Journal of General Internal Medicine最新文献

{"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}

{"title":"Differences in Ambulatory Care Outcomes Between Trainees and Faculty: A Multi-center Study.","authors":"Kelly L Graham, Maelys Amat, Elizabeth Norian, Jonathan Li, Jennifer Weintraub, Aleesha Shaik, Joel C Boggan, John Davy, Amalia Lyons, Leroy Semour, Rebecca Rogers, Roger B Davis","doi":"10.1007/s11606-025-09626-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09626-z","url":null,"abstract":"<p><strong>Background: </strong>Academic medical centers (AMCs) provide the nation's most complex care, with no differences in performance between trainees and faculty for inpatient outcomes. Single-center analyses demonstrated low performance on ambulatory outcomes among residents vs. faculty.</p><p><strong>Objective: </strong>Determine whether resident-faculty ambulatory care performance disparities are a national problem, understand contributing factors present in AMCs.</p><p><strong>Design: </strong>Retrospective cohort study, survey-based study PARTICIPANTS: A total of 146,961 patients receiving primary care at five AMCs within resident-faculty primary care training practices during calendar year 2019. Resident clinic directors at each of the sites participated in the survey-based analysis.</p><p><strong>Main measures: </strong>The main exposure was whether the patients received primary care in a faculty-supervised resident vs. faculty-only cohort. Outcome measures included rates of colorectal and breast cancer screening and control of type 2 diabetes mellitus and hypertension between the resident and faculty cohorts. We also assessed the level of agreement with five components of high-functioning primary care as defined by the National Academies of Sciences in interviews with residency practice leadership.</p><p><strong>Key results: </strong>After adjustment for key differences in social complexity, we observed resident-faculty disparities across all five sites for all outcomes, with disparities in breast cancer screening from RR 0.69 (0.62-0.78)-0.71 (0.63-0.80); disparities in colorectal cancer screening from RR 0.77 (0.68-0.88) to 0.90 (0.86-0.93); disparities in control of type 2 diabetes mellitus from RR 0.82 (0.69-0.97) to 0.90 (0.86-0.93); and disparities in control of hypertension from RR 0.79 (0.68-0.91) to 0.87 (0.79-0.95). The magnitude of resident-faculty performance disparities may be related to the likelihood of disagreement with the five components of high-functioning primary care.</p><p><strong>Conclusions: </strong>Residents performed lower than faculty on routine ambulatory quality measures. The magnitude and number of disparities may be related to disagreement on the presence of components of high-functioning primary care. These findings highlight the need for more robust infrastructural support in primary care settings to meet the needs of patients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216037","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":"Patient-Clinician Sex and Race and/or Ethnicity Concordance and Adherence to Preventive Services Guidelines: MEPS 2018-2020.","authors":"Alexis L Green, Randy Le, Erik J Rodriquez, Anna M Nápoles, Eliseo J Pérez-Stable, Paula D Strassle","doi":"10.1007/s11606-025-09631-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09631-2","url":null,"abstract":"<p><strong>Background: </strong>Patient-clinician sex, racial, and ethnic concordance have been shown to improve healthcare utilization, but the impact of each on adherence to preventive services guidelines among specific populations remains unclear.</p><p><strong>Objective: </strong>To estimate the association between patient-clinician sex and racial and/or ethnic concordance and adherence to preventive services guidelines.</p><p><strong>Design: </strong>Cross-sectional study using nationally representative data from the Medical Expenditure Panel Survey (2018, 2020).</p><p><strong>Participants: </strong>Adults ≥ 18 years old who reported having a usual healthcare clinician. Adults who identified as multiracial, identified their clinician as being multiracial, or who did not report clinician sex, race, or ethnicity were excluded.</p><p><strong>Main measures: </strong>Adherence to preventive services guidelines for influenza, pneumococcal, and shingles vaccines; breast, cervical, and colorectal cancer screening; and blood pressure and cholesterol screening. Predicted marginal prevalences and prevalence ratios were estimated using multivariable logistic regression, adjusting for sociodemographics, chronic conditions, and self-reported health status.</p><p><strong>Key results: </strong>Females were less likely to report sex concordance compared to males (52.5% vs. 69.8%, p < 0.01). Among females, sex concordance increased influenza (PR = 1.08, 95% CI = 1.04-1.12), pneumococcal (PR = 1.06, 95% CI = 1.02-1.11), and shingles (PR = 1.09, 95% CI = 1.01-1.17) vaccination, as well as breast (PR = 1.06, 95% CI = 1.01-1.10), cervical (PR = 1.09, 95% CI = 1.05-1.13), and colorectal (PR = 1.07, 95% CI = 1.03-1.10) cancer screening, but not among males. Racial and/or ethnic concordance was low among American Indian and Alaska Native, Black, Latino, and Native Hawaiian and Pacific Islander patients (< 25%) and was not associated with adherence in preventive services.</p><p><strong>Conclusions: </strong>Females with female clinicians are more likely to adhere to preventive services guidelines. Racial and/or ethnic concordance was not associated with adherence to preventive services guidelines, but racial and/or ethnic concordance was low among non-White patients. Sex and racial and/or ethnic concordance may be a powerful tool for increasing preventive services utilization, but increased racial and/or ethnic concordance is needed to reach more definitive conclusions.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216038","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":"Patient Assistance Programs for High-Cost Diabetes Medications: What Is Available for Uninsured Immigrants?","authors":"Constantinos P Karakousis, Francesca Polito, Kathleen R Page, Mariana Socal","doi":"10.1007/s11606-025-09623-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09623-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208621","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}