Journal of general internal medicine
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While older adults account for a disproportionate amount of healthcare spending, they are often underrepresented in clinical research needed to guide clinical care. The purpose of this perspective is to make readers aware of new data on age at enrollment for participants included in National Institutes of Health (NIH)-funded clinical research. We highlight key findings of relevance to general internal medicine and suggest ways readers could support the inclusion of older adults in clinical research. ⋯ For example, while 10% of participants in studies related to diabetes were ≥ 65 years old, older individuals represent 43% of all prevalent diabetes in the USA. Researchers should work with clinicians to advocate for older adults and ensure their participation in clinical research. Best practices and resources for overcoming common barriers to the inclusion of older adults in research could also be disseminated.
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Editorial
From Revolution to Evolution: Early Experience with Virtual-First, Outcomes-Based Primary Care.
Primary care is foundational to health systems and a common good. The workforce is threatened by outdated approaches to organizing work, payment, and technology. Primary care work should be restructured to support a team-based model, optimized to efficiently achieve the best population health outcomes. ⋯ Payments must be re-structured to cover the cost of, and reward the value created by, this advanced model. Technology investments should shift from legacy electronic health records to patient relationship management systems, built to support continuous, outcome-based care. These changes enable primary care team members to focus on building engaged, trusting relationships with patients and their families and collaborating on complex management decisions, and reconnecting team members with joy in clinical practice.
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The remarkable decline in cigarette smoking since 1964 has plateaued; approximately 12.5% of Americans still smoke. People who continue to smoke are largely members of marginalized groups, such as people with behavioral health conditions (BHC), encompassing both mental health and substance use disorders. Certified smoking cessation interventions can increase smoking abstinence in trials in people with BHC, yet smoking rates remain markedly increased, leading to increased mortality from smoking-related diseases, and worsening health disparities. ⋯ We propose smoking cessation trials utilizing electronic cigarettes in people with BHC. To this goal, the UK has already begun allowing companies to submit their products for approval as medically licensed electronic cigarettes that can be prescribed as smoking cessation aids. Our proposal is timely, backed by evidence, and aims to save hundreds of thousands of American lives.
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Editorial
Prescribing Syringes to People Who Inject Drugs: Advancing Harm Reduction in Primary Care.
Access to new syringes can reduce the risk of HIV and hepatitis C transmission, skin and soft tissue infections, and infectious endocarditis for people who inject drugs (PWID). Syringe service programs (SSPs) and other harm reduction programs are a good source of syringes. However, they are sometimes not accessible due to limited hours, geographic barriers, and other factors. ⋯ Such prescribing has numerous benefits, including insurance coverage of the cost of syringes and the sense of legitimacy conveyed by a prescription. We discuss these benefits as well as the legality of prescribing and dispensing syringes and address practical considerations such as type of syringe, quantity, and relevant diagnostic codes, if required. In the face of an unprecedented overdose crisis with many associated health harms, we also make the case for advocacy to change state and federal laws to make access to prescribed syringes uniform, smooth, and universal as part of a suite of harm reduction efforts.
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The emergence of narrative medicine has promoted reflective practices and story-telling as means of promoting compassion, building resiliency, and understanding the "patient" and "physician" as "persons." However, though some narrative medicine pieces describe patients' experiences, the narrative of the patient is usually told by physicians, producing a second-hand facsimile of the patient's lived experience. Stories written by physicians may have their roots in patient encounters, but are filtered through the physician's, rather than the patient's, understanding of the world. ⋯ This paper explores the ways in which well-meaning physicians aiming to elevate patients' stories frequently fall short, and what we can do to better elevate patients' voices on the wards, in clinics, and in the medical literature. Stories about patients are important to help clinicians and trainees develop and practice compassionate person-centered care; stories written by patients on topics and with orientations of their choosing are currently lacking, and, we argue, even more important.