Journal of general internal medicine
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Evidence is limited and mixed as to how the Patient Protection and Affordable Care Act (ACA) Medicaid expansions affected the utilization of primary care physicians (PCPs) and emergency departments (EDs) at the national level. ⋯ Using the nationally representative data of individuals who were affected by the ACA, we found that the ACA Medicaid expansions were associated with a modest improvement in access to PCPs without an increase in ED use.
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A clinical practice guideline (CPG) reporting checklist is used to assist CPG developers in recording what content should be provided in a CPG report. Recently, two checklists have become available on the Enhancing the QUAlity and Transparency Of health Research Network website: AGREE (Appraisal of Guidelines, Research and Evaluation) published in 2016 and RIGHT (Reporting Items for practice Guidelines in HealThcare) published in 2017. The objective of this study was to describe the advantages and disadvantages of these two CPG reporting checklists. ⋯ We recommend that CPG developers use either AGREE plus items unique to RIGHT or RIGHT plus items unique to AGREE.
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With the USPSTF reaffirming the importance of screening, counseling, and testing appropriate women for BRCA1/2 mutations, primary care has both an opportunity and a responsibility to lead in the implementation of these recommendations. Since the last UPSTF recommendations about preventing BRCA-related cancers in 2013, progress in incorporating risk assessment, counseling, and testing into primary care has been slow. ⋯ However, the early imbalance between hype and evidence in genomics led to a general skepticism among primary care providers about the importance of genomic medicine-a sharp contrast with many other areas of internal medicine. As a growing number of companies offer genetic testing directly to consumers and new models of genetic counseling are developed, primary care should capitalize on the opportunity to lead in the prevention of BRCA-related cancers-both to ensure that these services are delivered appropriately and in coordination with ongoing primary care and that primary care is not left behind as genomic medicine becomes a reality across internal medicine.
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Editorial Comment
Integrating Family Planning into Primary Care-a Call to Action.
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This capsule commentary, Capsule Commentary on Liaw et al., "Getting everyone on the same page": interprofessional team training to develop shared mental models on interprofessional rounds," was to have accompanied the article, DOI: https://doi.org/10.1007/s11606-019-05320-z, which appeared in the December 2019 issue.