Journal of general internal medicine
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Prior research has shown that primary care clinicians (PCPs) spend a large portion of clinic visits on tasks within the electronic health record (EHR). However, no time allocation studies have been done in the Veterans Health Administration (VHA) and little is known about EHR time spent during virtual visits. ⋯ PCPs at the VHA spend between one-third and one-half of each patient visit interfacing with the EHR. Most of this time is spent on documentation and chart review. Less time was spent in the EHR during in-person visits compared to virtual visits, suggesting that clinicians limit EHR task completion when the patient is present. Between patient visits during clinic sessions, PCPs spend 75% of their time working in the EHR. In total, this represents over 2 h per half-day clinic session spent on EHR tasks.
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Fentanyl use leads to increased opioid tolerance in people with opioid use disorder, complicating management of opioid withdrawal syndrome. While accepted as gold standard, methadone and buprenorphine may be insufficient to treat acute opioid withdrawal. Short-acting full agonist opioids (SAFAO) may improve treatment in the acute care setting. ⋯ Use of methadone/buprenorphine did not alleviate the need for SAFAO, suggesting that SAFAO administration may be an important intervention for opioid withdrawal. Use of escalating OMEs of SAFAO was associated with reduced withdrawal severity. This practice was well-tolerated with few AEs.