Journal of general internal medicine
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Little is known about the population of Medicare beneficiaries with both chronic kidney disease (CKD) and Alzheimer's disease and related dementias (ADRD). ⋯ The prevalence of Medicare FFS enrollees with both ADRD and CKD is increasing. Although the ADRD prevalence has declined, there is a rising number of individuals with CKD who are diagnosed with ADRD and a rising proportion of those with ADRD who also have CKD. Due to shared clinical and demographic risk factors, interventions to reduce CKD progression could also delay ADRD onset. In patients with both advanced ADRD and advanced CKD, clinicians and policymakers should focus on treatment options that consider both co-morbidities.
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The growth of telehealth care delivery during the COVID-19 pandemic highlighted its potential to enhance access to care and improve patient outcomes. As the healthcare landscape moves toward a new equilibrium in care delivery, few studies have examined physician usage of specific telehealth modalities. ⋯ This study identifies and assesses the widespread adoption of telehealth among U.S. physicians, particularly for provider-to-patient interactions, and highlights the potential for greater use of provider-to-provider modalities. While variations in usage patterns across provider types and specialties reflect the diverse needs and contexts within healthcare, ensuring that these variations are appropriate is critical to avoiding disparities in access and utilization. Addressing barriers related to reimbursement, interoperability, and training will be key to promoting equitable and appropriate adoption of various telehealth modalities across diverse clinical settings.
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With the increase in illicit fentanyl use in the USA, hospitals face challenges managing opioid withdrawal and opioid use disorder (OUD). To improve opioid withdrawal and OUD treatment among hospitalized patients with daily fentanyl use, we developed a rapid methadone titration (RMT) protocol. We describe development, implementation, and outcomes during the first 12 weeks. ⋯ With careful patient selection and ACT evaluation, a RMT protocol for hospitalized patients with fentanyl use disorder experienced few adverse events other than mild-moderate sedation, even among those receiving FAO and those with concurrent substance use disorders.