J Am Board Fam Med
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From the United States and Netherlands, we have 2 articles on back pain, with findings that indicate significant treatment differences between the countries, and a high likelihood of persistence. The Inflammatory Diet is now shown to be related to diabetes. Multiple perspectives on palliative care for the homeless. ⋯ Social determinants of health substantially influence health and medical care. Moreover, care for patients from deprived communities is under-reimbursed. Patient pre-existing conditions increased after the Affordable Care Act, suggesting that repealing pre-existing condition protections would likely exacerbate disparities in health and health care.
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Back pain is a prevalent health problem. Research often focuses on adults. Evidence on the long-term course of back pain in older patients is limited. A prospective cohort study (BACE) was conducted in a primary care setting in the Netherlands. We aim to investigate the 5-year course and medical consumption of older adults (>55 years) presenting with back pain in general practice. ⋯ Clinically relevant improvements in back pain intensity and disability were seen in the first 3 to 6 months of follow-up. A majority of patients does not become pain free within 3 months; this does not improve over 5 years. However, most patients stop consulting health care professionals during follow-up. Current medical strategies may not be sufficient in older back pain patients, where back pain becomes a recurrent or chronic condition in the majority of patients.
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Health Care Utilization and Pain Outcomes Following Early Imaging for Low Back Pain in Older Adults.
Professional societies have provided inconsistent guidance regarding whether older patients should receive early imaging for low back pain, in the absence of clinical indications. The study assesses the implications of early imaging by evaluating its association with downstream utilization in an elderly population. ⋯ Early imaging for low back pain in older individuals was common, and was associated with greater utilization of downstream services and persistent pain.
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Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement. ⋯ Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP.
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Observational Study
The Association Between Neighborhood Socioeconomic and Housing Characteristics with Hospitalization: Results of a National Study of Veterans.
Social determinants of health (SDOH) have an inextricable impact on health. If remained unaddressed, poor SDOH can contribute to increased health care utilization and costs. We aimed to determine if geographically derived neighborhood level SDOH had an impact on hospitalization rates of patients receiving care at the Veterans Health Administration's (VHA) primary care clinics. ⋯ Our results present the impact of neighborhood characteristics such as NSES and lack of proper heating system on the likelihood of hospitalization. The application of placed-based data at the geographic level is a powerful tool for identification of patients at high risk of health care utilization.