Journal of General Internal Medicine最新文献

{"title":"Early Adoption of Caregiver Training Services in Traditional Medicare.","authors":"Jessica I Billig, Joseph H Joo, Jennifer R Cardin, Yue Gao, Ching-Ching Claire Lin, Raymond N Kuo, Joshua M Liao","doi":"10.1007/s11606-026-10937-y","DOIUrl":"https://doi.org/10.1007/s11606-026-10937-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182400","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":"Expanded American Cancer Society Lung Cancer Screening Eligibility and Predicted Risk.","authors":"Adoma Manful, Melinda C Aldrich, Brian Mitzman, Nathorn Chaiyakunapruk, Richard E Nelson, Jennifer Richmond, Meng-Yun Lin","doi":"10.1007/s11606-026-10907-4","DOIUrl":"10.1007/s11606-026-10907-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182408","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":"Racial Differences in Respiratory Tract Infection Diagnosis and Antibiotic Prescriptions.","authors":"Kathryn A Martinez, Ava Rezaee, Victoria Criswell, Michael B Rothberg","doi":"10.1007/s11606-026-10930-5","DOIUrl":"https://doi.org/10.1007/s11606-026-10930-5","url":null,"abstract":"<p><strong>Background: </strong>Non-White patients are less likely than White patients to be prescribed antibiotics for respiratory tract infections (RTIs). Our objective was to understand whether this could be explained by differences in RTI diagnosis type by race.</p><p><strong>Methods: </strong>We conducted an observational cohort study of adults receiving urgent care at Cleveland Clinic in Northeast Ohio who were diagnosed with an RTI between 2016 and 2022. We used mixed effects logistic regression of antibiotic prescription by patient race (White versus non-White) in two models: 1) not accounting for RTI diagnosis type, and 2) accounting for diagnosis type. We used mixed effects logistic regression, including physician and individual patient as random effects, to assess differences in the odds of being diagnosed with sinusitis versus unspecified RTI by race. Finally, we assessed odds of being prescribed an antibiotic by race, stratified by diagnosis. Analyses were conducted at the visit level.</p><p><strong>Results: </strong>Among 100,052 visits with 62,972 unique patients (median visits per patient was 1), 21% percent were for sinusitis and 30% were for unspecified RTI. Eighty-four percent of patients were White and 16% were non-White. In the model not controlling for diagnosis, compared to White patients, non-White patients were significantly less likely to be prescribed an antibiotic (aOR: 0.79; 95%CI:0.76-0.82). After adjusting for diagnosis, the association between non-White race and antibiotic prescription was weaker but still significant (aOR:0.91; 95%CI:0.87-0.95). Compared to White patients, non-White patients were significantly less likely to be diagnosed with sinusitis versus unspecified RTI (aOR:0.61; 95%CI:0.56-0.66). Non-White patients were significantly less likely to be prescribed antibiotics for sinusitis and unspecified RTI than White patients.</p><p><strong>Conclusions: </strong>Racial differences in diagnosis of sinusitis partially explain lower rates of antibiotic prescription among non-White patients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182345","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":"Feasibility of Implementing a Pharmacist-Integrated Collaborative Model for Opioid Use Disorder: A Nonrandomized Clinical Trial.","authors":"Felicity Homsted, David A Fiellin, Udi E Ghitza, Vernon T Gardner, Bethany McLeman, Paul J Joudrey, Gerald Cochran, Sarah K Moore, Lisa Saldana, Edward Chongsi, Kimberly Kramer, Ashley Vena, Rebecca A Ottesen, Jacklyn Harris, Jesse S Boggis, Deepika Rao, Owen Murray, Scott Gerlach, Phoebe Gauthier, Katie P Osterhage, Laura-Mae Baldwin, Lisa A Marsch","doi":"10.1007/s11606-026-10924-3","DOIUrl":"10.1007/s11606-026-10924-3","url":null,"abstract":"<p><strong>Background: </strong>Addressing the opioid crisis requires an interdisciplinary approach. Pharmacists may provide medication expertise to primary care addiction teams.</p><p><strong>Objective: </strong>To determine whether implementing a pharmacist-integrated model of care for opioid use disorder (PrIMO) was feasible and acceptable.</p><p><strong>Design: </strong>Nonrandomized mixed-methods longitudinal feasibility/implementation trial conducted from March 2022 to October 2024.</p><p><strong>Participants: </strong>Four primary care sites with retail pharmacies and clinical pharmacists. Participants were adults employed by the clinics and adult patients receiving medications for opioid use disorder (MOUD) exposed to PrIMO for at least 2 weeks. Site staff (provider, pharmacists, leadership) were surveyed for 15 months (80.6% follow-up completion) and patients for 6 months (75.5% follow-up completion).</p><p><strong>Intervention: </strong>Pharmacist-integrated MOUD.</p><p><strong>Main measures: </strong>Primary: Feasibility (PrIMO launch). Secondary: acceptability (survey and interview data) and impact (electronic health record data).</p><p><strong>Key results: </strong>All sites launched PrIMO (100%) and maintained it for at least 1 year. From 3 months pre- to 1 year post-launch, site staff reported fewer barriers to providing MOUD (m [SD] 2.2 [0.8] to 1.8 [0.5], 1-4-point scale), increased knowledge of MOUD (3.8 [0.4] to 4.0 [0.5], 1-5-point scale), and steady acceptability by providers/pharmacists (2.1 [0.3] to 2.0 [0.4], 0-3-point scale) and leadership (2.1 [0.3] to 2.0 [0.4], 0-3-point scale). Patients reported less stigma (3.1 [1.1] to 2.8 [1.1], 1-5-point scale) and steady acceptability (2.2 [0.4] to 2.2 [0.4], 0-3-point scale). Electronic health records data demonstrated increases in the rate of patients retained in MOUD (m [SD] 59.5 [34.81] to 60.2 [35.35] proportion of days covered), adherence to MOUD (38.6 to 40.9%), clinic visits for MOUD (+ 100 encounters), and total patients treated per prescriber (m [SD] 12.9 [32.49] to 13.7 [35.07]) 1 year pre- vs 1 year post-launch, although statistical significance was not assessed.</p><p><strong>Conclusions: </strong>Integrating pharmacists into MOUD care teams may improve feasibility and acceptability of MOUD in primary care.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT05310786, March 14, 2022.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182336","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":"When Employment Structures Define Professionalism in General Internal Medicine.","authors":"Gus W Krucke","doi":"10.1007/s11606-026-10939-w","DOIUrl":"https://doi.org/10.1007/s11606-026-10939-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182443","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":"Does Patient-Centered Communication by Physicians Facilitate Cardiometabolic Disease Self-management Among Community Health Center Patients? A Nationwide Study.","authors":"Sudha Xirasagar, Zixiao Nan, Elena Platonova, Melinda Merrell, Nabil Natafgi","doi":"10.1007/s11606-026-10928-z","DOIUrl":"https://doi.org/10.1007/s11606-026-10928-z","url":null,"abstract":"<p><strong>Background: </strong>Cardiometabolic self-management through lifestyle behavior change is critical for patients with cardiometabolic risk conditions (obesity, high blood pressure, type 2 diabetes (T2DM) and/or dyslipidemia) to avoid life-threatening complications.</p><p><strong>Objective: </strong>To examine whether patient-centered communication (PCC) by community health center (CHC) physicians may facilitate patients with cardiometabolic conditions to implement disease self-management behaviors in daily life.</p><p><strong>Research design: </strong>We used secondary data from the 2022 Health Services and Resources Administration-Research Triangle International-designed, nationally representative sample survey of CHC patients (response rate 85.0%). We assessed the association of patients' adoption of cardiometabolic self-management behaviors in five domains (weight management, dietary change, physical activity, reducing sedentariness, and smoking reduction) with ratings of their physician's PCC during primary care visits.</p><p><strong>Participants: </strong>2,942 adults aged 18-74 years, with cardiometabolic condition(s) completing a primary care visit.</p><p><strong>Measures: </strong>Outcome: Cardiometabolic self-management (SM) score, sum of patient's weighted fraction scores of behaviors in five domains, multiplied by 100 to obtain a whole integer-based, ratio-scale score. Key independent variable: Patient-rated physician PCC aggregated from scores on five adapted Consumer Assessment of Healthcare Providers and Systems survey questions (CAHPS) during primary care visits (Likert scale 0-3).</p><p><strong>Results: </strong>Among 2,942 study-eligible patients (25.3% with T2DM, 62.8% obesity, 60.1% hypertension, 50.9% dyslipidemia), the mean cardiometabolic SM score was 246.3 (±82, median 250, possible score range, -30 to 470). The mean PCC score (validated by exploratory factor analysis) was 17.7 (±3.3, median 20, possible range 0-20). A unit increase in PCC was associated with 1.8-point increase in patients' SM score (SE 0.5, p<0.001), after adjusting for demographic variables, chronic conditions, and patient-reported measures of their enabling environment for physical activity, food security, and physical/mental health disability.</p><p><strong>Conclusions: </strong>Physicians' PCC as measured by the CAHPS survey may promote better self-management of cardiometabolic conditions by CHC patients who often have low health literacy.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182333","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":"Gaps in Access to Home and Community-Based Services Following Inpatient Rehabilitation for Traumatic Brain Injury in Older Adults.","authors":"Adam R Kinney, Jeri E Forster, Alexandra L Schneider, Lisa A Brenner, Raj G Kumar, Jason R Falvey, James E Graham, Ryan Holliday, Nazanin H Bahraini","doi":"10.1007/s11606-026-10844-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10844-2","url":null,"abstract":"<p><strong>Background: </strong>Older adults with traumatic brain injury (TBI) often experience residual self-care and mobility limitations after discharge from inpatient rehabilitation facilities (IRFs). Occupational therapy (OT) and physical therapy (PT) in home health or outpatient settings can address these limitations, yet access is poorly understood.</p><p><strong>Objective: </strong>Determine whether need for OT (self-care limitations) and PT (mobility limitations) at IRF discharge is associated with community rehabilitation utilization, and whether non-clinical factors are independently associated with utilization.</p><p><strong>Design: </strong>Cohort study using Medicare claims and assessment data. Modified Poisson regression estimated receipt of home health OT, home health PT, outpatient OT, and outpatient PT post-IRF discharge as a function of self-care and mobility performance, non-clinical factors, and clinical covariates.</p><p><strong>Participants: </strong>Community-dwelling older adults who received inpatient rehabilitation for TBI from 2020 to 2022 (n = 23,036).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main measures: </strong>Clinical need was defined using discharge Section GG self-care and mobility performance scores. Receipt of community rehabilitation was identified within 90 days post-IRF discharge.</p><p><strong>Key results: </strong>Most rehabilitation occurred via home health (OT 52%; PT 67%); only 15% received outpatient OT and 27% received outpatient PT. Worse self-care was associated with home health and outpatient OT use. Worse mobility predicted home health PT, but mobility did not predict outpatient PT use. Non-clinical factors were independently associated with a decreased likelihood of home health utilization, including younger age; Hispanic ethnicity (vs. White, non-Hispanic); and rurality. Similarly, beneficiaries who were older; identified as Black or Hispanic (vs. White, non-Hispanic); unmarried; or eligible for Medicaid were less likely to receive outpatient rehabilitation.</p><p><strong>Conclusions: </strong>Community rehabilitation was common, but care was concentrated in home health. Clinical need was not a dominant driver of utilization, and non-clinical factors shaped access. Findings highlight gaps in utilization of beneficial rehabilitative care upon discharge and reveal targets for improving transitional services.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182352","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":"Representation of the LGBTQIA+ Patient Community in Cardiovascular Disease Clinical Guidelines.","authors":"Cassandra Chu, Jiya Patel, Andres Castillo, Roman Zeltser, Amgad N Makaryus","doi":"10.1007/s11606-026-10857-x","DOIUrl":"https://doi.org/10.1007/s11606-026-10857-x","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is the leading cause of death worldwide¹, yet gaps remain for underrepresented populations in CVD research and clinical guidelines. The LGBTQIA+ community comprises 7% of the U.S. population², and evidence suggests a higher predisposition to CVD from increased psychosocial stressors, obesity, smoking, and use of gender-affirming therapy^5,6. Our study assesses existing CVD clinical guidelines' approach to the LGBTQIA+ community. In total, 313 cardiology clinical guidelines published by American, European, and international societies were reviewed. A systematic search for LGBTQIA+ related terms was conducted; guidelines containing these terms were analyzed. Only six guidelines (1.9%) contain LGBTQIA+-related terms. The 2023 ACC/AHA/ACCP/HRS Atrial Fibrillation Guideline mentions stroke risk reduction therapies should be offered equitably regardless of sex and gender diversity. The 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease (CCD) Guideline identifies sexual orientation as a social determinant of health (SDOH), which warrants future research on cardiovascular risk in hormone-treated transgender women with established CCD. The 2020 VA/DoD Obesity Guideline recommends research on individual differences, including transgender identity, in predicting bariatric procedure outcomes. The minimal acknowledgment of LGBTQIA+ patients in existing CVD guidelines highlights the need for tailored recommendations to improve outcomes in this community.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182367","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":"Reading Between the Lines: An Exercise in Clinical Reasoning.","authors":"Andrew Sanchez, Andrew Parsons, Anna Fretz","doi":"10.1007/s11606-026-10914-5","DOIUrl":"https://doi.org/10.1007/s11606-026-10914-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182411","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":"Rural Healthcare Is Different: A National Research and Policy Agenda.","authors":"Angelo E Volandes, Johnny Huynh, Nathan Goldstein","doi":"10.1007/s11606-026-10859-9","DOIUrl":"https://doi.org/10.1007/s11606-026-10859-9","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182365","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}