Category Archives: Primary care

Time for the COVID-19 vaccine plan to include primary care

By | February 26, 2021
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President Biden released the National Strategy for the COVID-19 Response and Pandemic Preparedness on January 21, 2020. It is an ambitious attempt to decrease the spread of the novel coronavirus and get hundreds of millions of Americans immunized. This COVID-19 vaccine plan, however, is missing a key element. Namely, primary care. An incomplete national strategy for… Read More: Time for the COVID-19 vaccine plan to include primary care »

Treating the Opioid Crisis: Current Trends and What’s Next, Part 2

By | February 17, 2021
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Last week, we discussed three noteworthy trends from the past decade in treating the opioid crisis. The first was recognizing medication for opioid use disorder (MOUD) as the standard of care. The second was formalizing an addiction medicine specialty. And the third was expanding the availability of MOUD. This week, we’ll consider three additional trends in… Read More: Treating the Opioid Crisis: Current Trends and What’s Next, Part… »

Treating the Opioid Crisis: Current Trends and What’s Next

By | February 11, 2021
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Throughout the past decade, the U.S. has seen a dramatic shift in addiction medicine research, clinical practice, and related stigma in seeking care. In a pair of blog posts, we will explore the top six trends related to treating the opioid crisis. And we’ll consider what may be next. The Opioid Epidemic Opioid addiction has… Read More: Treating the Opioid Crisis: Current Trends and What’s Next »

Pandemic Reminds Us to Pay Attention to Lack of Supplement Regulation in the U.S.

By | November 21, 2020
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During the COVID-19 pandemic, health misinformation has been soaring across the internet and social media platforms. Despite a lack of supplement regulation, vitamin and supplement use have seen a sudden 28% increase in the US and a 25% increase globally during COVID-19. Vitamin C supplements have gained particular attention because of studies finding it might reduce… Read More: Pandemic Reminds Us to Pay Attention to Lack of Supplement… »

Rural Telehealth in the COVID Era and Beyond

By | November 20, 2020
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National Rural Health Day provides an opportunity to reflect on the quality of medical care in rural and medically underserved communities. This year has posed additional challenges to fragile healthcare systems and vulnerable populations. Faced with new barriers, rural communities are adapting and innovating through telehealth. COVID-19 caught the entire country off balance, highlighting structural… Read More: Rural Telehealth in the COVID Era and Beyond »

Primary care after COVID-19: Is it time for capitation?

By | October 26, 2020
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The COVID-19 pandemic caused large reductions in in-person office visits, costing primary care practices billions and exposing many of the risks associated with the fee-for-service (FFS) payment system. Capitation arrangements, in which providers are paid a per-member per-month payment, may offer a more attractive, less risky arrangement in the post-COVID-19 world. Almost all US health… Read More: Primary care after COVID-19: Is it time for capitation? »

Is Sleep Driving Up Your Medical Costs?

By | October 22, 2020
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  Millions are losing sleep due to anxiety, fear, and the difficulty of maintaining a schedule during this pandemic. Research suggests that those who get insufficient sleep may be at risk for health conditions such as obesity and heart disease. Yet, too much sleep may increase the risk of other health conditions such as diabetes and… Read More: Is Sleep Driving Up Your Medical Costs? »

Complementary and integrative health in the VA

By | October 8, 2020
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The Veterans Health Administration (VA) has expanded research and education on complementary and integrative health (CIH) programs, focusing on pain, mental health, and chronic illness. CIH programs are a part of “Whole Health,” an approach to support veterans’ health and well-being. A recent Medical Care supplement contains several articles on the effectiveness and implementation of… Read More: Complementary and integrative health in the VA »

Rebuilding the Foundation of Rural Community Health after COVID-19

By | September 17, 2020
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COVID-19 has exposed the cracks in the foundation of America’s rural community health system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers. As a result, short-term relief to stabilize rural health systems and long-term strategies… Read More: Rebuilding the Foundation of Rural Community Health after COVID-19 »

Potential effects of COVID-19 on health care utilization and quality measures

By | September 17, 2020
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What are the potential impacts of COVID-19 on health care utilization? How will changes in healthcare use impact quality measures? Researchers are asking many key questions to understand the impacts of COVID-19. It is clear that trends in healthcare use are changing. These changes will likely affect quality measure scores in the future. This is… Read More: Potential effects of COVID-19 on health care utilization and quality… »

Behavioral Health: Actuarial Value, Integration, & Innovation

By | September 14, 2020
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Behavioral health — counseling, mental health care, and care for substance use issues — is one of the basic benefits associated with health insurance and healthcare delivery. The COVID-19 pandemic has reminded us of the gross inadequacy of current behavioral health to deliver high quality care to most Americans. The past 30 years of health… Read More: Behavioral Health: Actuarial Value, Integration, & Innovation »

Primary care doctors are well-trained to treat common mental health conditions

By | August 6, 2020
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The COVID-19 pandemic and the killing of George Floyd are further stressing the already strained U.S. mental health care system. Primary care doctors train to treat common mental health problems, and they can help alleviate this strain on the system. Mental health issues on the rise In a national survey [pdf] of primary care patients… Read More: Primary care doctors are well-trained to treat common mental health… »

Implementation of HCV Treatment Programs

By | November 8, 2022
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Successfully implementing an intervention within a complex service delivery system requires multiple, inter-related adoption strategies.  The Veterans Administration’s (VA) renewed emphasis on Hepatitis C treatment offered a perfect opportunity to study which strategies worked. In this post, I will review those findings. Then, I will discuss the importance of accounting for the complexity of strategy… Read More: Implementation of HCV Treatment Programs »

A story of primary care: neighborhood deprivation and health spending

By | July 2, 2020
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this image shows a blighted area of a downtown city, which is used to represent a neighborhood likely to be among the most deprived.

A new study out this month in Medical Care by Yongkang Zhang and colleagues finds that people in struggling neighborhoods have considerably higher spending on potentially preventable health care. While overall health care spending was similar between the most deprived areas and average communities, the finding about spending on potentially preventable health care tells an… Read More: A story of primary care: neighborhood deprivation and health spending »

Deportation and the Traumatizing of a Generation

By | June 18, 2020
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With less than five weeks to go before welcoming a second child, the patient sat in my exam room in tears. By all accounts, this was a routine appointment at the end of a routine pregnancy. Except on this particular day, clutching family photos from their recent baby shower, the patient shared with me that… Read More: Deportation and the Traumatizing of a Generation »

Framing Success for Supportive Housing Services

By | June 11, 2020
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In this post we reflect on the definition of success in a study measuring the value of peer support services administered through the HUD VASH program and discuss client-centered definitions of value. We propose designing and understanding programmatic success goals tailored to unique need categories within veteran participant groups. With stay-at-home orders lifting all across… Read More: Framing Success for Supportive Housing Services »

#SexEdForAll: What We Need to Prevent Intimate Partner Violence

By | June 1, 2020
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We just wrapped up #SexEdForAll month in May, yet most people still believe sex education is just about sex. But it’s so much more than that! That’s why I created the Sexuality Education Legislation and Policy: A State-by-State Comparison of Health Indicators story map, in conjunction with the Robert Graham Center for Policy Studies in… Read More: #SexEdForAll: What We Need to Prevent Intimate Partner Violence »

COVID-19: High risk of severe illness

By | April 13, 2020
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There is a lot of attention being paid to the proportions of severe and fatal cases in discussions of COVID-19. Unless you’ve been living under a rock since January, you know that there are groups who are more likely to get very sick or die during this pandemic. In this post, we explore the evidence… Read More: COVID-19: High risk of severe illness »

Healthcare utilization in the SARS-CoV-2 pandemic

By | April 22, 2020
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This post summarizes what we know right now about the SARS-CoV-2 virus and the disease it causes, COVID-19. The information contained in this post may change as the situation changes, or may become obsolete. We will attempt to update if any of this changes substantively.  News and social media outlets have fallen short of useful… Read More: Healthcare utilization in the SARS-CoV-2 pandemic »

The myth of female hysteria and women’s health disparities

By | March 5, 2020
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What role might the myth of “female hysteria” play in women’s health disparities? For thousands of years, women’s health complaints were often diagnosed as “female hysteria” – a catch-all term that basically implied “it’s all in her head.” The condition was sometimes believed to be caused by a wandering uterus and/or sexual frustration. Doctors treated… Read More: The myth of female hysteria and women’s health disparities »

Are Community Health Workers Worth It?

By | February 2, 2022
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Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More: Are Community Health Workers Worth It? »

Evidence Synthesis in a Learning Health Care System

By | January 31, 2020
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An October 2019 Medical Care supplement describes a learning health care system: the VA Evidence Synthesis Program (ESP). The ESP is dedicated to making high-quality evidence accessible to improve health and healthcare for veterans. The articles in the issue describe the outcomes from integrating research synthesis with qualitative and quantitative data from health systems. These… Read More: Evidence Synthesis in a Learning Health Care System »

Patient Portals: Part 3 – The Future of Portals

By | December 5, 2019
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mobile phone showing types of patient medical records information such as medications and tests

Welcome to the final post in our series on patient portals – an attempt to imagine the future. Part 1 of this series summarized the latest data on who is using portals. Part 2 explained some of the barriers to use as well as what factors increase use. Evidence of Increased Patient Engagement and Other… Read More: Patient Portals: Part 3 – The Future of Portals »

Patient Portals: Part 2 – What Factors Affect Patient Use?

By | November 22, 2019
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mobile phone showing types of patient medical records information such as medications and tests

In Part 1 of this series, I summarized the latest data on who is accessing patient portals and for what purposes. In this post, I discuss the facilitators and barriers to patient portal use. General barriers to patient portal use Let’s start by discussing barriers to portal use. Patient portals have generally not been created to… Read More: Patient Portals: Part 2 – What Factors Affect Patient Use? »

School Health Policy Series: Part 1 – Everything’s Coming up ACEs

By | November 14, 2019
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This month, the website www.ACEsAware.org is set to launch. It will train healthcare workers to screen for Adverse Childhood Experiences (known as ACEs) in primary care clinics, but is that scope too narrow?  Should school workers be included too? The website is part of the work of Dr. Nadine Burke Harris in her new role… Read More: School Health Policy Series: Part 1 – Everything’s Coming up… »

Introducing a Special Series on School Health

By | December 2, 2019
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This month, The Medical Care Blog is hosting a series of posts about the importance of school health. Following up on our 2016 series on the childhood roots of inequity (read the first in the series here), we are dedicating our Thursdays this month to posts that reflect on the health challenges that confront schools.… Read More: Introducing a Special Series on School Health »

Patient Portals: Part 1 – Who Is Using Portals, and For What?

By | December 2, 2019
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mobile phone showing types of patient medical records information such as medications and tests

Providers’ portal usage rates have been high for some time. While many patients have access to a portal, routine use is less common. In this three-part series, we will explore several questions: Who is using portals? What are the factors that prevent or facilitate the optimal use of portals to engage patients in their care?… Read More: Patient Portals: Part 1 – Who Is Using Portals, and… »

Identifying Team-Based Primary Care is a Major Challenge

By | October 2, 2019
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I have written a lot about primary care. I’ve covered its role in reducing ED visits, discussed the benefits of one of its most unique facets (coordination of care), and described the challenges of younger adults moving away from traditional models of primary care. It is hard to overstate just how important this field of medicine… Read More: Identifying Team-Based Primary Care is a Major Challenge »

At 5 Years: Great Blog Posts That (Almost) Nobody Read

By | September 12, 2019
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We announced last week that The Medical Care Blog has reached its 5-year milestone. As part of the editorial team, I’m excited to pause briefly and reflect on some great blog posts about healthcare that I think deserve to have been more widely read. Contributions from our authors have helped us reach more than 80,000… Read More: At 5 Years: Great Blog Posts That (Almost) Nobody Read »

Moving from Stigmatization to Healthy Sexuality: The Vital Role of Comprehensive Sex Ed

By | August 21, 2019
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As a sexual health educator at public high schools in Tennessee, teachers would consistently jump in as I approached the topic of contraception. Required by law, these teachers would “emphatically promote sexual risk avoidance through abstinence.” After this abrupt interruption, I would then proceed to talk about all forms of contraception, including abstinence. Students would… Read More: Moving from Stigmatization to Healthy Sexuality: The Vital Role of… »

Getting to the Values of Value-Based Care

By | July 11, 2019
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Value-based care is all the rage in health care system transformation. Promising in concept, value-based care initiatives aim to reward value over volume, shifting our understanding and practice of delivery and payment reform. These efforts received governmental support in 2015 via the Medicare Access and CHIP Reauthorization Act (MACRA), which launched a myriad of quality… Read More: Getting to the Values of Value-Based Care »

Can Technology Help Reduce Health Disparities?

By | June 27, 2019
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Health and health care disparities are frustratingly persistent. This is widely known, in great part, because of the landmark report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care that then spurred the Agency for Healthcare Research and Quality (AHRQ) to track and report on disparities for 250 measures since the early 2000s. The… Read More: Can Technology Help Reduce Health Disparities? »

The State of Abortion in America in 2019

By | June 19, 2019
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A 14-year-old girl came to my primary care clinic with abdominal pain, similar to abdominal pain she’s had intermittently for years. As with all women of reproductive age, I checked a urine pregnancy test, and it was positive. I returned to the patient’s room to talk with her about the result, and her first question… Read More: The State of Abortion in America in 2019 »

Staying Current in Primary Care Research: An Attempt to Take Stock

By | April 25, 2019
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For months, I’ve been keenly interested in trying to explore where the field of primary care research stands. It’s daunting to pull your head up from your own research, take stock of what your colleagues (both known and unknown) are doing and try to assess where the field is advancing. Doing this every now and… Read More: Staying Current in Primary Care Research: An Attempt to Take… »

Street Medicine—a home for high quality medical care for people experiencing homelessness

By | March 28, 2019
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“One foot in the grave,” he said. “Is that how you feel?” I asked.  “No, it’s how I live.” Unsheltered for 38 years, he had lived primarily behind a dumpster floating in and out of the medical, social and judicial system. In the month before the new Keck School of Medicine of the University of… Read More: Street Medicine—a home for high quality medical care for people… »

Tailoring VA primary care to address the social determinants of health

By | March 14, 2019
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Tailoring the primary care medical home model improves the care experience for US Department of Veterans Affairs (VA) patients with homelessness experience, according to a recent study by Dr. Audrey Jones and colleagues in the journal Medical Care. Researchers from the VA’s Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center and Center for Health Equity Research… Read More: Tailoring VA primary care to address the social determinants of… »

Health Care Revolt–Reflections on Democracy and Medicine

By | March 2, 2021
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“A book lying idle on the shelf is wasted ammunition.” – Henry Miller, The Books in My Life (1952) The Medical Care Blog is home to many strong opinions.  In the last year, contributors have written provocatively about the political determinants of health, highlighted the per-mile cost of President Trump’s wall in numbers of children who… Read More: Health Care Revolt–Reflections on Democracy and Medicine »

Health Equity Through the Lenses of Intersectionality and Allostatic Load

By | February 20, 2019
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Although the term health equity is widely used, a common understanding of this term is lacking. Viewing health equity through the lenses of allostatic load and intersectionality could help. This blog post considers three case scenarios, all of which are composites of actual cases that have occurred within the United States, to explore ideas of… Read More: Health Equity Through the Lenses of Intersectionality and Allostatic Load »

The Desire to Avoid Pregnancy Scale: A new way to measure pregnancy preferences

By | February 12, 2019
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Why do we care about unintended pregnancies? Rates of unintended pregnancy “indicate the extent to which women and couples can determine freely whether and when they have children,” as stated by Finer and Zolna. There is some evidence that women and girls who have unintended pregnancies have a higher likelihood of other risk factors, such as… Read More: The Desire to Avoid Pregnancy Scale: A new way to… »

Can teamwork make the dream work?

By | January 17, 2019
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In 2019, mental health and opioid use disorders remain major public health issues. The most recent estimates suggest that 40 million adults experience mental illness in the U.S. and nearly 8 million adults experience both mental and substance use disorders at the same time. Individuals with mental illness also face higher risks of co-occurring chronic health conditions and… Read More: Can teamwork make the dream work? »

In Massachusetts, primary care sensitive emergency department use persists 5 years after health reform

By | July 24, 2019
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Primary care sensitive (PCS) emergency department (ED) use is a measure that highlights the connection between primary and emergency care. The right care, for the right person, in the right place, at the right time is a reasonable goal of a high-quality health system. In the US, however, many people go to the emergency department… Read More: In Massachusetts, primary care sensitive emergency department use persists 5… »

The Link Between Prescription Copayments, Contraceptive Adherence, and Unintended Pregnancy in the United States

By | December 12, 2018
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There are approximately 61 million women of reproductive age (15-44 years) in the United States, and at any given time, 70% of them are at risk of unintended pregnancy—that is, they are sexually active but do not want to become pregnant. About 72% of women who currently use contraception use non-permanent methods, such as the… Read More: The Link Between Prescription Copayments, Contraceptive Adherence, and Unintended Pregnancy… »

The Health and Social Costs of Homelessness

By | September 26, 2019
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The burden of homelessness on the health of those afflicted continues to be a major global public health concern. Last year, the United States recorded an increase in the number of homeless for the first time since 2010. On any given night in 2017, there were 553,742 people in the U.S. experiencing homelessness. In terms of… Read More: The Health and Social Costs of Homelessness »

Priority Topics for Obesity and Diabetes Research

By | December 10, 2018
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Patients are increasingly involved in shaping research in health care, especially since the advent of the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI actively promotes the engagement of patients and other stakeholders (clinicians, caregivers, purchasers, etc.) in the research process. As we discussed in an earlier entry on this blog, research terminology alone can be a… Read More: Priority Topics for Obesity and Diabetes Research »

Swiping left and the evolution of primary care

By | September 25, 2019
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A few weeks ago, a headline in the Chicago Tribune grabbed my attention: “Millennials are trading primary care doctors for faster, cheaper alternatives.” This headline fits the rather unfortunate stereotype of millennials as impatient, job-hopping, financially-struggling, digital natives. But if this is true, then millennials are bound to “swipe left” to health care delivered in a… Read More: Swiping left and the evolution of primary care »

Expressing Dissatisfaction with Health Care is Hard for Vulnerable Populations

By | September 27, 2018
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Are you happy with your healthcare provider?  Most people are happy, even if they’re unhappy with the health care system as a whole.  But if you’re unhappy with your doctor or your care, how likely are you to say so or search out a new healthcare provider? Visiting your doctor can be intimidating; so much so,… Read More: Expressing Dissatisfaction with Health Care is Hard for Vulnerable Populations »

“What the Eyes Don’t See” – A call to look beyond our clinic walls

By | September 6, 2018
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Last Tuesday I saw eight patients in my morning clinic; I felt like I did a lot. I saw Ms. S, a sixty-two-year-old lady with high blood pressure and diabetes; we chatted about her cats while I checked her feet and titrated her insulin. I treated my 9:30 am patient with some antibiotics for a… Read More: “What the Eyes Don’t See” – A call to look… »

A Public Health Approach to Addressing Sexually Transmitted Infections

By | August 30, 2018
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Chlamydia and gonorrhea are among the most common sexually transmitted infections (STIs) in the United States, and research shows that 50% of sexually active individuals will contract an STI by 25 years old. Though chlamydia and gonorrhea are often asymptomatic in women, screening is important in order to prevent complications, such as pelvic inflammatory disease… Read More: A Public Health Approach to Addressing Sexually Transmitted Infections »

It’s not just Roe v. Wade that’s at stake: Why we have to keep our eyes on Title X funding decisions about family planning for women’s health

By | August 22, 2018
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Title X, a program that provides federal dollars to be used for family planning services, is under siege. The public comment period ended July 31, 2018, and now we wait to see how funding changes for Title X unfold. Title X is a critical program that provides essential reproductive health services to women, created by… Read More: It’s not just Roe v. Wade that’s at stake: Why… »

Medication-Assisted Treatment: A Vital Player in the Opioid Epidemic

By | August 15, 2018
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For two years in a row, the United States has experienced a decrease in life expectancy, which researchers have largely attributed to the opioid epidemic. Life expectancy for the United States population was 78.6 years in 2016, a decrease of 0.1 year from 2015 [PDF]. Age-specific death rates between 2015 and 2016 increased for younger… Read More: Medication-Assisted Treatment: A Vital Player in the Opioid Epidemic »