unresolved questions in the literature, particularly around recruitment and casting, with a high level of agreement.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484674","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":"Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits.","authors":"Emily Brunner, Chwen-Yuen A Chen, Tracy Klein, Donovan Maust, Maryann Mazer-Amirshahi, Marcia Mecca, Deanna Najera, Chinyere Ogbonna, Kiran F Rajneesh, Elizabeth Roll, Amy E Sanders, Brett Snodgrass, Amy VandenBerg, Tricia Wright, Maureen Boyle, Amanda Devoto, Sarah Framnes-DeBoer, Bethea Kleykamp, Janette Norrington, Dawn Lindsay","doi":"10.1007/s11606-025-09499-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09499-2","url":null,"abstract":"<p><strong>Description: </strong>The American Society of Addiction Medicine (ASAM) has partnered with nine other medical societies and professional associations representing a wide range of clinical settings and patient populations to provide guidance on evidence-based strategies for tapering benzodiazepine (BZD) medication across a variety of settings.</p><p><strong>Methods: </strong>The guideline was developed following modified GRADE methodology and clinical consensus process. The process included a systematic literature review as well as several targeted supplemental searches. The clinical practice guideline was revised based on external stakeholder review.</p><p><strong>Recommendations: </strong>Key takeaways included the following: Clinicians should engage in ongoing risk-benefit assessment of BZD use/tapering, clinicians should utilize shared decision-making strategies in collaboration with patients, clinicians should not discontinue BZDs abruptly in patients who are likely to be physically dependent and at risk of withdrawal, clinicians should tailor tapering strategies to each patient and adjust tapering based on patient response, and clinicians should offer patients adjunctive psychosocial interventions to support successful tapering.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317078","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":"A Quasi-Experimental Evaluation of a Primary Care Behavioral Health Integration Program Based on the Chronic Care Model.","authors":"Neda Laiteerapong, Sandra A Ham, Mim Ari, Nancy Beckman, Lisa M Vinci, Fabiana S Araújo, Daniel Yohanna, Danica Moser, Vivek Nandur, Erin M Staab","doi":"10.1007/s11606-025-09641-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09641-0","url":null,"abstract":"<p><strong>Background: </strong>Mental health conditions are often underdiagnosed and undertreated in primary care, particularly in underserved areas. Integrated behavioral health models can address this gap, but their reliance on mental health professionals may limit scalability. A multi-level intervention based on the chronic care model may enhance mental health care delivery in resource-limited settings.</p><p><strong>Objective: </strong>To evaluate the effectiveness of a chronic care model-based primary care behavioral health integration program for improving the diagnosis and management of mental health conditions in a primary care setting.</p><p><strong>Design: </strong>Quasi-experimental, pre-post observational study using interrupted time series analysis over a 10-year period (2010-2019).</p><p><strong>Participants: </strong>In total, 59,723 adult patients aged >18 who had at least two medical visits between 2010 and 2019. The patient population was 58% non-Hispanic Black, 29% non-Hispanic White, and 64% female.</p><p><strong>Interventions: </strong>Implementation of clinical decision support systems for common mental health conditions (e.g., depression, anxiety, ADHD), self-management support, delivery system re-design within integrated behavioral health services, and health system community support with weekly behavioral health tips.</p><p><strong>Main measures: </strong>Changes in the rate of mental health diagnoses and follow-up care (including psychiatric medications, referrals to psychiatry or behavioral medicine, and primary care visits with a mental health diagnosis).</p><p><strong>Key results: </strong>The rate of mental health diagnoses increased by 58.8 per 1000 person-years in the first year after intervention implementation (p = 0.001). Follow-up care in primary care increased by 102.1 per 1000 person-years (p = 0.03), while psychiatry referrals decreased by 59.8 per 1000 person-years annually after the intervention (p = 0.004).</p><p><strong>Conclusions: </strong>This chronic care model-based system-level intervention was associated with significant increases in mental health diagnosis and treatment within primary care. Expanding the role of primary care in managing mental health conditions may offer a scalable solution to mental health professional shortages, especially in underserved areas.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248243","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":"Incorporating Patient and Provider Voices into the Veterans Pain Care Organizational Improvement Comparative Effectiveness Study: Informing Future Implementation.","authors":"Hildi J Hagedorn, Natalie Purcell, Beth M DeRonne, Hope Salameh, William C Becker, Karen H Seal, Erin E Krebs","doi":"10.1007/s11606-025-09639-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09639-8","url":null,"abstract":"<p><strong>Background: </strong>Clinicians and healthcare systems have little evidence available to guide effective strategies to manage pain while reducing opioid use. The Veterans Pain Care Organizational Improvement Comparative Effectiveness (VOICE) trial tested two strategies to manage pain and reduce opioid use in primary care settings: interdisciplinary pain team (IPT) and pharmacist collaborative management (PCM).</p><p><strong>Objectives: </strong>This qualitative process evaluation was conducted parallel to the effectiveness trial to inform future implementation efforts.</p><p><strong>Design: </strong>Ethnographic observations and semi-structured interviews.</p><p><strong>Participants: </strong>Study staff (n=19), facility clinicians (n=37), facility clinical champions (n=4), and patients (n=32) from 10 Veterans Health Administration (VHA) facilities.</p><p><strong>Approach: </strong>Guided by the Practical Implementation Sustainability Model (PRISM), we used rapid analysis procedures to identify and categorize themes relevant to implementation. Key themes were identified for the PRISM constructs of implementation and sustainability infrastructure, organizational characteristics, organizational perspectives of the interventions, patient perspectives of the interventions, patient characteristics, and the external environment. To facilitate the development of recommendations for successful and sustainable implementation, identified themes were also mapped to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) outcomes, which are part of the PRISM framework.</p><p><strong>Key results: </strong>Successful adoption required leadership support and scanning the environment for existing similar programs and interested, knowledgeable clinical champions. Implementation was supported by training in core features of the interventions, which included meaningful patient involvement in decision-making, responsiveness of the clinical team, and the longevity and intensity of the interventions. Maintenance was supported through sustained leadership support for dedicated clinical team positions and standardized roles and procedures.</p><p><strong>Conclusion: </strong>This process evaluation identified strategies to support the successful implementation and sustainment of both interventions. Implementation considerations are particularly important as sites determine which intervention(s) to adopt, given that the VOICE trial found the interventions to be similarly effective at improving pain and reducing opioid dosage.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248244","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":"Prediction of Cardiovascular Risk Among People with HIV Using the PREVENT Equations Compared to the Pooled Cohort Equations.","authors":"Matthew S Durstenfeld, Megan M McLaughlin, Monica Gandhi, John Kornak, Alexis L Beatty, Priscilla Y Hsue","doi":"10.1007/s11606-025-09642-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09642-z","url":null,"abstract":"<p><strong>Background: </strong>People with HIV (PWH) are at elevated risk of atherosclerotic cardiovascular disease (ASCVD), and current risk prediction tools underestimate risk among PWH. The American Heart Association developed new risk prediction equations, Predicting Risk of cardiovascular disease EVENTs (PREVENT), which have not been studied among PWH.</p><p><strong>Objective: </strong>To compare predicted 10-year ASCVD risk using PREVENT with the pooled cohort equations (PCE) and the implications for statin recommendations among PWH.</p><p><strong>Design: </strong>A cross-sectional observational study using real-world, electronic health records PARTICIPANTS: All people with HIV ages 40 to 75 without cardiovascular disease at 23 primary care and HIV clinics affiliated with two health systems in San Francisco, California from 2019 to 2024 MAIN MEASURES: We compared predicted 10-year ASCVD using the PREVENT equations and the PCE. Then we considered implications of PREVENT for statin therapy using current guidelines.</p><p><strong>Key results: </strong>Among 3357 PWH (median 57 years old; 73% male,12% female, 15% transgender/nonbinary/nondisclosed; 20% Black and 25% Latino), 91% were on antiretroviral therapy and 86% had virologic suppression. Among 2853 PWH with complete data for both calculators, the median predicted risk was 7.7% (interquartile range (IQR) 3.7, 14.0) using the PCE and 3.3% (IQR 1.9, 5.4) using PREVENT. Predicted risk was lower for 97% of individuals using PREVENT. Using a 10-year ASCVD risk threshold of 5%, only 28.6% of PWH would be strongly recommended for statins with PREVENT compared to 67.3% with PCE. The difference in predicted risk between the two equations varied across sex and race/ethnicity.</p><p><strong>Conclusions: </strong>The PREVENT equations predict lower 10-year ASVCD risk for PWH compared to the PCE, which underpredicts risk for PWH. Underprediction of ASCVD risk, which -using new guidelines -would translate to 58% fewer PWH strongly recommended for statins using PREVENT compared to PCE, has the potential to increase cardiovascular disease and worsen healthcare disparities among PWH.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248245","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":"A Qualitative Assessment of Pelvic Floor Physical Therapy Experiences for Women Veterans in VHA Care.","authors":"Ashley C Mog, Jessica P Young, Jordan H Mamkhezri, Caroline Merkel, Kristen E Gray","doi":"10.1007/s11606-025-09645-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09645-w","url":null,"abstract":"<p><strong>Background: </strong>Nearly 25% of women experience pelvic floor disorders, for which pelvic floor physical therapy (PFPT) is a first-line treatment. Within the Veterans Health Administration (VHA), only one-third of health care systems offer PFPT on site. Alternatives include receiving care from providers in the community (\"Community Care\") or from VHA providers at a distant site via telehealth (\"Clinical Resource Hub\"). Little is known about Veterans' experiences with these two PFPT care pathways.</p><p><strong>Objective: </strong>To characterize women Veterans' experiences with PFPT, including factors affecting access to and receipt of care.</p><p><strong>Design: </strong>Using VHA data, we recruited and conducted semi-structured qualitative interviews with women Veterans who had received PFPT services within the last 6 months.</p><p><strong>Participants: </strong>We recruited N = 20 women Veterans from five VHA health care systems. Participants from four health care systems went through the Community Care pathway (N = 12), while participants from the fifth went through the Clinical Resource Hub (N = 8).</p><p><strong>Approach: </strong>We recorded and auto-transcribed semi-structured interviews. Using structured interview summaries, we completed a two-step analysis process, first using rapid, team-based matrix analysis, followed by thematic analysis. We identified key themes and domains into which we organized those themes.</p><p><strong>Key results: </strong>We identified themes in three domains: barriers getting care, experiences of care, and barriers extending care. Veterans described barriers to receiving care initially, including a lack of knowledge, stigma, providers dismissing concerns, and referral challenges. Participants were generally satisfied with their care and experienced quality of life improvements. Most desired some in-person care. Patients wanting more care after completing initially approved visits faced additional administrative barriers, leading to symptom recurrence.</p><p><strong>Conclusions: </strong>Findings about patient access barriers suggest provider training and education (including awareness of PFPT's clinical benefits, referral pathways, and trauma-informed care), patient education, hybrid care modalities, expansion of the PFPT provider workforce, and streamlining referrals may improve access to PFPT among Veterans.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248242","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":"Trends and Disparities in Clinician Diagnosis of Overweight and Obesity.","authors":"Simar S Bajaj, Anthony Zhong, Mihir Khunte, Fatima Cody Stanford","doi":"10.1007/s11606-025-09633-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09633-0","url":null,"abstract":"<p><strong>Background: </strong>While obesity is a highly visible condition, adiposity often goes undetected by individuals and community members, especially as larger body sizes become more common and recalibrate expectations. However, there are no contemporary data about such underdiagnosis.</p><p><strong>Objective: </strong>To examine trends in clinician diagnoses of overweight or obesity by race, ethnicity, and socioeconomic disadvantage.</p><p><strong>Design: </strong>Repeated cross-sectional study.</p><p><strong>Participants: </strong>Noninstitutionalized adults age 20 or older who responded to the 2011-2018 National Health and Nutrition Examination Survey (NHANES).</p><p><strong>Main measures: </strong>Clinician diagnosis of overweight or obesity was defined as affirming the question, \"Has a doctor or health professional ever told you that you were overweight?\" Weight-related perception and desire to lose weight were also assessed.</p><p><strong>Key results: </strong>We included 8311 adults with obesity (weighted, 356,426,842). From 2011 to 2018, the proportion of participants receiving a clinician diagnosis of overweight or obesity increased from 67.5 to 73.0% (p = 0.019). In multivariable logistic regression, Black people with obesity were less likely to receive a diagnosis (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.48-0.75, p < 0.001) than non-Hispanic White people, while citizens (OR, 1.73; 95% CI, 1.22-2.45; p < 0.001) and college graduates (OR, 2.17; 95% CI, 1.55-3.05; p < 0.001) were more likely to be diagnosed than non-citizens and non-high school graduates. Hypertension (OR, 1.40; 95% CI, 1.12-1.75) and diabetes (OR, 2.52; 95% CI, 1.86-3.49) were also associated with a greater likelihood of a diagnosis. People with a diagnosis were more likely to perceive themselves as overweight (94.6% vs. 75.2%, p < 0.001) and preferred to weigh less rather than stay at the same weight (96.4% vs. 83.7%, p < 0.001).</p><p><strong>Conclusion: </strong>While rates of overweight and obesity diagnoses improved over time, almost a third of people with obesity remain undiagnosed, with higher rates among Black Americans, non-citizens, non-high school graduates, sicker patients, and other marginalized groups.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225680","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}