Pub Date : 2024-11-04DOI: 10.1001/jamainternmed.2024.5489
Vincent Lo Re, Jessie Torgersen, Amy C Justice
{"title":"Risk of Liver Injury With Potentially Hepatotoxic Drugs-Reply.","authors":"Vincent Lo Re, Jessie Torgersen, Amy C Justice","doi":"10.1001/jamainternmed.2024.5489","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5489","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamainternmed.2024.5333
Jennifer A Foster, Deborah Freeland, Melissa M Mauskar
{"title":"When Dysuria Is More Than Just a Urinary Tract Infection: A Teachable Moment.","authors":"Jennifer A Foster, Deborah Freeland, Melissa M Mauskar","doi":"10.1001/jamainternmed.2024.5333","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5333","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamainternmed.2024.5932
Chima D Ndumele, Hannah Factor, Matthew Lavallee, Anthony Lollo, Jacob Wallace
<p><strong>Importance: </strong>Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.</p><p><strong>Objective: </strong>To examine the association between work requirements and safety-net program enrollment.</p><p><strong>Design, setting, and participants: </strong>This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024.</p><p><strong>Exposures: </strong>The reintroduction of SNAP work requirements in 2016.</p><p><strong>Main outcomes and measures: </strong>Proportion of enrollees disenrolled from SNAP and Medicaid.</p><p><strong>Results: </strong>Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did no
{"title":"Supplemental Nutrition Assistance Program Work Requirements and Safety-Net Program Participation.","authors":"Chima D Ndumele, Hannah Factor, Matthew Lavallee, Anthony Lollo, Jacob Wallace","doi":"10.1001/jamainternmed.2024.5932","DOIUrl":"10.1001/jamainternmed.2024.5932","url":null,"abstract":"<p><strong>Importance: </strong>Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.</p><p><strong>Objective: </strong>To examine the association between work requirements and safety-net program enrollment.</p><p><strong>Design, setting, and participants: </strong>This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024.</p><p><strong>Exposures: </strong>The reintroduction of SNAP work requirements in 2016.</p><p><strong>Main outcomes and measures: </strong>Proportion of enrollees disenrolled from SNAP and Medicaid.</p><p><strong>Results: </strong>Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did no","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamainternmed.2024.5940
Angela O Suen, Anand S Iyer, Irena Cenzer, Jonathan P Singer, Alexander Smith, Rebecca L Sudore, Ashwin Kotwal
{"title":"Social Isolation and Mortality in Adults With Chronic Obstructive Pulmonary Disease.","authors":"Angela O Suen, Anand S Iyer, Irena Cenzer, Jonathan P Singer, Alexander Smith, Rebecca L Sudore, Ashwin Kotwal","doi":"10.1001/jamainternmed.2024.5940","DOIUrl":"10.1001/jamainternmed.2024.5940","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamainternmed.2024.5492
Einar S Björnsson
{"title":"Risk of Liver Injury With Potentially Hepatotoxic Drugs.","authors":"Einar S Björnsson","doi":"10.1001/jamainternmed.2024.5492","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5492","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamainternmed.2024.4884
Nicholas Peoples, Peter A Ubel
{"title":"Are Students Ready to Run Student-Run Clinics?","authors":"Nicholas Peoples, Peter A Ubel","doi":"10.1001/jamainternmed.2024.4884","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.4884","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamainternmed.2024.4320
Timothy S Anderson, Deborah Grady
{"title":"Glucagon-Like Peptide-1 Receptor Agonists and Suicidality-Two Important Pieces of Data but an Incomplete Puzzle.","authors":"Timothy S Anderson, Deborah Grady","doi":"10.1001/jamainternmed.2024.4320","DOIUrl":"10.1001/jamainternmed.2024.4320","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamainternmed.2024.4435
A Parker Ruhl, Matthew M Hsieh, Elizabeth A Stuart
{"title":"Charting the Waters of Sickle Cell Disease With Target Trial Emulation.","authors":"A Parker Ruhl, Matthew M Hsieh, Elizabeth A Stuart","doi":"10.1001/jamainternmed.2024.4435","DOIUrl":"10.1001/jamainternmed.2024.4435","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamainternmed.2024.4739
Katie Fitzgerald Jones, Kelly Stolzmann, Jolie Wormwood, Jacquelyn Pendergast, Christopher J Miller, Michael Still, Barbara G Bokhour, Joseph Hanlon, Steven R Simon, Amy K Rosen, Amy M Linsky
Importance: Patient-directed educational materials are a promising implementation strategy to expand deprescribing reach and adoption, but little is known about the impact across medication groups with potentially different perceived risks.
Objective: To examine the impact of a patient-directed education intervention on clinician deprescribing of potentially low-benefit (proton pump inhibitors) or high-risk medications (high-dose gabapentin, diabetes agents with hypoglycemia risks).
Design, setting, and participants: This pragmatic multisite nonrandomized clinical trial took place at 3 geographically distinct US Veterans Affairs (VA) medical centers from April 2021 to October 2022. The total study sample was composed of the intervention cohort and the historical control cohort cared for by 103 primary care practitioners (PCPs).
Intervention: The primary intervention component was a medication-specific brochure, mailed during the intervention time frame to all eligible patients 2 to 3 weeks prior to upcoming primary care appointments. Patients seen by the same PCPs at the same sites 1 year prior to the study intervention served as controls.
Main outcome and measures: The primary binary outcome variable was deprescribing 6 months after the intervention, defined as complete cessation or any dose reduction of the target medication using VA pharmacy dispensing data.
Results: The total study sample included 5071 patients. The overall rate of deprescribing among the intervention cohort (n = 2539) was 29.5% compared with 25.8% among the controls (n = 2532). In an unadjusted model, the intervention cohort was statistically significantly more likely to have deprescribing (odds ratio [OR], 1.17 [95% CI, 1.03-1.33]; P = .02). In a multivariable logistic regression model nesting patients within PCPs within sites and controlling for patient and PCP characteristics, the odds of deprescribing in the intervention cohort were 1.21 times that of the control cohort (95% CI, 1.05-1.38; P = .008). The difference in deprescribing prevalence between the intervention and control cohorts (proton pump inhibitors: 29.4% vs 25.4%; gabapentin: 40.2% vs 36.2%; hypoglycemia risk: 27.3% vs 25.1%) did not statistically significantly differ by medication group (P = .90).
Conclusion and relevance: This nonrandomized clinical trial found that patient-directed educational materials provided prior to scheduled primary care appointments can effectively promote deprescribing for potentially low-benefit and high-risk medication groups.
{"title":"Patient-Directed Education to Promote Deprescribing: A Nonrandomized Clinical Trial.","authors":"Katie Fitzgerald Jones, Kelly Stolzmann, Jolie Wormwood, Jacquelyn Pendergast, Christopher J Miller, Michael Still, Barbara G Bokhour, Joseph Hanlon, Steven R Simon, Amy K Rosen, Amy M Linsky","doi":"10.1001/jamainternmed.2024.4739","DOIUrl":"10.1001/jamainternmed.2024.4739","url":null,"abstract":"<p><strong>Importance: </strong>Patient-directed educational materials are a promising implementation strategy to expand deprescribing reach and adoption, but little is known about the impact across medication groups with potentially different perceived risks.</p><p><strong>Objective: </strong>To examine the impact of a patient-directed education intervention on clinician deprescribing of potentially low-benefit (proton pump inhibitors) or high-risk medications (high-dose gabapentin, diabetes agents with hypoglycemia risks).</p><p><strong>Design, setting, and participants: </strong>This pragmatic multisite nonrandomized clinical trial took place at 3 geographically distinct US Veterans Affairs (VA) medical centers from April 2021 to October 2022. The total study sample was composed of the intervention cohort and the historical control cohort cared for by 103 primary care practitioners (PCPs).</p><p><strong>Intervention: </strong>The primary intervention component was a medication-specific brochure, mailed during the intervention time frame to all eligible patients 2 to 3 weeks prior to upcoming primary care appointments. Patients seen by the same PCPs at the same sites 1 year prior to the study intervention served as controls.</p><p><strong>Main outcome and measures: </strong>The primary binary outcome variable was deprescribing 6 months after the intervention, defined as complete cessation or any dose reduction of the target medication using VA pharmacy dispensing data.</p><p><strong>Results: </strong>The total study sample included 5071 patients. The overall rate of deprescribing among the intervention cohort (n = 2539) was 29.5% compared with 25.8% among the controls (n = 2532). In an unadjusted model, the intervention cohort was statistically significantly more likely to have deprescribing (odds ratio [OR], 1.17 [95% CI, 1.03-1.33]; P = .02). In a multivariable logistic regression model nesting patients within PCPs within sites and controlling for patient and PCP characteristics, the odds of deprescribing in the intervention cohort were 1.21 times that of the control cohort (95% CI, 1.05-1.38; P = .008). The difference in deprescribing prevalence between the intervention and control cohorts (proton pump inhibitors: 29.4% vs 25.4%; gabapentin: 40.2% vs 36.2%; hypoglycemia risk: 27.3% vs 25.1%) did not statistically significantly differ by medication group (P = .90).</p><p><strong>Conclusion and relevance: </strong>This nonrandomized clinical trial found that patient-directed educational materials provided prior to scheduled primary care appointments can effectively promote deprescribing for potentially low-benefit and high-risk medication groups.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT0429490.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamainternmed.2024.4846
Christopher L Cai, Aaron S Kesselheim, Benjamin N Rome
{"title":"Estimated Savings Under the Medicare High-Value Drug List Model.","authors":"Christopher L Cai, Aaron S Kesselheim, Benjamin N Rome","doi":"10.1001/jamainternmed.2024.4846","DOIUrl":"10.1001/jamainternmed.2024.4846","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":null,"pages":null},"PeriodicalIF":22.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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