Journal of general internal medicine
-
Many individuals do not receive recommended vaccines, increasing infectious disease morbidity and mortality. It is unknown whether the financial practices of US healthcare institutions contribute to vaccine hesitancy. ⋯ Current medical debt is associated with lower likelihood of recent vaccine receipt in both insured and uninsured individuals. Policies that minimize medical debt may improve vaccine coverage.
-
In medical education, learner self-assessments are standard methods used to evaluate the impact of curricula and workshops. Due to the subjective nature of self-assessment, these measures are prone to known biases including framing, recall, social desirability, and response-shift bias. These biases can contribute to floor and ceiling effects of measurement, which can lead to false conclusions about whether the intended learning objectives were achieved. ⋯ For each design, we review strengths, weaknesses, and known biases and discuss examples to highlight trade-offs between options. We also discuss the use of control groups and follow-up surveys to measure retention over time as additional methods to address bias and related confounding. The guidance presented here is intended to raise educators' awareness of common pitfalls in self-assessment; minimize the impact of known biases when possible; provide evidence, examples, and rationales for optimal design choices; and increase the rigor of self-assessment evaluations.
-
Healthcare organizations attempt to address unwarranted fentanyl use, which often leads to increased risk of addiction and overdose. ⋯ Requiring specialist approval for fentanyl initiation for non-oncological chronic pain was associated with a decrease in fentanyl prescription initiations, especially among non-elderly patients. A decrease also occurred gradually in total opioid dispensations, further decreasing following the extension of the requirement to continuous fentanyl. The requirement for specialist approval upon fentanyl initiation and continuous fentanyl may present an effective tool for limiting the use of fentanyl and total opioids in healthcare systems.