Journal of General Internal Medicine最新文献

{"title":"Association Between Telehealth Delivery and Same-day Access to Integrated Mental Health in a National VA Sample.","authors":"Taona P Haderlein, Darren Lov, Amy Bonilla, Martin L Lee, Lucinda B Leung","doi":"10.1007/s11606-025-09816-9","DOIUrl":"10.1007/s11606-025-09816-9","url":null,"abstract":"<p><strong>Background: </strong>Same-day access to mental health services is associated with better patient outcomes (e.g., diagnosis, treatment). Telehealth appointments via video or phone can improve timely access to care but may complicate in-person care transfers (\"warm handoffs\") between primary care and mental health teams.</p><p><strong>Objective: </strong>To examine associations between receiving telehealth services and same-day access to integrated mental health services within primary care (PCMHI).</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included 1,220,902 Veterans who newly initiated PCMHI services between 10/01/18 and 09/30/23.</p><p><strong>Main measure(s): </strong>Our primary outcome of interest was whether \"same-day access\" occurred, defined as a PCMHI visit that took place on the same day as a primary care visit. Our exposure of interest was whether a patient's initial PCMHI visit took place through in-person versus telehealth, defined as either video or phone. Using multi-level regression models, we examined the association between same-day access and PCMHI visit modality (in-person/phone/video), adjusting for time, region, patient (e.g., demographics, physical and mental health diagnoses), and clinic (e.g., rurality, staffing). Models were stratified by pre-/early-pandemic (FY19-21) versus late-pandemic (FY22-23) periods.</p><p><strong>Results: </strong>Patients with an initial PCMHI visit conducted through telehealth (video/phone) had 86% lower odds of receiving same-day access than those with an in-person PCMHI visit (95% CI = 0.1444-0.1448). Lower odds of same-day access with PCMHI providers were found for both video (OR = 0.0912; 95% CI = 0.0909-0.0915) and phone (OR = 0.1604, 95% CI = 0.1602-0.1606) visits. Odds of same-day access from primary care to telehealth-based PCMHI care improved with time (OR_FY19-21 = 0.10, 95% CI = 0.09-0.12; OR_FY22-23 = 0.18, 95% CI = 0.16-0.20).</p><p><strong>Conclusions and relevance: </strong>Results suggest that primary care patients who receive integrated mental health services via telehealth may be less likely to access primary care services on the same day. Further research should consider how traditional primary care workflows (e.g., warm handoffs) may need to adapt to better integrate tele-mental health services.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091829","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":"Effectiveness of Low-cost, Technology-enhanced Simulation Training for Healthcare Training in Low-and Middle-income Countries (LMICs): A Systematic Literature Review.","authors":"Julia Messina Gonzaga Ferreira, José Roberto Generoso, Alexandre R Marra, Rodrigo Octávio Deliberato, Maya Dewan, Daniel Loeb, Francis Real, Kelly Collins, Kelly Ely, Matthew Zackoff, Gabriel de Oliveira Vasques Lopes, Isabele Pardo, Maria Celidonio Gutfreund, Gustavo Yano Callado, Eneida A Mendonça","doi":"10.1007/s11606-025-09794-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09794-y","url":null,"abstract":"<p><strong>Background: </strong>Simulation-based training is essential for enhancing healthcare education and patient safety. However, its implementation often requires significant financial investment, limiting access in low- and middle-income countries (LMICs). Adapting simulation techniques to low-cost alternatives could improve accessibility and reduce educational disparities across global settings. This review aims to synthesize evidence on low-cost, technology-enhanced educational tools for healthcare training in resource-constrained settings.</p><p><strong>Methods: </strong>We searched Medline (PubMed), CINAHL, Cochrane CENTRAL, Web of Science, Scopus, and Embase until August 31, 2024. Eligible studies involved LMICs, health trainees, and low-cost, technology-enhanced simulation tools for resource-constrained settings. We excluded comments, reviews, editorials, and studies not meeting these criteria. The review followed PRISMA guidelines, and study quality was assessed via the Downs and Black scale. This study was registered on PROSPERO (CRD42024554815) and received no funding.</p><p><strong>Results: </strong>A total of 13 studies were included: six randomized trials and seven nonrandomized trials. These studies assessed various learning tools, including smartphone apps (six), virtual or augmented reality (three), telesimulation (two), a virtual simulation website (one), and a high-fidelity simulator (one), across multiple healthcare disciplines. Most studies have reported positive learning outcomes, such as improved skills and knowledge, although none have assessed long-term behavioral changes or patient outcomes. The reported barriers included internet connectivity issues, software instability, language limitations, and variability in prior knowledge. User satisfaction was generally high.</p><p><strong>Discussion: </strong>This review highlights scalable, technological simulation tools for LMICs that improve medical training in resource-limited settings. It adheres to PRISMA guidelines, ensuring rigor, and includes studies from multiple continents and healthcare disciplines. Limitations include variations in low-cost tool definitions, study quality, and a lack of long-term behavior or clinical impact assessment. Additionally, comparisons often involve traditional learning methods rather than high-fidelity simulation tools used in high-income countries, and no cost-effectiveness analyses have been conducted.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086268","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":"Assessing Anorectal Sexual Function: Validity and Clinical Utility of a New Measure.","authors":"Thomas W Gaither, Myles Anderson, Jonathan A Balcazar, Marcia M Russell, Mark S Litwin","doi":"10.1007/s11606-025-09852-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09852-5","url":null,"abstract":"<p><strong>Background: </strong>Various conditions can disrupt anorectal sexual function, potentially reducing pleasure or increasing pain. There is currently no standard diagnostic criteria for anorectal sexual dysfunction, including anhedonia and anodyspareunia, despite a described need for better measurement tools.</p><p><strong>Objective: </strong>To evaluate the Anorectal Sexual Function Index (ASFI) in a clinical sample of people with and without problematic receptive anal intercourse (RAI) and to develop diagnostic cut-off scores for potential classification of sexual dysfunction.</p><p><strong>Design: </strong>Between July 2024 and January 2025, we conducted a mixed-method, cross-sectional study of a population with mixed sexual function/dysfunction among individuals assigned male at birth.</p><p><strong>Participants: </strong>We recruited individuals with concerns during RAI, including pain or lack of pleasure in addition to people with known pelvic pathology.</p><p><strong>Main measures: </strong>All participants completed a clinical interview and a questionnaire, including the ASFI and other health-related quality-of-life measures.</p><p><strong>Key results: </strong>Among the 122 participants, the mean age was 42 years, the majority (97%) were cis-gender men, and 85% of whom identified as gay. Participants reporting reduced pleasure in the interview scored lower on the pleasure domain (11 vs 17, p < 0.01), while those reporting pain in the interview had higher pain scores (23 vs 13, p < 0.01). Participants with active fissures, IBS, IBD, anal cancer, and chronic prostatitis/pelvic pain syndrome consistently reported higher pain scores and lower pleasure scores. Participants classified with anodyspareunia reported lower sexual satisfaction, reduced erectile frequency during RAI, fewer orgasms during RAI, and higher levels of internalized homophobia. Participants classified with anhedonia reported lower sexual satisfaction, reduced erectile frequency during RAI, fewer orgasms during RAI, and higher prevalence of HIV.</p><p><strong>Conclusions: </strong>We standardized the diagnosis for anodyspareunia and RAI anhedonia using the ASFI. Respondents with anodyspareunia and RAI anhedonia reported worse patient-reported outcomes than those who did not meet criteria.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091893","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":"Entropy in Clinical Decision-Making: A Narrative Review Through the Lens of Decision Theory.","authors":"Cory Rohlfsen, Kevin Shannon, Andrew S Parsons","doi":"10.1007/s11606-025-09868-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09868-x","url":null,"abstract":"<p><p>Navigating uncertainty is fundamental to sound clinical decision-making. With the advent of artificial intelligence, mathematical approximations of disease states-expressed as entropy-offer a novel approach to quantify and communicate uncertainty. Although entropy is well established in fields like physics and computer science, its technical complexity has delayed its routine adoption in clinical reasoning. In this narrative review, we adhere to Shannon's definition of entropy from information processing theory and examine how it has been used in clinical decision-making over the last 15 years. Grounding our analysis in decision theory-which frames decisions in terms of states, acts, consequences, and preferences-we evaluated 20 studies that employed entropy. Our findings reveal that entropy is predominantly used to quantify uncertainty rather than directly guiding clinical actions. High-stakes fields such as oncology and radiology have led the way, using entropy to improve diagnostic accuracy and support risk assessment, while applications in neurology and hematology remain largely exploratory. Notably, no study has yet translated entropy into an operational, evidence-based decision-support framework. These results point to entropy's value as a quantitative tool in clinical reasoning, while also highlighting the need for prospective validation and the development of integrated clinical tools.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086201","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":"Beyond Black and White: Cancer Disparities Within Racial Groups.","authors":"Davidi Tawfiles, Mutlay Sayan, Brandon A Mahal, Miriam Tawfiles, Erin Jay G Feliciano, Paul L Nguyen, Edward Christopher Dee","doi":"10.1007/s11606-025-09879-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09879-8","url":null,"abstract":"<p><p>Racial and ethnic disparities in cancer outcomes are well documented in the USA, yet current data systems often obscure important subgroup differences by relying on overly broad racial classifications. This paper argues that such aggregation-labeling diverse populations simply as \"White,\" \"Black,\" or \"Asian\"-masks clinically significant heterogeneity and perpetuates structural invisibility in public health efforts. Drawing on national databases like SEER and NCDB, we illustrate how ethnic disaggregation among Asian American subgroups has already revealed marked disparities in cancer incidence and staging. Extending this approach, we highlight local and regional studies showing similarly divergent cancer outcomes among subgroups within Black, Hispanic/Latino, and White populations-including African immigrants, Puerto Ricans, and Arab Americans. These disparities remain hidden in national surveillance systems, undermining efforts to tailor cancer screening, prevention, and treatment. We further examine the consequences of broad racial classification for genetic risk stratification, culturally appropriate health messaging, public trust, and equitable funding allocation. The forthcoming inclusion of Middle Eastern and North African (MENA) populations as a distinct category in the 2030 U.S. Census offers a timely opportunity to reform health data systems and align them with the nuanced realities of population diversity. Ultimately, we argue that precision public health depends on disaggregated data that make invisible populations visible. Addressing cancer disparities-particularly in under-recognized ethnic subgroups-requires not only better data, but also a commitment to cultural humility, linguistic inclusivity, and equity-centered research frameworks that bridge the gap between identity and intervention.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086245","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":"Disparities in Physical Function and Rehabilitation Utilization: A Cross-sectional Study of Patients Hospitalized for Acute Medical Illness.","authors":"Maylyn Martinez, Rachel Baccile, Joshua Johnson, Jason Falvey, Monica E Peek, Vineet Arora, David Meltzer","doi":"10.1007/s11606-025-09826-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09826-7","url":null,"abstract":"<p><strong>Background: </strong>Black patients have poorer physical function and mobility compared to White patients but utilize physical rehabilitation services less.</p><p><strong>Objective: </strong>To determine whether racial differences exist in physical function and post-acute care facility utilization and whether neighborhood social disadvantage influences these differences.</p><p><strong>Design: </strong>A cross-sectional study of hospitalized patients at a large urban academic hospital.</p><p><strong>Participants: </strong>We included self-identified Black or White adults who were hospitalized between January 2018 and May 2022.</p><p><strong>Main measures: </strong>The main exposure was self-identified race. The exposure in our secondary aim was neighborhood social disadvantage measured by the Area Deprivation Index. Neighborhood disadvantage was categorized as \"more\" (deciles 6-10) vs. \"less\" (deciles 1-5). Primary outcomes included inpatient functional measures, inpatient and post-acute physical therapy referral, and discharge location.</p><p><strong>Key results: </strong>Compared to White patients, Black patients had more functional impairment on admission [OR 1.52; 95% CI (1.37, 1.69)], poorer mobility change [β-0.83; 95% CI (- 1.16, 0.50)], more mobility loss [OR 1.25; 95% CI (1.12, 1.41)], but no statistically significant difference in inpatient PT referrals after adjusting for physical function. Most differences in function persisted when stratified by neighborhood disadvantage. Despite similar odds of recommendation for discharge to a PAC facility, Black patients had significantly lower odds of discharge to a facility [OR 0.53; 95% CI (0.42, 0.68). This difference persisted when stratified by more neighborhood disadvantage [OR 0.60; 95% CI (0.43, 0.85)] and less neighborhood disadvantage [OR 0.43; 95% CI (0.31, 0.61)].</p><p><strong>Conclusion: </strong>In this study of patients hospitalized at a large urban academic medical center, Black patients had poorer functional outcomes yet nearly half the likelihood of discharging to a post-acute care facility compared to White patients. Race was a more consistent driver of disparities than neighborhood disadvantage. Hospital, healthcare system, and public policy changes are needed to improve discharge location appropriateness and recovery after hospitalization for vulnerable patients.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086270","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":"Concise Research Report: Telemedicine Payment Parity and Overdose Rates.","authors":"Jiawen C Chen, Seynabou Diagne, Adam E Block","doi":"10.1007/s11606-025-09875-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09875-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080598","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":"Beyond Debunking: Physicians Can Prevent Misinformation.","authors":"Hooi Min Lim, Adam G Dunn, Chirk Jenn Ng","doi":"10.1007/s11606-025-09846-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09846-3","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080605","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":"Assessment of Spanish Language Interpretation Access at Primary Care Offices in Allegheny County: A Secret Shopper Study.","authors":"Christina White, Tanya Nikiforova, Eliana Bonifacino","doi":"10.1007/s11606-025-09857-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09857-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080656","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":"Caring for Communities: Comparing Health Care System Patient Populations to Regional Populations.","authors":"John P Powers, Timothy S Carey, Taylor W Hargrove, Aubrey Limburg, Victoria Udalova, Amy Shaheen, Robert Bowers, Emily R Pfaff, Barbara Entwisle","doi":"10.1007/s11606-025-09867-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09867-y","url":null,"abstract":"<p><strong>Background: </strong>Recent years have seen an increase in the number and size of integrated health care delivery systems in the USA. The size and sophistication of these systems afford a greater focus on population health, leading to a fundamental question: How do the patients of these systems compare to the underlying regional populations that the systems serve?</p><p><strong>Objective: </strong>To demonstrate an approach to answering this question for a large public integrated delivery system, with a particular focus on neighborhood social determinants of health (SDOH).</p><p><strong>Design: </strong>We present a descriptive, graphical comparison of the neighborhood characteristics of UNC Health patients and the overall population of North Carolina (NC).</p><p><strong>Subjects: </strong>We leveraged electronic health record data from a 5-year period for patients at UNC Health, an integrated health care delivery system focused on serving the NC population. Estimates for the NC population were obtained from the American Community Survey (ACS).</p><p><strong>Main measures: </strong>Measures included neighborhood SDOH indices for NC census tracts derived from ACS data as well as race and ethnicity.</p><p><strong>Key results: </strong>Overall, patients were more concentrated in neighborhoods with the least and greatest disadvantage. However, the density patterns of specific racial and ethnic groups across neighborhood SDOH scores were similar between the patients and NC population.</p><p><strong>Conclusions: </strong>Using a large, public integrated health care delivery system, we illustrate an approach for comparing the demographic and neighborhood characteristics of the patients of such a system and its underlying regional population using freely available data and open-source software. Our findings indicate many similar patterns between the health care system patients and regional population, but overall higher concentrations of patients in neighborhoods with the least and greatest disadvantage.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080633","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}