J Am Board Fam Med
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On June 22, 2020, the Centers for Medicare and Medicaid Services (CMS) unveiled an aggregate data set on the impact of the coronavirus disease 2019 (COVID-19) on its beneficiaries. The CMS brief is especially noteworthy for offering COVID-19-related racial and ethnic health disparity data on a national scale, thereby extending reports heretofore limited to states, cities, or health systems. The CMS COVID-19 brief exposes distressing racial and ethnic health disparities. It is the objective of this commentary to trace the origins of the CMS COVID-19 brief, discuss its salient findings, and consider its implications.
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Prescription opioid dependence remains a major source of morbidity and mortality in the United States. Patients previously on high-dose opioids may poorly tolerate opioid tapers. Current guidelines support the use of buprenorphine therapy in opioid-tapering protocols, even among patients without a diagnosis of opioid use disorder. ⋯ From November 2019 to April 2020, we transitioned 8 patients on high-dose prescribed opioids for pain to sublingual buprenorphine-naloxone using a microdose protocol without any evidence of precipitated withdrawal. Six of these patients remain on buprenorphine-naloxone and report improved analgesia. Because of its simplicity, the buprenorphine microinduction protocol can be easily adapted for telemedicine and may help to prevent unnecessary clinic visits and opioid-related admissions in the setting of social distancing regulations during the coronavirus 2019 pandemic.
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Recent data demonstrated that socioeconomic, environmental, demographic, and health factors can contribute to vulnerability for coronavirus 2019 (COVID-19). The goal of this study was to assess association between severe acute respiratory syndrome coronavirus (SARS CoV-2) infection and demographic and socioeconomic factors in patients from a large academic family medicine practice to support practice operations. ⋯ Our data provide insight into the association of COVID-19 with race/ethnic minority patients residing in highly socioeconomically deprived areas. These data could impact outreach and management of ambulatory COVID-19 in the future.
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The patient-doctor relationship lies at the heart of medicine. Confronted with the challenges of COVID-19, we find ourselves unable to provide care and comfort in the same physical space as our patients. ⋯ I will argue that face-to-face visits remain essential in establishing the most fundamentally human components of relationships: responsibility and vulnerability. This established bond assures fidelity in subsequent encounters, whether by phone, video, or in person.
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This study was conducted to determine if limited access to health care during the COVID-19 pandemic impacted utilization of recommended nonpharmacological treatments, nonsteroidal anti-inflammatory drugs, and opioids by patients with chronic low back pain and affected clinical outcomes relating to pain intensity and disability. ⋯ The pandemic threatens to exacerbate the impact of chronic low back pain, particularly among African American patients and the older population, by impeding access to guideline-informed noninvasive treatments.