Annals of family medicine
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Annals of family medicine · Nov 2020
Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model.
We sought to determine the financial impact to primary care practices of alternative strategies for offering buprenorphine-based treatment for opioid use disorder. ⋯ Using a simulation model, we estimate that many types of primary care practices could financially sustain buprenorphine-based treatment if demand and no-show rate requirements are met, but a nurse care manager-based approach might be the most sustainable.
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Annals of family medicine · Nov 2020
Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey.
We undertook a study to assess the associations between barriers to insurance coverage for gender-affirming hormones (either lack of insurance or claim denial) and patterns of hormone use among transgender adults. ⋯ Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.
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A weekly habit of viewing my performance data led me to question the value of my doctoring. I tried to answer this quandary in my head for months, but it was a patient encounter that revealed what I had been searching for. As a doctor I am bound to the care of another, especially when disease, disability, or injury create any space between a patient and their personhood. ⋯ To offset my data habit, I have adopted a practice that reviews my patient care and interior movements at the end of the day. The daily exercise has uncovered a pattern in which my anger, despair, or isolation are invariably are tied to those times when I have failed to stand in the breach with a patient. More importantly, the practice illuminates my finest hours, when I have entered into that chasm with an unstated and binding promise to my patient that they will not be abandoned.