Journal of general internal medicine
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Observational Study
Abrupt Discontinuation of Long-term Opioid Therapy Among Medicare Beneficiaries, 2012-2017.
With mounting pressure to reduce opioid use, concerns exist about abrupt withdrawal of treatment for the millions of Americans using long-term opioid therapy (LTOT). However, little is known about how patients are tapered from LTOT nationally. ⋯ Medicare beneficiaries on LTOT were increasingly likely to have their therapy discontinued from 2012 to 2017. The vast majority of discontinuing users, even those on high doses, had less than 50% reduction in dose, which is inconsistent with existing guidelines.
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Food insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity's role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity. ⋯ Food insecurity is strongly associated with worse HRQoL, with differences between food-secure and food-insecure individuals best measured using the SF-6D, EQ-5D, and PROPr. Future work should develop a specific instrument to measure changes in HRQoL in food insecurity interventions.
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Observational Study
Adoption of Health System Innovations: Evidence of Urban-Rural Disparities from the Ohio Primary Care Marketplace.
Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the meaningful use of electronic health records (EHRs) generated particular attention during the last decade. Translating these reforms into meaningful increases in population health depends on improving the quality and clinical integration of primary care providers (PCPs). However, if these innovations spread more quickly among PCPs in urban and wealthier areas, then they could potentially worsen existing geographic disparities in health outcomes. ⋯ Market penetration of PCMH and ACOs increased faster in urban markets compared to rural markets. However, the adoption of EHRs increased faster in rural markets. The results are a cause for optimism as well as a call to action: although recent efforts to increase PCMH and ACO adoption were less effective among the rural population in Ohio, federal programs to accelerate adoption of EHRs were overwhelmingly successful in rural areas.