Journal of General Internal Medicine最新文献

{"title":"Approach to Estimating Adherence to Heart Failure Medications Using Linked Electronic Health Record and Pharmacy Data.","authors":"Saul Blecker, Yunan Zhao, Xiyue Li, Ian M Kronish, Amrita Mukhopadhyay, Tyrel Stokes, Samrachana Adhikari","doi":"10.1007/s11606-024-09216-5","DOIUrl":"10.1007/s11606-024-09216-5","url":null,"abstract":"<p><strong>Background: </strong>Medication non-adherence, which is common in chronic diseases such as heart failure, is often estimated using proportion of days covered (PDC). PDC is typically calculated using medication fill information from pharmacy or insurance claims data, which lack information on when medications are prescribed. Many electronic health records (EHRs) have prescription and pharmacy fill data available, enabling enhanced PDC assessment that can be utilized in routine clinical care.</p><p><strong>Objective: </strong>To describe our approach to calculating PDC using linked EHR-pharmacy data and to compare to PDC calculated using pharmacy-only data for patients with heart failure.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult patients with heart failure who were prescribed guideline-directed medical therapy (GDMT) and seen in a large health system. Using linked EHR-pharmacy data, we estimated medication adherence by PDC as the percent of days in which a patient possessed GDMT based on medication pharmacy fills over the number of days the prescription order was active. We also calculated PDC using pharmacy-only data, calculated as medications possessed over days with continued medication fills. We compared these two approaches for days observed and PDC using a paired t-test.</p><p><strong>Results: </strong>Among 33,212 patients with heart failure who were prescribed GDMT, 2226 (6.7%) never filled their medications, making them unavailable in the assessment of PDC using pharmacy-only data (n = 30,995). Linked EHR-pharmacy data had slightly longer days observed for PDC assessment (164.7 vs. 163.4 days; p < 0.001) and lower PDC (78.5 vs. 90.6, p < 0.001) as compared to assessment using pharmacy-only data.</p><p><strong>Conclusions: </strong>Linked EHR-pharmacy data can be used to identify patients who never fill their prescriptions. Estimating adherence using linked EHR-pharmacy data resulted in a lower mean PDC as compared to estimates using pharmacy-only data.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"811-817"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Federally Illicit Lifetime Drug Use in the Health Professions.","authors":"Ellen T Kurtzman","doi":"10.1007/s11606-024-09052-7","DOIUrl":"10.1007/s11606-024-09052-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"955-957"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Prevalence of Obesity and Primary Hyperaldosteronism: Co-incidence or Connected Circumstances Leading to Hypertension? A Narrative Review.","authors":"Shweta Bansal, Houry Puzantian, Raymond R Townsend","doi":"10.1007/s11606-024-09081-2","DOIUrl":"10.1007/s11606-024-09081-2","url":null,"abstract":"<p><p>While obesity and its associated complications, mainly diabetes and hypertension, have been the largest public health problems of modern world, the emerging data suggests an increasing prevalence of primary hyperaldosteronism (PA) as one of the most common undiagnosed causes of hypertension. We believe that rising prevalence of PA in the era of high rates of obesity is likely not a chance finding but is deeply intersected with the rising rates of obesity. Higher serum aldosterone concentrations and urinary aldosterone excretion have been observed in patients with increased body mass index or larger waist circumference. The in vitro and pre-clinical studies suggest that adipocytes not only synthesize and secrete aldosterone but also release factors which stimulate production of aldosterone from adrenal glands. Aldosterone excess causing ligand-dependent activation of the mineralocorticoid receptor (MR) has increasingly been recognized as one of the important mechanisms of obesity-related hypertension. The aldosterone excess in these cases can be labelled as acquired hyperaldosteronism to differentiate it from the non-obesity related classical cases of PA. Because of serious consequences, recognizing aldosterone excess in obesity is important, as it gives a more compelling reason for weight loss and guidance to choosing pharmacotherapy wisely. Dietary sodium restriction and mineralocorticoid receptor antagonists play important roles in the management of PA associated with obesity.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"871-878"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Methamphetamine-Related Admissions among People Experiencing Homelessness, 2006-2021.","authors":"Andrea E Tyrer, Robert A Kleinman","doi":"10.1007/s11606-024-09000-5","DOIUrl":"10.1007/s11606-024-09000-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"958-961"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Generated Photos: A Means of Gaining Context about Patient Medication Practices.","authors":"Jane Jih, Yea Eun Lee, Tiffany Chinn, Michael A Steinman","doi":"10.1007/s11606-024-09072-3","DOIUrl":"10.1007/s11606-024-09072-3","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"970-972"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gap in Sexual Dysfunction Management Between Male and Female Patients Seen in Primary Care: An Observational Study.","authors":"Elizabeth E Stanley, Elizabeth Pfoh, Laura Lipold, Kathryn Martinez","doi":"10.1007/s11606-024-09004-1","DOIUrl":"10.1007/s11606-024-09004-1","url":null,"abstract":"<p><strong>Background: </strong>Female sexual dysfunction (FSD), defined as clinically distressing problems with desire, arousal, orgasm, or pain, affects 12% of US women. Despite availability of medications for FSD, primary care physicians (PCPs) report feeling underprepared to manage it. In contrast, erectile dysfunction (ED) is frequently treated in primary care.</p><p><strong>Objective: </strong>To describe differences in patterns of FSD and ED diagnosis and management in primary care patients.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Subjects: </strong>Primary care patients with an incident diagnosis of FSD or ED seen at a large, integrated health system between 2016 and 2022.</p><p><strong>Main measures: </strong>Sexual dysfunction management (referral or prescription of a guideline-concordant medication within 3 days of diagnosis), patient characteristics (age, race, insurance type, marital status), and specialty of physician who diagnosed sexual dysfunction. We estimated the odds of FSD and ED management using mixed effects logistic regression in separate models.</p><p><strong>Key results: </strong>The sample included 6540 female patients newly diagnosed with FSD and 16,591 male patients newly diagnosed with ED. Twenty-two percent of FSD diagnoses were made by PCPs, and 38% by OB/GYNs. Forty percent of ED diagnoses were made by PCPs and 20% by urologists. Patients with FSD were managed less frequently (33%) than ED patients (41%). The majority of FSD and ED patients who were managed received a medication (96% and 97%, respectively). In the multivariable models, compared to diagnosis by a specialist, diagnosis by a PCP was associated with lower odds of management for FSD patients (aOR, 0.59; 95% CI, 0.51-0.69) and higher odds of management (aOR, 1.52; 95% CI, 1.36-1.64) for ED patients.</p><p><strong>Conclusions: </strong>Primary care patients with FSD are less likely to receive management if they are diagnosed by a PCP than by an OB/GYN. The opposite was true of ED patients, exposing a gap in the quality of care female patients receive.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"847-853"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary and Cardiac Smoking-Related History Improves Abstinence Rates in an Urban, Socioeconomically Disadvantaged Patient Population.","authors":"Zain Khera, Nicholas Illenberger, Scott E Sherman","doi":"10.1007/s11606-024-09071-4","DOIUrl":"10.1007/s11606-024-09071-4","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use continues to take the lives of many, and targeted interventions can counter this health burden. One possible target population is patients who have had a smoking-related diagnosis, as they may have a greater drive to quit.</p><p><strong>Objective: </strong>To assess whether patients with previous cardiac or pulmonary conditions directly attributable to smoking have greater rates of abstinence post-discharge from hospitalization in the CHART-NY trial.</p><p><strong>Design: </strong>CHART-NY was a randomized comparative effectiveness trial comparing a more intensive versus a less intensive smoking cessation intervention after hospital discharge. We divided the 1618 CHART-NY participants into a smoking-related history group of 597 and a nonsmoking-related history group of 1021 based on cardiac or pulmonary conditions in a retrospective chart review. We conducted chi-squared analyses on baseline characteristics. Using follow-up survey data, we conducted chi-squared analyses on abstinence outcomes and made logistic regression models for the predictive value of smoking-related conditions on abstinence.</p><p><strong>Participants: </strong>A total of 1059 and 1084 participants in CHART-NY who completed both 2- and 6-month follow-up surveys respectively.</p><p><strong>Main measures: </strong>Self-reported 30-day abstinence at 2- and 6-month follow-up and survey data for baseline characteristics.</p><p><strong>Key results: </strong>Those abstinent at 6-month follow-up were more likely to have a smoking-attributable history (OR = 1.40, 95% CI 1.09-1.81). When stratified based on intervention, only the intensive counseling group was significant (OR = 1.53, 95% CI 1.08-2.17). The regression model using a smoking-related comorbidity score was significant at 6 months (OR = 1.29, p = 0.03), and the multivariate logistic regression model analyzing each smoking-related condition separately demonstrated significance for myocardial infarction at 6 months (OR = 1.66, p = 0.03).</p><p><strong>Conclusions: </strong>People who smoke who have experienced smoking-related conditions may be more likely to benefit from smoking cessation interventions, especially intensive telephone-based counseling. Multiple conditions had an additive effect in predicting long-term abstinence after intervention, and myocardial infarction had the greatest predictive value.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"749-755"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Post Hoc Pitfall: Rethinking Sensitivity and Specificity in Clinical Practice.","authors":"Benjamin D Gallagher","doi":"10.1007/s11606-024-09233-4","DOIUrl":"10.1007/s11606-024-09233-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"947"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The State of Medical Education on Criminal Justice Health: A Systematic Review.","authors":"Claire Stover, Ang Le, Rose Onyeali, Nicole Mushero","doi":"10.1007/s11606-024-09239-y","DOIUrl":"10.1007/s11606-024-09239-y","url":null,"abstract":"<p><strong>Background: </strong>The justice-involved population faces significant health disparities yet is often overlooked in medical education, resulting in medical providers having limited preparation to serve this community. The objective of this study is to understand the scope and context of medical education in correctional healthcare.</p><p><strong>Methods: </strong>Literature was systematically reviewed for curriculum on correctional healthcare aimed at undergraduate or graduate medical learners in U.S. educational institutions. The search strategy was developed with the guidance of a medical research librarian and included five literature databases, which were analyzed by two data analysts. The risk of bias was assessed using the appropriate Critical Appraisal Skills Programme checklists.</p><p><strong>Results: </strong>Our search identified 49 studies highlighting 95 unique curricula. Curricula were evenly split between the undergraduate (n = 44) and graduate (n = 50) level. The two most represented specialties were psychiatry (n = 43) and general medicine (n = 30). Educational modalities included clinical rotation (n = 48), didactics (n = 14), or a combination (n = 28). Curricula increased knowledge in correctional and specialty-specific medicine and improved attitudes towards justice-involved patients; however, there was no significant effect on plans to work with the justice-involved population. Common themes of curricula included treating justice-involved patients with respect (n = 23), structure and function of the legal system (n = 20), and career recruitment (n = 16).</p><p><strong>Discussion: </strong>There is limited education on the care of the justice-involved population and most learners are unlikely to experience education on this population during their training despite the extensive and unique health and psycho-social needs of this population. Quality of education remains variable and challenging to assess due to limited outcome data and the low quality of literature; however, our thorough search strategy and standardized approach allow for a complete and accurate representation of the literature.</p><p><strong>Systematic review registration number: </strong>Registration number CRD42023427470.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"892-917"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Equity for Latinos: Political Inaction in Addressing Fundamental Flaws of the US Health System.","authors":"Olveen Carrasquillo, Cynthia N Lebron","doi":"10.1007/s11606-024-09293-6","DOIUrl":"10.1007/s11606-024-09293-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"737-738"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}