Journal of General Internal Medicine最新文献

{"title":"Impact of COVID-19 on Trends in Physician Payments from Traditional Medicare from 2017-2021.","authors":"Xenia Mendez, Ulrike Muench, Corinne P Lewis, Taressa K Fraze","doi":"10.1007/s11606-024-08927-z","DOIUrl":"https://doi.org/10.1007/s11606-024-08927-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605165","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 2024 National Academies of Sciences, Engineering, and Medicine Long COVID Definition: What Clinicians Need to Know.","authors":"Lily Chu, Karyn Bishof, Abigail A Dumes, E Wesley Ely, Paule V Joseph, Andrea B Troxel","doi":"10.1007/s11606-025-09415-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09415-8","url":null,"abstract":"<p><p>Millions of Americans affected by Long COVID (LC) report difficulty accessing care and support. One barrier is obtaining a diagnosis. In response, US federal agencies commissioned a National Academies of Sciences, Engineering, and Medicine (NASEM) committee to re-examine the existing federal definitions for LC. The Committee concluded that LC is \"an infection-associated chronic condition (IACC) occurring after SARS-CoV-2 infection that is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that can present as singular or multiple symptoms and/or diagnosable conditions.\" The full report was released in June 2024. We briefly highlight features and aspects of the definition that may help clinicians identify those who remain undiagnosed and improve care for all LC patients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators to Cross-Institutional Referrals: System Configuration Analysis of VA Staff Experiences.","authors":"April Savoy, Frances M Weaver, Himalaya Patel, Amanda Taylor, Diana J Govier, Denise M Hynes","doi":"10.1007/s11606-025-09450-5","DOIUrl":"10.1007/s11606-025-09450-5","url":null,"abstract":"<p><strong>Background: </strong>In 2014 and 2018, respectively, Congress passed the Veterans Access, Choice, and Accountability Act (Choice Act) and the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION Act), which expanded eligibility for and use of cross-institutional referrals among U.S. Veterans enrolled in the Veterans Health Administration.</p><p><strong>Objective: </strong>To identify facilitators and barriers to patient information sharing for cross-institutional, outpatient referrals resulting from policy changes.</p><p><strong>Design: </strong>Applying the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework, we conducted work system and configural analyses of semi-structured interviews.</p><p><strong>Participants: </strong>Clinical and administrative staff in six Department of Veterans Affairs (VA) facility community care liaison program offices.</p><p><strong>Approach: </strong>Interviews focused on barriers and facilitators to sharing patients' information across healthcare institutions. Transcripts were summarized by domain and coded to consensus, followed by directed content analysis and visualization using configural diagrams.</p><p><strong>Key results: </strong>From 19 interviews, we characterized a nine-step, ad hoc referral process. Barriers were reported in four of nine referral steps: scheduling, coordination, sending of pre-visit clinical records, and receipt of post-visit records. Low adoption of new technology, strained relationships with CCN clinicians, and inconsistent policies were commonly reported barriers. Largely, perceived barriers were classified as technology, people, or organization factors. The COVID-19 pandemic and a transition between third-party administrators were reported as notable environment factors.</p><p><strong>Conclusions: </strong>VA staff perceived increases in patient care delays and staff workload associated with social and technical barriers to sharing patients' information across healthcare institutions. In the cross-institutional referral process, we identified the primary configuration or combination of work system factors-technology, people, and organization- related to prevalent barriers. System-level interventions are needed to enhance relationships with clinicians across healthcare institutions, implement policies that guide patient information exchange, and design supportive technologies for efficient clinician communication during cross-institutional referrals.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597204","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":"Subjective Cognitive Decline in COPD - A Cross-Sectional Analysis of the Behavioral Risk Factor Surveillance System.","authors":"Michael L Stellefson, Min Qi Wang, Isabelle M Boyd, Sarah M Flora, Olivia K Campbell, Karin F Hoth, Leah J Witt, Ashwin A Kotwal, Angela O Suen, Russell G Buhr, Anand S Iyer","doi":"10.1007/s11606-025-09464-z","DOIUrl":"10.1007/s11606-025-09464-z","url":null,"abstract":"<p><strong>Background: </strong>Subjective cognitive decline (SCD), an early indicator of cognitive impairment, may affect COPD care and outcomes, yet its sociodemographic associations in Chronic Obstructive Pulmonary Disease (COPD) remain poorly understood.</p><p><strong>Objective: </strong>To investigate the prevalence of SCD among people with COPD across different age groups and identify associations between demographics, risk behaviors, comorbidities, and self-reported SCD.</p><p><strong>Design: </strong>Pooled 2019 BRFSS data from 24 states using the Cognitive Decline module were analyzed. Logistic regression assessed relationships between demographics, behaviors, comorbidities, and SCD, adjusting for confounders.</p><p><strong>Participants: </strong>A total of 12,003 adults with COPD aged ≥ 45 were included in the study (weighted population = 617,792).</p><p><strong>Main measures: </strong>Prevalence of SCD, associations with demographics, behaviors, health status, income, employment, and smoking.</p><p><strong>Key results: </strong>Among adults with COPD, 24.1% reported SCD. The prevalence among those with SCD was highest in those aged 55-64 (30.2%), followed by 65-74 (24.5%) and 45-54 (23.1%). Older age (55 to 64: AOR = 0.63, 95% CI: 0.49 - 0.80; 65 to 74: AOR = 0.54, 95% CI: 0.40 - 0.72; 75 to 79: AOR = 0.41, 95% CI: 0.29 - 0.60; 80 + : AOR = 0.47, 95% CI: 0.32 - 0.69) and higher annual income (e.g., $25,000 to $49,999: AOR = 0.80, 95% CI: 0.65 - 0.99; $50,000 to $74,999: AOR = 0.68, 95% CI: 0.51 - 0.91) were associated with lower odds of reporting SCD, while unemployment (AOR = 1.73, 95% CI: 1.33 - 2.27), history of stroke (AOR = 1.35, 95% CI: 1.05 - 1.74), and fair or poor health (AOR = 0.47, 95% CI: 0.39 - 0.57) were linked to higher odds of reporting SCD.</p><p><strong>Conclusions: </strong>Among adults with COPD, the prevalence of SCD varied by age, with the highest rates in those aged 55-64, and was independently associated with socioeconomic factors and health risks, emphasizing the complex interplay of demographic and health-related factors in SCD.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597211","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":"Pre-exposure Prophylaxis (PrEP) For Prevention of Human Immunodeficiency Virus: A Primary Practice Approach.","authors":"Beena Sattar, Robin Beach, Philip C Johnson","doi":"10.1007/s11606-025-09437-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09437-2","url":null,"abstract":"<p><p>Acquired immunodeficiency syndrome (AIDS) is a chronic immune system disease caused by human immunodeficiency virus (HIV), first reported in 1981, and continues to interfere with the body's ability to fight infection and disease. There is no cure for HIV/AIDS, but medication can control infection and prevent disease progression. Pre-exposure prophylaxis (PrEP) taken orally, or as intramuscular injection, is safe and effective in reducing the chances of acquiring HIV. United States Preventive Services Task Force (U.S.P.S.T.F.) and Center of Disease Control and Prevention (CDC) guidelines recommend providing behavioral counseling as well as prescribing PrEP for all sexually active adolescents and adults to decrease risk of HIV acquisition. In light of the United States (U.S.) Department of Health and Human Services (DHHS) goal for ending the HIV epidemic, all healthcare providers should be familiar with recommending PrEP as indicated to aid in disease eradication. The goal is to reduce new HIV infections in the U.S. by 75% in 2025 and 90% in 2030. In 2021, CDC data showed 30% of people who could benefit from PrEP were prescribed medication, an improvement from 13% in 2017. Although progress has been made in preventing and treating HIV, prevention efforts must further improve to reach all populations equitably to achieve a national PrEP coverage goal of 50%, by the end of this year, 2025. In this review, we highlight the urgency for all healthcare providers to offer PrEP to their sexually active patients, we provide the supportive data behind PrEP use, and we guide the clinician through safely ordering and monitoring its use in routine patient care. Continued education for providers and the public will help facilitate early intervention and better management to end the HIV epidemic.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585831","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":"Predictors and Consequences of Poor Health Trajectories Among US Adults Ages 50-64: A Latent Class Growth Analysis.","authors":"Renuka Tipirneni, Monita Karmakar, John Z Ayanian, Kara Zivin, Donovan T Maust, Kenneth M Langa","doi":"10.1007/s11606-025-09436-3","DOIUrl":"10.1007/s11606-025-09436-3","url":null,"abstract":"<p><strong>Background: </strong>US middle-aged adults have experienced concerning declines in health and life expectancy since 2010.</p><p><strong>Objective: </strong>To investigate which groups of middle-aged adults are at risk of poor health trajectories, identify predictors of unhealthy aging, and assess potential consequences on health care utilization, costs, and mortality after these adults age into older adulthood.</p><p><strong>Design: </strong>We used longitudinal survey data from the nationally representative, biennial Health and Retirement Study (HRS) to follow a representative sample of adults age 51 and older.</p><p><strong>Participants: </strong>A total of 12,333 US community-dwelling respondents.</p><p><strong>Main measures: </strong>We estimated health trajectories from biennial self-reported health status and limitations in activities of daily living and instrumental activities of daily living. Predictors of health trajectories included sociodemographic, clinical, and health care characteristics. Consequences of poor health trajectories after age 65 included self-reported hospitalizations, out-of-pocket medical costs, and mortality.</p><p><strong>Key results: </strong>We identified four distinct trajectories: \"Healthy Agers\" (14.2%), \"Less Healthy Agers\" (40.7%), \"Unhealthy Agers, Low Baseline\" (31.0%), and \"Persistently Ill\" (14.1%). Predictors of the \"Persistently Ill\" and \"Unhealthy Agers, Low Baseline\" trajectories included male gender, non-Hispanic Black race, and Hispanic ethnicity. Predictors of less healthy and unhealthy aging trajectories included ≤ high school education, income ≤ 250% of federal poverty level, smoking, obesity, and chronic diseases including diabetes, whereas continuous insurance coverage in ages 50-64, compared with intermittent or no insurance, was associated with lower odds of less healthy and unhealthy aging trajectories. After age 65, less healthy and unhealthy aging trajectories were associated with greater hospitalizations, out-of-pocket costs, and mortality compared with \"Healthy Agers.\"</p><p><strong>Conclusion: </strong>The findings suggest that unhealthy aging trajectories may frequently be set prior to age 50. Policy interventions earlier in life, such as availability of consistent health insurance coverage in early and mid-life, may mitigate downstream poor health and health care outcomes in older adulthood.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573067","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 Rise of the Hospital Chief Equity Officer-A National Survey of Early Experiences and Attributes.","authors":"Joel S Weissman, Rachel R Adler, Saba Ilkhani, Aswita Tan-McGrory, Alysa Pomer, Joy Lewis, Catherine DesRoches, Andrea Liebig, Elaine Singh, Saathvika Diviti, Tanujit Dey, Joseph Betancourt","doi":"10.1007/s11606-025-09453-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09453-2","url":null,"abstract":"<p><strong>Background: </strong>Many hospitals have created the position of equity officer (EQO) in efforts to reduce disparities and address social determinants of health.</p><p><strong>Objective: </strong>To describe EQOs' experiences and needs, and the environment in which they operate.</p><p><strong>Design and participants: </strong>A national, cross-sectional survey of EQOs in US community hospitals in 2023. Hospitals determined not to have an EQO were excluded, leaving an estimated 1228 eligible EQOs.</p><p><strong>Main measures: </strong>Characteristics of the respondents and their positions, perceptions of preparedness, critical attributes for success, and obstacles.</p><p><strong>Key results: </strong>We obtained 363 survey responses (response rate 29.6%). About one-third of respondents had been in their position for less than 1 year (35.8%), and 46.1% reported directly to the CEO. Only 8.3% had their entire full-time equivalent effort dedicated to equity work. Respondents scored positively on about half of the criteria considered important for a robust equity environment. Only 14.4% reported their hospital had an adequate, dedicated equity budget. Persons of color were significantly more likely to work in places where equity was included in the strategic plan, but also faced more environment-related obstacles. Overall, many EQOs felt less than well prepared to fulfill certain key functions of their position, such as developing community health programs (47.2%) or changing the culture of their hospital (46.9%). More than 90% of respondents identified good community relations (93.7%) and access to their hospital or health system's equity data (92.2%) as critically or very important attributes of their position. The most common obstacle to achieving their equity goals was lack of sufficient equity staff (81.5%). Differences by hospital type also were noted.</p><p><strong>Conclusions: </strong>The position of EQO is relatively new and the majority in these positions commit only a small amount of their effort to health equity issues. EQOs will need appropriate and adequate resources going forward to achieve their goals.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573073","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":"Resistance to Switching Health Care Institution Among Veterans Referred for VA-Purchased Care.","authors":"Christopher G Slatore, Natalie Disher, Jennifer Y Scott, Sara E Golden, Elizabeth Hooker, Diana J Govier, Denise M Hynes","doi":"10.1007/s11606-025-09404-x","DOIUrl":"10.1007/s11606-025-09404-x","url":null,"abstract":"<p><strong>Background: </strong>Little is known about how Veterans choose between receiving Veterans Affairs (VA)-paid health care from VA-direct care (care provided in VA facilities) vs. non-VA facilities (VA-purchased care).</p><p><strong>Objective: </strong>To evaluate Veterans' resistance to switch their hypothetical choice of health care institution with reasonable alterations in quality and access using Discrete Choice Experiments (DCE).</p><p><strong>Design: </strong>We conducted a nationwide survey among Veterans who had been offered a referral for VA-purchased care.</p><p><strong>Participants: </strong>Of the 12,547 Veterans we approached, 1253 (10.0%) respondents had evaluable data.</p><p><strong>Main measures: </strong>We summarized DCE results. We evaluated the multi-variable adjusted association of travel time to the nearest VA facility (≤ 1 h vs. > 1 h) with resistance to switch health care institutions. We calculated predicted probabilities (PP) for resistance to switching and separately based on distrust in VA health care.</p><p><strong>Key results: </strong>When respondents imagined their local VA facility was 1 h farther away than their local VA-purchased care facility, more than 60% chose VA-direct care for every quality and access improvement scenario (e.g., VA had higher quality of care). However, when all factors of care in both institutions were equal, up to 60% of respondents who initially chose VA-purchased care would not switch to VA-direct care for any incremental improvement in access and quality of VA-direct care. Travel time was not associated with high resistance to switching health care location (adjusted OR 1.1, 95% CI 0.8-1.4; p = .70). Respondents who originally chose VA-purchased care and had high distrust in VA had the highest predicted probabilities of resistance to switch (≤ 1 h travel time: PP 36%, CI 28-43%; > 1 h travel time: PP 42%, CI 34-49%).</p><p><strong>Conclusions: </strong>Interventions to increase Veterans choosing VA-direct care should improve Veterans' understanding of VA and non-VA quality and access and also improve trust in VA.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573070","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":"Impact of Primary Care Team Configuration on Access and Quality of Care.","authors":"Sylvia J Hysong, Kelley Arredondo, Houston F Lester, Richard SoRelle, Trang Pham, Frederick L Oswald, LeChauncy Woodard, Laura A Petersen, Joshua Hamer, Ashley M Hughes","doi":"10.1007/s11606-025-09456-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09456-z","url":null,"abstract":"<p><strong>Background: </strong>Team-based primary care has become the norm within many large healthcare systems; however, limited guidance exists on how to optimally staff primary care teams in relationship to healthcare.</p><p><strong>Objective: </strong>This paper examines the associations between variations in team staffing configurations on primary care access and clinical quality.</p><p><strong>Design: </strong>Observational study linking national Veterans Health Administration (VHA) data from February 2020 on primary care team staffing configurations to data on access to and quality of care the teams delivered.</p><p><strong>Participants: </strong>We examined data from 22,390 primary care personnel assigned to 7050 teams from 1050 VA Medical Centers and Community-Based Outpatient Clinics across the USA.</p><p><strong>Main measures: </strong>We used data from VHA's Corporate Data Warehouse. We assessed team-based measures of overall adherence to VHA's national guidelines for front-line clinical team staffing based on achievement of recommended staffing configurations in terms of quantity of staff and diversity of professional roles. To measure staffing sufficiency, we integrated total number of team members (team size) with their full-time equivalents (FTEs). To measure role diversity, we assessed deviation from guidelines using network analysis of staffing data. As outcomes, we used three measures of patient access to primary care and four measures of clinical quality that were prioritized by a prior expert panel. We analyzed associations between predictors and outcomes using random intercept multilevel models, with teams nested within healthcare facility.</p><p><strong>Key results: </strong>Variation in team size and FTE reflected lack of adherence to VHA guidelines rather than normal variation. Overall adherence to VHA guidelines was unrelated to access or quality of care delivered. In most cases, teams with higher FTEs exhibited better outcomes. Increased role diversity was associated with decreased secure messaging communication ratios. Teams with more members exhibited improved 2-day post-hospital discharge contact, but reduced access through third next available appointments.</p><p><strong>Conclusions: </strong>Primary care teams require a minimum amount of FTE staff capacity to deliver high quality and access to healthcare. Future work should examine how these associations vary by specific job role to further optimize staffing configurations.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573054","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 Study of Older Adult Perspectives on Continuous Glucose Monitoring for Type 2 Diabetes.","authors":"Molly L Tanenbaum, Ilana Peterson, Connie Uratsu, Minnie W Chen, Lisa Gilliam, Andrew J Karter, Anjali Gopalan, Richard W Grant, Esti Iturralde","doi":"10.1007/s11606-025-09458-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09458-x","url":null,"abstract":"<p><strong>Background: </strong>Continuous glucose monitoring (CGM) may improve self-management and reduce hypoglycemia risk among individuals with diabetes. However, little is known about how older adults with insulin-treated type 2 diabetes (T2D) experience and incorporate this technology into their daily lives.</p><p><strong>Objective: </strong>To explore experiences, preferences, barriers, and questions related to using CGM among older adults with insulin-treated T2D with and without experience using CGM.</p><p><strong>Design: </strong>Qualitative focus group study.</p><p><strong>Participants: </strong>English-speaking older adults with T2D in a large, integrated healthcare delivery system. Groups included either experienced CGM users or adults who had not previously used CGM. Recruitment efforts prioritized individuals ≥ 75 years of age.</p><p><strong>Approach: </strong>Transcripts were analyzed using the Framework Method to identify perspectives on CGM. Specific thematic categories were hypoglycemia-related benefits, general benefits, usefulness and ease of use concerns, and CGM questions.</p><p><strong>Key results: </strong>The study included 26 participants: 17 (65%) were experienced CGM users, 58% were female; median age was 74 (range 62-88) years. Participants perceived and anticipated these CGM benefits: informing behavior changes, reducing in-the-moment hypoglycemia risk, improving awareness and decision-making, and strengthening clinician collaboration. Perceived CGM barriers included challenges with wearability and reliability, burdens to others, distrust of technology, sensory and learning challenges, insufficient clinician support or engagement, and access and payer hurdles. Despite these downsides, experienced users perceived CGM as a worthwhile alternative to daily fingerstick glucose checks. Non-users were able to formulate many usability questions, providing a snapshot of informational needs for this age group.</p><p><strong>Conclusions: </strong>Older adults with insulin-treated T2D experienced or anticipated benefits from CGM for diabetes management. Findings indicate a need for tailored education and self-management support for older adults to learn and gain maximal benefit from this technology.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556943","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}