Prevalence and Factors Associated with Family Physicians Providing E-Visits

The use of telemedicine has grown in recent years. As a subset of telemedicine, e-visits typically involve the evaluation and management of a patient by a physician or other clinician through a Web-based or electronic communication system. The national prevalence of e-visits by primary care physicians is unclear as is what factors influence adoption. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors.

A national, cross-sectional practice demographic questionnaire for 7580 practicing family physicians was utilized. Bivariate statistics were calculated and logistic regression was conducted examining both physician level and practice level factors associated with offering e-visits.

The overall prevalence of offering e-visits was 9.3% (n 702). Compared with private practice physicians, other physicians were more likely to offer e-visits if their primary practice was an academic health center/faculty practice (odds ratio [OR], 1.73; 95% CI, 1.03 to 2.91), managed care/health maintenance organization (HMO) practice (OR, 9.79; 95% CI, 7.05 to 13.58), hospital-/health system– owned medical practice (not including managed care or HMO) (OR, 2.50; 95% CI, 1.83 to 3.41), workplace clinic (OR, 2.28; 95% CI, 1.43 to 3.63), or federal (military, Veterans Administration [VA]/Department of Defense) (OR, 4.49; 95% CI, 2.93 to 6.89). Physicians with no official ownership stake (OR, 0.44; 95% CI, 0.28 to 0.68) or other ownership arrangement (OR, 0.29; 95% CI, 0.12 to 0.71) had lower odds of offering e-visits compared with sole owners.

Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier.

The full article can be downloaded below.  

ANTIBIOTIC RESISTANCE THREATS IN THE UNITED STATES

CDC’s Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) includes updated national death and infection estimates that underscore the continued threat of antibiotic resistance in the United States. New CDC data show that while the burden of antibiotic-resistance threats in the United States was greater than initially understood, deaths are decreasing since the 2013 report. This suggests that U.S. efforts—preventing infections, stopping spread of bacteria and fungi, and improving use of antibiotics in humans, animals, and the environment—are working, especially in hospitals. Vaccination, where possible, has also shown to be an effective tool of preventing infections, including those that can be resistant, in the community.

Yet the number of people facing antibiotic resistance in the United States is still too high. More than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result. In addition, nearly 223,900 people in the United States required hospital care for C. difficile and at least 12,800 people died in 2017.

Germs continue to spread and develop new types of resistance, and progress may be undermined by some community-associated infections that are on the rise. More action is needed to address antibiotic resistance. While the development of new treatments is one of these key actions, such investments must be coupled with dedicated efforts toward preventing infections in the first place, slowing the development of resistance through better antibiotic use, and stopping the spread of resistance when it does develop to protect American lives now and in the future.

The full report can be viewed at this link.  

Risks and remedies for artificial intelligence in health care

Artificial intelligence (AI) is rapidly entering health care and serving major roles, from automating drudgery and routine tasks in medical practice to managing patients and medical resources. As developers create AI systems to take on these tasks, several risks and challenges emerge, including the risk of injuries to patients from AI system errors, the risk to patient privacy of data acquisition and AI inference, and more. Potential solutions are complex but involve investment in infrastructure for high-quality, representative data; collaborative oversight by both the Food and Drug Administration and other health-care actors; and changes to medical education that will prepare providers for shifting roles in an evolving system.

The full Brookings Institution report can be viewed at this link.  

How Big-Box Retailers Can Revitalize Rural Health Care

There's a surefire, and perhaps unlikely, way to bolster access to health care for underserved Americans—at the shopping mall.

Millions of Americans struggle to get affordable, timely medical care. Roughly one-quarter of rural Americans haven't been able to get needed care at some point in recent years, according to a May 2019 poll conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health.

The main reasons? Affordability. Trouble scheduling an appointment. Having to travel a long distance.

Retailers can help overcome these barriers. In many rural communities, the local Walmart or CVS is not just an economic anchor but a civic institution. It's a gathering place for far-flung residents. And it may be the most convenient place for historically underserved populations to seek health care.

Adding telehealth capabilities to our existing retail infrastructure could significantly expand access to top-notch care—and reduce costs for patients and the healthcare system.

The full Forbes article can be viewed at this link.  

Electronic Medical Records, Burnout, And “Man’s 4th Best Hospital”

Graduating from medical school in 1978, I started my hellish internship while reading Samuel Shem’s classic, “The House of G-d,” a scathing indictment of medical education and the mercenary incentives in patient care. I found it shocking, crude at times and disillusioning—but at its core, absolutely correct about what was happening in medicine that was so wrong.

Thus it seems fitting that I received a review copy of Shem’s new book, “Man’s 4^th Best Hospital,” as my medical career is coming to a close. Once again, Shem nails where medical care has lost its way. Physician “burnout” and dissatisfaction are increasing in step with patients’ unhappiness.

Much of the blame can be attributed to two things—corporate greed and electronic medical records, which are like conjoined twins. There’s no small irony that this is what is forcing many experienced physicians, like myself, out of practice prematurely, contributing to a waste of both talent and experience that is needless and costly.

The full Forbes article can be viewed at this link.  

HEALTH RESEARCH AND DEVELOPMENT TO STEM THE OPIOID CRISIS: A NATIONAL ROADMAP

As the opioid crisis continues to devastate the United States (U.S.) and its communities, science and technology have been recognized as key components of a comprehensive approach to combat the crisis. Achieving scientific breakthroughs and advancements to help resolve the opioid crisis requires a Federal research portfolio that strategically supports basic, applied, and implementation science. In December 2017, the Office of Science and Technology Policy (OSTP) convened a Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis (Opioid FTAC) under the National Science and Technology Council (NSTC) Committee on Science. The Opioid FTAC was charged with creating a Roadmap for health research and development (R&D), and related science and technology (S&T), to support the President’s opioid response. This Roadmap achieves its purpose in the present report by identifying (1) R&D critical to addressing key gaps in knowledge and tools, and (2) opportunities to improve coordination of R&D essential to combating the opioid crisis.

To organize its efforts and the Roadmap, the Opioid FTAC identified seven areas of R&D: (1) the Biology and Chemistry of Pain and Opioid Addiction; (2) Non-Biological Contributors to Opioid Addiction; (3) Pain Management; (4) Prevention of Opioid Addiction;(5) Treatment of Opioid Addiction and Sustaining Recovery; (6) Overdose Prevention and Recovery; and (7) Community Consequences of Opioid Addiction. The research recommendations generated by the FTAC in each of these areas, as well as an eighth section that includes recommendations on ways to enhance coordination, are summarized below.

The full report can be downloaded below.  

The impact of artificial intelligence on the current and future practice of clinical cancer genomics

Artificial intelligence (AI) is one of the most significant fields of development in the current digital age. Rapid advancements have raised speculation as to its potential benefits in a wide range of fields, with healthcare often at the forefront. However, amidst this optimism, apprehension and opposition continue to strongly persist. Oft-cited concerns include the threat of unemployment, harm to the doctor–patient relationship and questions of safety and accuracy. In this article, we review both the current and future medical applications of AI within the sub-speciality of cancer genomics.

The full article can be downloaded below.  

Development of a real-time physician– patient communication data collection tool

This study highlights the importance of effective physician–patient communication and presents a unique data collection tool to assess and improve physician communication in real time. This tool can provide physicians with personalised feedback and relate specific communication behaviours to patient experience measures to provide high-quality care and improve the patient experience.

The full article can be downloaded below.  

Measuring Patient-Reported Shared Decision-Making to Promote Performance Transparency and Value-Based Payment: Assessment of collaboRATE’s Group-Level Reliability

Shared decision-making (SDM) between clinicians and patients is a key component of patient experience, but measurement efforts have been hampered by a lack of valid and reliable measures that are feasible for routine use. In this study, we aim to investigate collaboRATE’s reliability, calculate required sample sizes for reliable measurement, and compare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey items to collaboRATE. CollaboRATE’s provider group-level reliability reached acceptable reliability at 190 patient reports, while the CAHPS SDM measure demonstrated similar reliability at a sample size of 124. The CAHPS communication measure reached acceptable reliability with 55 patient reports. A strong correlation was observed between collaboRATE and CAHPS communication measures (r ¼ 0.83). As a reliable measure of SDM, collaboRATE may be useful for both building payment models that support shared clinical decision-making and encouraging data transparency with regard to provider group performance.

The full article can be downloaded below.

Changing the mindset for precision medicine: from incentivized biobanking models to genomic data

The emerging paradigm in contemporary healthcare, precision medicine, is widely seen as a revolutionary approach to both clinical treatment and overall health promotion. Precision models are making use of the most up-to-date technological advancements – such as genomics and ‘big data’ processing – in an effort to tailor healthcare to each individual. Yet the list of hurdles to successful implementation of precision medicine is no secret. Among the challenges, it was recently suggested in this journal that we must change the ‘mindset’ of patients, practitioners and the wider public (McGonigle, 2016). And while precision medicine indeed demands a significant shift, we must not understate the extent of the overhaul required. In particular, I argue, against McGonigle’s suggestion, that the ethical challenges regarding participant contributions cannot be tackled by relying upon existing models of incentivized blood banking or organ donation. Instead, the success of precision medicine requires a wholescale change in mindset.

The full article can be downloaded below.