Journal of General Internal Medicine最新文献

{"title":"Building a Low-Threshold Model for HCV Diagnosis and Treatment Among Formerly Incarcerated Patients in Alabama.","authors":"Margaret Hayden, Sanjay Kishore, Davis Bradford, Mikaela Dedona, Meghan Hunter, Mary Ellen Luck, Ryan Pratt","doi":"10.1007/s11606-025-09411-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09411-y","url":null,"abstract":"<p><strong>Background: </strong>Millions of Americans remain infected with hepatitis C (HCV). Innovation in care delivery is required to achieve the goal of national elimination.</p><p><strong>Aim: </strong>Develop a low-threshold HCV treatment program.</p><p><strong>Setting: </strong>Free clinic with mobile unit providing transitional care to people leaving jails and prisons across Alabama.</p><p><strong>Participants: </strong>Formerly incarcerated persons, many of whom are uninsured and live in rural areas.</p><p><strong>Program description: </strong>We utilized point-of-care diagnostics to condense the HCV screening and pre-treatment evaluation into a single encounter. Patient assistance programs were used to obtain medications for uninsured patients. Clinical support was provided through in-person and telehealth care.</p><p><strong>Program evaluation: </strong>From January 2023 to December 2024, 369 patients were screened for HCV; 104 (28.1%) were HCV antibody positive, and 71 (19.2%) were viremic. Of these patients, 70 completed pre-treatment diagnostics, 54 started treatment, 41 confirmed completion, 20 had SVR12 collected, with 19 achieving cure (94% cure rate). The median time from diagnosis to treatment initiation was 27 days.</p><p><strong>Discussion: </strong>It is possible to both diagnose HCV and complete the entire pre-treatment evaluation in a single encounter and initiate treatment within 1 month, even for predominantly uninsured populations in rural areas.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Implementation of Long-Acting Injectable Cabotegravir for HIV Prevention in a Safety Net Hospital-based Primary Care Center in U.S. South.","authors":"Dylan Baker, Lauren F Collins, Valeria D Cantos, Emma Hollenberg, Alexander Kaplan, Terri Cowan, Jose Garcia, Meredith Lora","doi":"10.1007/s11606-025-09350-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09350-8","url":null,"abstract":"<p><strong>Background: </strong>Long-acting injectable cabotegravir (CAB-LA), approved in 2021, is a more effective HIV prevention method than daily oral PrEP. CAB-LA expansion addresses key HIV prevention gaps, especially in the Southern United States (U.S.), to support national Ending the HIV Epidemic (EHE) goals. However, complex implementation requirements hinder CAB-LA expansion, highlighting the need for real-world data to guide effective and equitable scale-up.</p><p><strong>Objective: </strong>Describe the implementation and early outcomes of implementing CAB-LA in a large safety-net primary care center in the Southern U.S.</p><p><strong>Design: </strong>We described the integration of CAB-LA into an existing oral PrEP program. We manually abstracted individual sociodemographic and clinical data. We developed a CAB-LA care continuum and reported early outcomes among CAB-LA initiators.</p><p><strong>Participants: </strong>Individuals referred to the CAB-LA program from 12/1/2022 to 8/1/2023, with outcomes assessed through 12/1/2023.</p><p><strong>Main measures: </strong>Development of a CAB-LA care continuum from linkage, eligibility assessment, program enrollment, initiation, and persistence. We reported the sociodemographic and clinical characteristics of individuals referred for and initiated on CAB-LA, the total number and timing of injections administered, self-reported adverse events, CAB-LA discontinuations, and HIV seroconversions.</p><p><strong>Key results: </strong>Integration of CAB-LA into an existing oral PrEP program required multidisciplinary team adaptation, protocol development for drug procurement and care coordination, and adapting an existing population health registry to the CAB-LA workflow to monitor and track individuals. Of 221 referred individuals, 77 (35%) initiated CAB-LA. Initiation barriers included program intake scheduling delays (29%), individuals declining CAB-LA (19%), and delayed medication procurement (16%). Among CAB-LA initiators, 275 injections were administered, 94% were administered on time, six individuals (8%) reported adverse effects, and eight (10%) discontinued CAB-LA. No HIV seroconversions occurred.</p><p><strong>Conclusions: </strong>We successfully implemented a CAB-LA PrEP program in a safety-net primary care center in the U.S. South, using an approach designed to address structural barriers to PrEP uptake and persistence.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399291","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":"Acute Medical Care by Nocturnists: A Narrative Review.","authors":"Lawrence A Haber, Justin Tien, Marisa Echaniz, Anil N Makam","doi":"10.1007/s11606-025-09403-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09403-y","url":null,"abstract":"<p><p>Nocturnists are the principal means by which hospital medicine groups currently ensure continuous overnight coverage of hospitalized patients within academic medical centers and community hospitals. Yet despite their involvement in most aspects of overnight care, a comprehensive review of the impact of nocturnists in the hospital is absent. Here we examine the physiologic effects of overnight work on clinicians, the quality of medical care delivered by nocturnists in floor and intensive care units, the impact of nocturnist presence on trainee supervision and graduated autonomy in academic settings, and prevalent staffing models. Nocturnists serve diverse roles across institutions, including performing overnight admissions and consultations, managing patients, supervising trainees, and participating in rapid response activations. Physiologically, nocturnists may experience circadian misalignment and sleep deprivation, which can impact cognitive function and results in potential long-term health risks to those working overnight. Studies show mixed results of nocturnist impact on patient outcomes, with comparative observational analyses revealing no significant differences in mortality, readmissions, or length of stay, despite perceived benefits. Nocturnist presence has been shown to enhance resident supervision and educational value of overnight rotations without compromising decision-making autonomy, though trainees' fear of revealing knowledge gaps persists. Overnight staffing models vary, with some institutions employing dedicated nocturnists and others using hybrid models; the heterogeneity of nocturnist responsibilities across institutions makes determining ideal models difficult. Compensation is typically greater for nocturnists, but the role's sustainability and impact on overall group retention remain unknown. Nocturnist programs are essential to provide continuous care of hospitalized patients and meet trainee supervision mandates, yet their full impact on patient and educational outcomes requires further investigation. Future research should aim to optimize staffing models to enhance patient care, trainee education, and clinician well-being.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391019","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":"Language Concordance and Interpreter Use for Spanish-Preferring Patients: Qualitative Study of Perspectives from Primary Care Providers.","authors":"Denise D Quigley, Nabeel Qureshi, Efrain Talamantes, Zachary Predmore","doi":"10.1007/s11606-025-09414-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09414-9","url":null,"abstract":"<p><strong>Background: </strong>Poor quality communication and language barriers lead to worse care experiences and inferior health care outcomes for those with limited English proficiency. Fewer than one-third of outpatient providers regularly use professional interpreters when communicating with non-English preferring patients. Effective strategies to address language barriers in primary care are lacking and in demand.</p><p><strong>Objective: </strong>Examine provider perspectives on providing in-person care to Spanish-preferring patients.</p><p><strong>Design: </strong>Partnered with a large, urban Federally Qualified Health Center predominantly caring for Spanish-preferring Hispanic patients, we identified primary care providers who (1) were language-concordant (provider and patient speak same language); (2) used qualified interpreters; and (3) used informal strategies for interpretation/communication.</p><p><strong>Participants: </strong>We interviewed 24 providers (10 language-concordant, 9 who used qualified interpreters, 5 who used informal interpreters and other strategies; response-rate 23%).</p><p><strong>Approach: </strong>We established codes using systematic, inductive procedures to generate insights from responses and identified themes using content analysis.</p><p><strong>Results: </strong>Providers-both language-concordant and those using interpreters-preferred to speak the same language as the patient, employed varying communication strategies, and required more time to care for Spanish-preferring patients for differing reasons. Using interpreters did not always improve communication because using qualified interpreters requires more time for initiating interpretation, connectivity issues, and conducting consecutive interpretation; using any interpreter requires provider-interpreter clarification or staff to translate, and sometimes interpreters had difficulty with medical content/terminology. Provider-patient visits also qualitatively differed based on language spoken and interpreter use in eliciting concerns, topics covered, patient comprehension, and time spent on rapport-building and patient education.</p><p><strong>Conclusions: </strong>Providers described barriers that organizations need to address to facilitate effective communication and language interpretation when caring for Spanish-preferring patients. Research is needed that identifies and tests language support strategies for providers and clinics and structural changes that preserve time during patient visits for providers and patients to spend on health care needs.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390998","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":"Association of Medicare Advantage vs Traditional Medicare with Clinical Outcomes Among Patients Hospitalized for Substance Use Disorders.","authors":"Eden Y Bernstein, Christina X Fu, John Z Ayanian, Vilsa E Curto, Timothy S Anderson, Bruce E Landon","doi":"10.1007/s11606-025-09413-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09413-w","url":null,"abstract":"<p><strong>Background: </strong>Medicare Advantage (MA) includes incentives to reduce health care spending and insures over half of Medicare eligible adults. Substance use disorders (SUD) are common in this population.</p><p><strong>Objective: </strong>To compare clinical outcomes between MA and traditional Medicare beneficiaries hospitalized with SUD.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Patients: </strong>Medicare beneficiaries hospitalized for alcohol withdrawal or opioid overdose from 2016 to 2021.</p><p><strong>Measures: </strong>Primary outcomes included mortality and all-cause readmissions within 30 days of discharge. Secondary outcomes included use of SUD medications.</p><p><strong>Results: </strong>Of 104,833 beneficiaries hospitalized for alcohol withdrawal (mean age 62.1 [SD 11.5] years, 71.8% male) and 75,463 hospitalized for opioid overdose (mean age 64.5 [SD 12.5] years, 40.8% male), 36.4% and 37.3% were enrolled in MA, respectively. Adjusted rates of 30-day mortality were lower in MA for alcohol withdrawal (unadjusted 2.5% in MA vs 2.4% in traditional Medicare; adjusted difference -0.27 pp [95% CI -0.47, -0.08]) but similar for opioid overdose (7.8% in MA vs 7.9% in traditional Medicare; adjusted difference -0.13 pp [-0.54, 0.27]). Rates of 30-day readmissions were lower in MA for both alcohol withdrawal (12.3% in MA vs 13.7% in traditional Medicare; adjusted difference -1.01 pp [95% CI -1.44, -0.59]) and opioid overdose (14.8% in MA vs 17.6% in traditional Medicare; adjusted difference -1.93 pp [95% CI -2.49, -1.37]). Enrollment in MA was associated with lower use of medications for alcohol use disorder (unadjusted 9.6% in MA vs 11.3% in traditional Medicare; adjusted difference -1.66 pp [95% CI -2.72, -0.60]) but higher use of medications for opioid use disorder (unadjusted 4.9% in MA vs 4.2% in traditional Medicare; adjusted difference, 0.82 pp [95% CI 0.08, 1.57]).</p><p><strong>Conclusions: </strong>Compared to traditional Medicare, MA was associated with modestly lower 30-day mortality after alcohol withdrawal, lower 30-day readmission rates after alcohol withdrawal and opioid overdose hospitalizations, and mixed findings on medication use.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391024","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":"Association of Primary Care Access with Health-Related ChatGPT Use: A National Cross-Sectional Survey.","authors":"Oluwatobiloba Ayo-Ajibola, Catherine Julien, Matthew E Lin, Jeffrey Riddell, Naihua Duan, Richard L Kravitz","doi":"10.1007/s11606-025-09406-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09406-9","url":null,"abstract":"<p><strong>Background: </strong>ChatGPT has quickly gained popularity as a source of online health information (OHI). However, it is unclear how having a usual source of primary care (USPC) is related to OHI-seeking.</p><p><strong>Objective: </strong>Explore how having a USPC and other characteristics thought to affect access-to-care influence the use of ChatGPT and other OHI forms.</p><p><strong>Design: </strong>Cross-sectional national survey.</p><p><strong>Participants: </strong>Adult members of ResearchMatch, a non-profit affiliate of the National Institutes of Health, between June and August 2023.</p><p><strong>Main measures: </strong>The survey evaluated demographics, health characteristics, and OHI-seeking behaviors, including ChatGPT usage. OHI sources were categorized as \"passive\" (Google, Wikipedia, WebMD) and \"interactive\" (forums, Q&A sites, ChatGPT). Descriptive statistics, t-tests, and chi-square tests compared users by USPC status. Multiple logistic regression estimated adjusted effects on ChatGPT use.</p><p><strong>Key results: </strong>Of 21,499 adults invited to participate in the survey, 2406 (11.2%) responded. Among respondents, 56% reported having a USPC. Those with a USPC, compared to those without, were older, spoke English as their primary language, had higher income, and had more formal education (all p<.001). Participants with a USPC were more likely to use passive OHI (OR 2.46, 95% CI 1.55-3.90, p<.001) and less likely to use interactive OHI (OR 0.73, 95% CI 0.60-0.89, p=.002) or ChatGPT (OR 0.56, 95% CI 0.44-0.71, p<.001). Age over 50 (OR 0.11, 95% CI 0.06-0.20, p<.001), non-White race (OR 0.51, 95% CI 0.38-0.70, p<.001), very good or better health (OR 0.71, 95% CI 0.55-0.92, p=.009), and college education (OR 0.61, 95% CI 0.39-0.97, p=.035) were inversely related to ChatGPT use.</p><p><strong>Conclusions: </strong>In this national survey of patients participating in a clinical research matching service, those with regular primary care access relied less on ChatGPT, suggesting that a personal primary care relationship may attenuate the need or motivation to use AI-derived OHI.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390995","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":"Chronic Disease Burden and Healthcare Utilization by Gender Among US Adults with Lifetime Criminal Legal Involvement.","authors":"Amelia Papadimitriou, Laura Hawks, Joni S Williams, Leonard E Egede","doi":"10.1007/s11606-025-09416-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09416-7","url":null,"abstract":"<p><strong>Background: </strong>Criminal legal involvement (CLI) has been associated with increased burden of disease, worse health outcomes, and high healthcare utilization. The health needs of women with CLI are often overlooked despite the rising proportion of women in the US legal system.</p><p><strong>Objective: </strong>Examine differences by binary gender in the prevalence of disease and healthcare utilization among individuals with lifetime CLI.</p><p><strong>Design/setting: </strong>Cross-sectional nationally representative multivariate logistic regression and negative binomial regression.</p><p><strong>Participants: </strong>Adult respondents with lifetime CLI (N = 37,279) with response rate of 66-69%.</p><p><strong>Measures: </strong>The primary independent variable was binary gender (woman/man). Outcomes included medical conditions, substance use disorders, mental illness, and healthcare utilization. Covariates included sociodemographic confounders.</p><p><strong>Results: </strong>Women comprised 29.1% of respondents with lifetime CLI and reported 0.83 times the odds of chronic heart disease compared to men (95%CI 0.74, 0.92; p = 0.001), but 1.86 times the odds of COPD (95%CI 1.63, 2.13; p < 0.001), 1.78 times the odds of asthma (95%CI 1.63, 1.93; p < 0.001), and 1.30 times the odds of cancer (95%CI 1.08, 1.53; p = 0.005). While women were less likely to have a substance use disorder (OR 0.84; 95%CI 0.78, 0.90), they were more likely to currently smoke (OR 1.29, 95%CI 1.20, 1.28; p < 0.001) and to have any mental illness (OR 2.45; 95%CI 2.26, 2.63; p < 0.001). Women reported increased rates of all forms of healthcare utilization compared to men after adjustments.</p><p><strong>Conclusions: </strong>Women with lifetime CLI experience a different profile of diseases compared to men with increased prevalence of any mental illness and chronic disease, especially respiratory diseases. They also had higher rates of healthcare utilization. Additional research should focus on interventions tailored to the unique needs of this population.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390997","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":"Prevalence of Patient Knowledge Gaps Regarding the Purpose of Their Cardiometabolic Medications.","authors":"Alexander Chaitoff, Alexander R Zheutlin, Miguel Linares, Jeffrey T Kullgren","doi":"10.1007/s11606-025-09407-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09407-8","url":null,"abstract":"<p><strong>Background: </strong>Patient knowledge regarding why they are prescribed their medications is paramount for the delivery of quality and patient-centered cardiometabolic care.</p><p><strong>Objective: </strong>To generate national estimates of the proportion of patients who do not know why they are taking their anti-hypertensive, anti-diabetes, or anti-lipid medications.</p><p><strong>Design: </strong>Cross-sectional study using data from the National Health and Nutrition Examination Survey from January 2013 through March 2020.</p><p><strong>Participants: </strong>Non-institutionalized adults in the United States.</p><p><strong>Main measures: </strong>Medication use was ascertained by respondent self-report and pill bottle review of their anti-hypertensive, anti-diabetes, or anti-lipid medications. The primary outcome was the proportion of respondents with a knowledge deficiency about why they were taking their respective medications defined by respondents reporting (1) they did not know why or (2) an incorrect indication for why they were taking each medication. We also report knowledge deficiency prevalences stratified by respondent characteristics and use multivariable logistic regression analysis to assess for relationship between respondent characteristics and odds of having a knowledge deficiency.</p><p><strong>Key results: </strong>4.9% (95% confidence interval [CI] 4.0-5.6%, n=391) of respondents on cardiometabolic medications had ≥ 1 knowledge deficiency, which corresponds to approximately 3,152,243 US adults. This was driven most strongly by knowledge deficiencies in anti-hypertensive medication use (4.5%, 95% CI 3.7-5.3%). There were large variations in knowledge deficiency prevalence by respondent characteristics. Most notably, 12.9% (95% CI 9.8-16.0%) of adults ≥ 80 years and 12.2% (95% CI 8.6-16.0%) of adults taking ≥ 10 medication had a knowledge deficiency. Of older adults with polypharmacy (≥ 5 prescriptions), 11.2% (95% CI 8.9-13.5%) > 65 years and 15.8% (95% CI 11.5-20.2%) > 80 years had a knowledge deficiency.</p><p><strong>Conclusions: </strong>Most adults report a plausible reason for their use of their cardiometabolic medications. However, the prevalence of having a knowledge deficiency varied greatly by respondent demographic and health characteristics.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of an Enhanced Data Visualization Tool for Hypertension in the Electronic Health Record on Physician Judgments About Hypertension Control.","authors":"Victoria A Shaffer, Pete Wegier, K D Valentine, Sean Duan, Shannon M Canfield, Jeffery L Belden, Linsey M Steege, Mihail Popescu, Richelle J Koopman","doi":"10.1007/s11606-025-09381-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09381-1","url":null,"abstract":"<p><strong>Purpose: </strong>Uncontrolled hypertension is a significant US health problem, despite existing effective treatments. This study assessed the impact of variations in patterns of blood pressure data on physician perceptions of hypertension control using different forms of data visualization.</p><p><strong>Method: </strong>Physicians (N = 57) reviewed eight brief vignettes describing a fictitious patient; each vignette included a graph of the patient's blood pressure data. We examined how variations in mean systolic blood pressure (SBP), blood pressure standard deviation (SD), and form of visualization (e.g., line graph with raw values or smoothed values only) affected judgments about hypertension control and need for medication change.</p><p><strong>Results: </strong>Smoothing successfully reduced visual noise for the physicians. For controlled hypertension, physician judgments were more consistent with clinical guidelines when using the smoothed graph compared with the raw data graph. Judgments about hypertension control with the smoothed graph were similar to judgments made using the raw data graph for cases of uncontrolled hypertension.</p><p><strong>Conclusion: </strong>Data visualization can direct physicians to attend to more clinically meaningful information, thereby improving their judgments of hypertension control.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370838","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 and Hypertension Control in an Urban Community Health Center Cohort.","authors":"Fabiola Molina, Sarah Westvold, Pamela R Soulos, Anthony Brockman, Emmanuel Martinez Alcaraz, Benjamin J Oldfield","doi":"10.1007/s11606-025-09393-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09393-x","url":null,"abstract":"<p><strong>Background: </strong>Real-time or synchronous telemedicine can be a valuable adjunctive strategy for chronic disease management, but few studies have assessed its impact on hypertension control among safety-net populations.</p><p><strong>Objective: </strong>To evaluate whether telemedicine is associated with blood pressure (BP) control.</p><p><strong>Design: </strong>Retrospective cohort study. Mixed-effects logistic regression models clustered by the patient estimated associations between telemedicine and BP control after adjusting for patient factors and neighborhood context.</p><p><strong>Participants: </strong>Patients seeking care at an urban, multisite community health center with hypertension and ≥1 BP measurement between 2020 and 2022 (3663 patient-year observations across 2086 unique patients).</p><p><strong>Main measures: </strong>The primary outcome was BP control defined as a binary variable. We used the Centers for Medicare & Medicaid Services' Controlling High Blood Pressure quality measure criteria of systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg in the most recent recording in the measurement year.</p><p><strong>Key results: </strong>Among the 2086 patients with hypertension in our sample, there were 1257 (60.3%) Latinx and 425 (20.4%) Black patients. Over 90% lived in a neighborhood of high deprivation as categorized by the social deprivation index. Telemedicine visits, compared to none, were not associated with blood pressure control (1-2 telemedicine visits aOR, 1.05 [95% CI, 0.86-1.28]; ≥3 telemedicine visits aOR, 0.86 [95% CI, 0.68-1.09]). One in-person visit per year, compared to 2-3, was associated with lower odds of BP control (aOR, 0.72 [95% CI, 0.55-0.94]). Black patients, compared to Latinx patients, were less likely of having BP control (aOR, 0.64 [95% CI, 0.48-0.87]).</p><p><strong>Conclusions: </strong>In this community health center cohort of patients with hypertension, telemedicine did not compromise blood pressure control. Persistent racial disparities in blood pressure control underscore the need for equity-centered strategies for hypertension management in safety-net primary care settings.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370837","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}