Journal of general internal medicine
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Prior research has shown that African American men and women are more likely to receive lower quality healthcare compared to their white counterparts, which is exacerbated in jail and prison healthcare systems. ⋯ This study highlights the need to address barriers to accessing healthcare during and after incarceration, particularly given racial disparities in healthcare treatment and outcomes.
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Fentanyl use leads to increased opioid tolerance in people with opioid use disorder, complicating management of opioid withdrawal syndrome. While accepted as gold standard, methadone and buprenorphine may be insufficient to treat acute opioid withdrawal. Short-acting full agonist opioids (SAFAO) may improve treatment in the acute care setting. ⋯ Use of methadone/buprenorphine did not alleviate the need for SAFAO, suggesting that SAFAO administration may be an important intervention for opioid withdrawal. Use of escalating OMEs of SAFAO was associated with reduced withdrawal severity. This practice was well-tolerated with few AEs.
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Prior research has shown that primary care clinicians (PCPs) spend a large portion of clinic visits on tasks within the electronic health record (EHR). However, no time allocation studies have been done in the Veterans Health Administration (VHA) and little is known about EHR time spent during virtual visits. ⋯ PCPs at the VHA spend between one-third and one-half of each patient visit interfacing with the EHR. Most of this time is spent on documentation and chart review. Less time was spent in the EHR during in-person visits compared to virtual visits, suggesting that clinicians limit EHR task completion when the patient is present. Between patient visits during clinic sessions, PCPs spend 75% of their time working in the EHR. In total, this represents over 2 h per half-day clinic session spent on EHR tasks.
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Hypertension management is a national priority. However, hypertension control rates are suboptimal and vary across clinics, even among those in the same health system and geographic region. ⋯ Primary care clinics experience multiple interrelated organizational barriers to effective hypertension management. Future studies should examine the impact of different clinic staffing models, including multidisciplinary care teams, telemedicine, and remote BP monitoring, on BP outcomes in diverse primary care settings.
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Advances in artificial intelligence and machine learning have facilitated the creation of mortality prediction models which are increasingly used to assess quality of care and inform clinical practice. One open question is whether a hospital should utilize a mortality model trained from a diverse nationwide dataset or use a model developed primarily from their local hospital data. ⋯ A single-hospital inpatient mortality prediction model can achieve performance comparable to a national model when evaluated on a single-hospital population, given sufficient sample size.