Articles: health.
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One of the ACGME's six core competencies, systems-based practice (SBP), is difficult to interpret and developing proficiency over a one-year fellowship poses a challenge. Given the implications that successful SBP can have on pain medicine, it is especially important for fellows to focus on this competency during their training. Here, we propose a way to implement effective SBP into a pain medicine fellowship and the impact it may have within the larger health care system.
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Sickle cell disease (SCD) is the most common monogenetic condition in the United States (US) and one that has been subjected to a history of negative bias. Since SCD was first described approximately 120 years ago, the medical establishment has, directly and indirectly, harmed patients by reinforcing biases and assumptions about the disease. Furthermore, negative biases and stigmas have been levied upon patients with SCD by healthcare providers and society, researchers, and legislators. This article will explore the historical context of SCD in the US; discuss specific issues in care that lead to biases, social and self-stigma, inequities in access to care, and research funding; and highlight interventions over recent years that address racial biases and stigma.
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Lung cancer screening can save lives through the early detection of lung cancer, and professional societies recommend key lung cancer screening program components to ensure high-quality screening. Yet, little is known about the key components that comprise the various screening program models in routine clinical settings. The objective was to compare the utilization of these key components across centralized, hybrid, and decentralized lung cancer screening programs. ⋯ Although there is overlap between the components of various lung cancer screening program types, centralized programs more frequently implemented practices before the initial screening to support lung cancer screening. This work provides a path for future investigations to identify which lung cancer screening practices are effective to improve lung cancer screening outcomes, which could help inform implementation in settings with limited resources.
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Primary care supports the global health care system. With an increased need for primary care physicians, medical schools must provide resources, role models, and opportunities to increase the number of medical students matching into primary care residencies. Some medical schools have developed primary care pipeline programs for students. The outcomes of one such program-the Primary Care Program (PCP)-at the Keck School of Medicine (KSOM) of the University of Southern California (USC), an urban and private academic medical training center, are evaluated here. ⋯ The PCP data demonstrate the program's success at increasing the number of KSOM graduates matching into primary care residencies. The program provides a replicable training model.
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Chronic pain affects an estimated 20% of U.S. adults. Because high-deductible health plans have captured a growing share of the commercial insurance market, it is unknown how high-deductible health plans impact care for chronic pain. ⋯ By reducing the use of nonpharmacologic chronic pain treatments and marginally increasing out-of-pocket costs among those using these services, high-deductible health plans may discourage more holistic, integrated approaches to caring for patients with chronic pain conditions.