Articles: patients.
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The USA has some of the highest costs of medical care in the world. Telemedicine has been proposed as an affordable alternative to traditional in-person care, increasing access to medical services. ⋯ This viewpoint discusses the equity implications of the expansion of direct-to-consumer telemedicine-only medical care or care, which takes place entirely in the virtual realm, often with no requirement for a previous patient-provider relationship. We propose an approach to digital health that looks beyond digital literacy and access to technology to consider systemic challenges to equitable implementation.
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A growing number of aging adults are living with multiple chronic conditions (MCC). Older adults living with MCC are predisposed to developing frailty, a state of decreased physiologic reserve that increases risk for geriatric syndromes and associated morbidity and mortality. ⋯ Here, we discuss current gaps for using eFI to identify frail older adults living with MCC, and artificial intelligence (AI) approaches to enhance eFI accuracy. Accurate and routine frailty assessment can aid the generalist providing care to older adults living with MCC across multiple care settings to optimize physiologic reserve for these vulnerable patients.
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The outpatient continuity clinic experience is a crucial component of internal medicine residency training. While in many contexts the teaching physician must be physically present for key parts of the patient encounter, some outpatient environments qualify for use of the Primary Care Exception Rule (PCER), which allows indirect supervision of residents for low-complexity visits. Despite pervasive use of the PCER in resident continuity clinics, the literature regarding its effects on various stakeholders is limited. ⋯ We also suggest best practices for its use: to wit, we advise against using the PCER when the history and/or physical exam is critical to the diagnosis and/or management of the patient's chief concern, and advocate for competency-based, rather than time-based, benchmarks for resident supervision under it. We make recommendations for PCER reform, most importantly expanding the PCER to moderate-complexity visits once competency-based assessments have been instituted. We conclude with future directions for research to improve application of the PCER.