Journal of general internal medicine
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The June 2016 legalization of medical assistance in dying (MAiD) provided an added layer of choice to end-of-life care in Canada. Family caregivers play an important role in patient end-of-life decision-making. They may experience unique psychological burden or distress associated with their role. However, we know little about the caregiver experience associated with patient MAiD requests and the nature of psychosocial supports caregivers require before, during, and following MAiD intervention. ⋯ The "race to the end" theoretical model contributes new knowledge and understanding that can inform the development of tailored support services for caregivers, the impact of legislative changes on this population, and future research examining decision-making near end of life and the caregiver experience.
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Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. ⋯ In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.
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Prior work has shown that provider network structures correlate with outcomes such as patient costs, utilization, and care. However, it remains unknown whether certain provider networks are associated with reduced disparity gaps. ⋯ Network structures where PCPs are more central relative to medical and surgical specialists are associated with reduced non-Hispanic black-to-white disparity gaps, suggesting that how we organize and structure our health systems has implications for disparity gaps between non-Hispanic black and white Medicare beneficiaries with diabetes.
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Information about telehealth versus in-office visits and how patient experience before compared to during the COVID-19 pandemic is important for healthcare planning. ⋯ The positive experiences with telehealth, especially tele-video, may be due to patient appreciation of efforts made to maintain access, the focused nature of telehealth visits, and help by staff for navigation technical issues. Lessons learned about delivering responsive telehealth care can be used to ensure high-quality care after the pandemic.