Journal of general internal medicine
-
While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. ⋯ Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.
-
Observational Study
Impact of a Remote Primary Care Telehealth Staffing Model on Primary Care Access in the Veterans Health Administration.
The Veterans Health Administration (VHA) implemented the Clinical Resource Hub (CRH) program to fill staffing gaps in primary care (PC) clinics via telemedicine and maintain veterans' healthcare access. ⋯ In a national VHA telemedicine program developed to provide gap coverage for PC clinics, no wait time differences were observed between clinics using and not using CRH services. This hub-and-spoke telemedicine service is an effective model to provide gap coverage while maintaining access. Further investigation of quality and long-term access remains necessary.
-
How state opioid policy environments with multiple concurrent policies affect opioid prescribing to individuals with acute pain is unknown. ⋯ State opioid policies may have differential effects on high-dose opioid dispensing in individuals with acute pain. Policymakers should consider effectiveness of individual policies in the presence of other opioid policies to address the ongoing opioid crisis.
-
Patients with rare conditions often experience substantial delays between presentation and diagnosis, and some remain undiagnosed. In this Perspective, we outline the many challenges in diagnosing rare conditions in the modern clinical context. ⋯ We present solutions currently available for clinicians to mitigate some of these problems, including facilitating deliberate reflection, utilizing a diagnostic management team, and optimizing diagnostic calibration. Finally, we speculate how technology, such as chatbots and decision support tools enhanced by artificial intelligence, may augment a clinician's ability to diagnose rare conditions in a timely and accurate manner without excessive resource use.