J Am Board Fam Med
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Increased use of telemedicine could potentially streamline influenza diagnosis and reduce transmission. However, telemedicine diagnoses are dependent on accurate symptom reporting by patients. If patients disagree with clinicians on symptoms, previously derived diagnostic rules may be inaccurate. ⋯ Patients and clinicians frequently disagree about symptom presence, which leads to reduced accuracy when CDRs built with clinician data are applied to patient-reported symptoms. Predictive models using patient-reported symptom data performed worse than models using clinician-reported data and prior results in the literature. However, the differences are minor, and developing new models with more data may be possible.
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Patients have varying levels of chronic conditions and health insurance patterns as they become Medicare age-eligible. Understanding these dynamics will inform policies and reforms that direct capacity and resources for primary care clinics to care for these aging patients. This study 1) determined changes in chronic condition rates following Medicare age eligibility among patients with different insurance patterns and 2) estimated the number of chronically ill patients who remain inadequately insured post-Medicare eligibility among patients receiving care in community health centers. ⋯ Post-Medicare age eligibility, a significant proportion of patients were diagnosed with new conditions leading to high burden of disease. One in 4 older adults continue to have inadequate health care coverage in their older age.
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COVID-19 has transformed the landscape of telemedicine utilization, shifting from predominantly in-person services to increased virtual encounters. Although telemedicine offers increased accessibility for medical care, many advocates voice concern about utilization and satisfaction with these services among individuals who experience intimate partner violence (IPV) given the unique practical, mental, and physical health challenges many face. ⋯ Clinicians using telemedicine should be aware of the multiple challenges faced by individuals experiencing IPV and take additional steps to ensure their needs are met in a safe way. These results have potentially important clinical and policy implications.
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Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care redesign strategies to support telemedicine implementation in 2020 and 2021, and identifies improvement opportunities. ⋯ Telemedicine implementation in FQHCs involved care redesign to optimize virtual interactions and care processes. Guidelines and evidence-based practices are needed to improve telemedicine use in FQHCs, including strategies to support interpersonal connections; approaches to virtually screen for and address social needs; and protocols to further mitigate privacy issues. Future research is needed to identify when telemedicine can optimally supplement in-person care to improve patient outcomes and clinic efficiency, particularly in safety net settings.
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Implementation of Social Isolation Screening and an Integrated Community Resource Referral Platform.
Screening and referral programs for social isolation and loneliness in older patients increased during the COVID-19 pandemic in primary care settings to mitigate associated adverse health outcomes. This study explores community health centers' experiences implementing a social isolation and loneliness screening program involving a community resource referral platform integrated into the electronic health record to support referrals. ⋯ Screening older patients for social isolation could increase care team awareness of social risk; assistance related referral options should be considered carefully.