Journal of general internal medicine
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The COVID-19 pandemic has been associated with increased opioid prescribing. It is not known if perceived COVID-19 related stress is associated with increased odds of long-term opioid use. ⋯ Patients who attribute worsening pain to the COVID-19 pandemic are more likely to be persistent opioid users. Further research is warranted to identify mechanisms underlying this association. Clinicians may consider discussing pain in the context of the pandemic to identify patients at high risk for persistent opioid use.
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Health information exchanges (HIEs) have proliferated over the last decade, but a gap remains in our understanding of their benefits to patients and the healthcare system. In this systematic review, we provide an updated report on what is known regarding the impacts of HIE on clinical, health care utilization, and cost outcomes in the adult inpatient setting. ⋯ Evidence for the impacts of HIE remains largely observational with little direct measure of HIE use during clinical care, making causality difficult to assess. The highly variable outcomes examined by these studies limit meaningful synthesis. The strength of evidence is low that HIE reduces unplanned readmissions and mortality and there is insufficient evidence for the impact of HIE on cost or utilization. The increased number of studies specific to inpatient settings that examine objective outcomes with more rigorous statistical methods is a promising development since prior reviews.
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It is unclear whether highly fragmented ambulatory care (i.e., care spread across multiple providers without a dominant provider) increases the risk of an emergency department (ED) visit. Whether any such association varies with race is unknown. ⋯ Highly fragmented ambulatory care was an independent predictor of ED visits, especially among Black individuals.
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Patients with type 2 diabetes frequently have both medical- and health-related social needs that must be addressed for optimal disease management. Growing evidence suggests that intersectoral partnerships between health systems and community-based organizations may effectively support improved health outcomes for patients with diabetes. ⋯ The views and experiences of patient and essential staff stakeholder groups reported here thematically according to CFIR domains may inform the development of other chronic disease interventions that address medical- and health-related social needs in additional settings.