Prescription drug monitoring programs (PDMP) have been crucial tools to address unsafe opioid prescribing. Many states have enacted comprehensive mandates that all clinicians consult the PDMP prior to prescribing an opioid for any given patient. Previously, our team has shown that comprehensive mandates work, reducing not only prescriptions but also opioid-related hospitalizations. Yet, we have to consider all the consequences of these policies – both intended and unintended. Specifically, we need to understand whether comprehensive mandates deter clinicians from writing opioid prescriptions for appropriate indications. In a new study published in JAMA (and presented at the 2021 AcademyHealth Annual Research Meeting), we focus on opioid prescribing for two groups of patients with chronic illness that can cause severe pain: sickle cell disease and cancer with bone metastasis.
As African immigrants settle in Europe and the United States, they experience rising rates of chronic diseases such as diabetes and hypertension, at levels not seen in their home countries. Self-care is key to managing these chronic illnesses, but this population may face cultural and societal challenges to adherence to recommended health practices. In the Journal of Advanced Nursing, we report on the results of a systematic review, finding that an interplay of cultural and structural factors influences the self-care practices of African immigrants with chronic diseases. While cultural identity is a powerful influence, African immigrants also report systemic barriers to adopting self-care recommendations.
Criminal justice-involved populations are disproportionately affected by HIV. In the US, one in seven people living with HIV leaves a correctional facility each year. Marginalized populations are at increased risk of both HIV infection and incarceration, and this dual risk is amplified among communities of color.
The 2021–2025 HIV National Strategic Plan—released in January 2021 by the Office of Infectious Disease and HIV/AIDS Policy in the Department of Health and Human Services (HHS)—recognizes the overarching impact of the criminal justice system on the HIV epidemic and includes objectives to increase the capacity of correctional settings to diagnose and treat HIV. However, the plan overlooks the role of HIV prevention strategies within correctional settings. Two such evidence-based strategies—medication for opioid use disorder (MOUD) and pre-exposure prophylaxis (PrEP)—are the focus of this blog post.
There is broad agreement that there is plenty of wasteful and low-value care in our health care system. But there’s less agreement about how to identify it and even less agreement about what to do about it. Health insurers have taken different approaches to this problem. Some insurers have adopted prior authorization, a managed care tool that requires physicians to obtain insurer approval before performing particular services. The different approaches to prior authorization are made apparent in a new study in JAMA Health Forum by Aaron Schwartz and colleagues, in which they apply the typical coverage rules of a large Medicare Advantage plan to fee-for-service Medicare, which lacks prior authorization. They find that about 25% of all spending on Medicare Part B outpatient services would be subject to prior authorization if the private plan rules applied.
The parents of a 7-year-old girl call their clinic with concerns about the health of their daughter. A telehealth visit is scheduled. On the day of the appointment, her parents, who speak and read a language other than English, are unable to navigate the patient portal account to join the virtual visit. She subsequently misses the appointment and experiences months with declining health and school performance that could have been avoided with early diagnosis and treatment.
Telemedicine provides incredible opportunities for patient access and engagement that could mitigate limitations often experienced by vulnerable families. However, like we see in the case above, those benefits may not be enjoyed equally by all.
The opioid epidemic has had devastating effects in red states and blue states alike, making it a prime target for bipartisan action. But both federal and state policy have been characterized by sharp partisan differences in response to rising rates of opioid-related overdose deaths. In a study recently published in the Journal of General Internal Medicine, we sought to understand how partisanship might affect legislative progress on this seemingly bipartisan issue by analyzing the content of state legislators’ opioid-related social media posts over time.
"There are decades when nothing happens, and there are weeks when decades happen...that describes what's happening right now,” said Sen. Tom Daschle, at Penn LDI’s recent conference on health care reform. An unusual mix of optimism and pragmatism pervaded the conference sessions, as participants acknowledged the serious ideological divides that threaten any large-scale reforms. At the same time, they pointed out the possibilities of this political moment as the nation emerges from the pandemic.
One important barrier to equitable participation in clinical trials is coming down: as of January 2022, Medicaid will be required to cover routine costs associated with clinical trials, something that Medicare and commercial insurers already do. In the New England Journal of Medicine, my colleagues and I propose three ways we can leverage the new Medicaid policy to further reduce inequities in access to clinical trials, using enhanced transportation benefits, patient navigators, and greater accountability measures.
Even in the midst of a pandemic, most U.S. consumers would not look favorably upon the use of their digital data for public health purposes, according to a new JAMA Network Open studyby LDI Fellows David Grande, Nandita Mitra, Raina Merchant, David Asch, and Carolyn Cannuscio. These findings reveal some of the challenges in using social media and smartphone strategies, such as the contact tracing apps launched by Google and Apple, to curb the spread of COVID-19.
During the pandemic, the nationwide moratorium on evictions for rent non-payment had clear public health and economic goals: to reduce unnecessary COVID-19 transmission and avoid widespread homelessness. But the benefits of the moratorium, which has been challenged in court and is now set to expire on June 30, might go far beyond the pandemic: a new study finds that evictions have detrimental effects on the physical and mental health of young adults for many years to come. In a longitudinal study in Social Science and Medicine, Morgan K. Hoke and Courtney E. Boen find that eviction is associated with declines in mental and self-reported health as young people age.
To achieve the estimated 75%-80% vaccination rate needed for herd immunity, the nation will need to invest in reaching virtually all adults in the United States. This daunting task requires thinking about communities at risk for poor health outcomes, particularly communities of color.
Last week, the Biden administration shifted its strategy from mass vaccination sites to more local settings, targeting younger adults and those hesitant to get vaccinated. With the goal of getting at least 70% of the population vaccinated with at least one dose by July 4, access to convenient vaccination services will be critical. This means implementing pop-up and mobile clinics, particularly in rural areas, as well as dispersing an army of community outreach workers to help with transportation and childcare services in neighborhoods in which individuals face structural barriers to access. With these concerted efforts, many more people will be able to be vaccinated, and we can inch closer toward the coverage levels we need to “return to normal.”
The rapid expansion of Urgent Care Centers (UCC) over the past decade has raised the tantalizing possibility that UCCs could be a cost-effective alternative for visits that do not need the full capabilities of an emergency department (ED). On the surface, this seems to make sense. In our new study in Health Affairs, the average UCC visit cost only $171 compared to the staggering $1,646 for an ED visit. That per-visit difference likely explains why insurers have implemented strategies such as higher copayments to deter ED visits and encourage patients to use lower-cost alternatives. However, the relative convenience of UCCs could result in increased numbers of visits, which might increase overall spending. That’s exactly what we found.