Journal of general internal medicine
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State policies facilitating telehealth implemented early in COVID may support buprenorphine treatment of opioid use disorder. However, little empirical information is available about those policies' effects. ⋯ Policies undertaken during the pandemic we examined were associated with few significant changes in buprenorphine treatment initiation and duration. Findings suggest realizing the benefits of telehealth and other policy changes for buprenorphine may require more extensive implementation and infrastructure support.
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Few eligible patients in the United States participate in lung cancer screening (LCS) with low-dose computed tomography (LDCT). ⋯ Evidence on efficacy of interventions to increase LCS participation is limited due to a small number of prospective studies performed in non-diverse populations with critical risk of bias. Further, overall, studied interventions did not improve lung cancer screening participation, though interventions targeting multiple barriers may have some benefit.
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Black-White coronary heart disease (CHD) treatment disparities are well documented, especially regarding the use of high-quality hospitals. Physician referral networks may play a role. ⋯ PCPs' referral decisions for CHD treatment are primarily driven by access to specific professional networks and the socioeconomic circumstances of their patients. Nevertheless, PCPs strive to make the best available decisions, leaning into their networks and honoring patient preferences. While PCPs acknowledged existing disparities, they attributed them to patient and system factors rather than provider referral bias. Mitigating disparities will require interventions to improve minority-serving providers' formal and informal connections with high-quality specialists and hospitals, address patient socioeconomic constraints, and train providers to recognize their potential biases and misconceptions.
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Generative artificial intelligence (generative AI) is a new technology with potentially broad applications across important domains of healthcare, but serious questions remain about how to balance the promise of generative AI against unintended consequences from adoption of these tools. In this position statement, we provide recommendations on behalf of the Society of General Internal Medicine on how clinicians, technologists, and healthcare organizations can approach the use of these tools. We focus on three major domains of medical practice where clinicians and technology experts believe generative AI will have substantial immediate and long-term impacts: clinical decision-making, health systems optimization, and the patient-physician relationship. ⋯ We further recommend deep and ongoing partnerships with clinicians and patients as necessary collaborators in this work. And for healthcare organizations, we recommend pursuing a combination of both incremental and transformative change with generative AI, directing resources toward both endeavors, and avoiding the urge to rapidly displace the human clinical workforce with generative AI. We affirm that the practice of medicine remains a fundamentally human endeavor which should be enhanced by technology, not displaced by it.
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Diet-related chronic diseases account for seven out of the ten leading causes of death in the USA. Food is Medicine (FIM) interventions can be effective adjuncts to standard medical care to address this cost burden. While the Food is Medicine Pyramid recommends some culinary skill development when integrating FIM into healthcare, the emphasis is on medically tailored meals and food provision. Hence, there is a practice gap to ensure patients develop the necessary skills to apply nutrition recommendations into improved food behaviors to achieve positive long-term health outcomes. ⋯ It describes how these interventions can and have been used in a clinical setting as adjuncts to clinical care. While there is published evidence for each modality individually, the literature lacks evidence of the value of an integrated approach. The framework therefore provides a roadmap to both identify best practices and evaluate outcomes that will inform viable financial models.