Eric W. Fleegler, Laura Vargas, Christian D. Pulcini, Stephen Hargarten
This JAMA Viewpoint explores how public health principles related to communicable diseases and bullet-specific regulations could be applied in the US to prevent further injury and death due to gun violence.
{"title":"Bullets as Pathogen—The Need for Public Health and Policy Approaches","authors":"Eric W. Fleegler, Laura Vargas, Christian D. Pulcini, Stephen Hargarten","doi":"10.1001/jama.2024.25535","DOIUrl":"https://doi.org/10.1001/jama.2024.25535","url":null,"abstract":"This JAMA Viewpoint explores how public health principles related to communicable diseases and bullet-specific regulations could be applied in the US to prevent further injury and death due to gun violence.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this narrative medicine essay, an infectious diseases physician shares how her journey to and through a depressive episode led her to raise awareness of mental health challenges and to help create supportive working environments.
{"title":"Redefining Resilience","authors":"Julie B. Trivedi","doi":"10.1001/jama.2024.23209","DOIUrl":"https://doi.org/10.1001/jama.2024.23209","url":null,"abstract":"In this narrative medicine essay, an infectious diseases physician shares how her journey to and through a depressive episode led her to raise awareness of mental health challenges and to help create supportive working environments.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olivier J. Wouters, Sean D. Sullivan, Emma M. Cousin, Nico Gabriel, Irene Papanicolas, Inmaculada Hernandez
This study analyzes how prices negotiated by Medicare in the US compare with net prices before negotiation, ceiling prices, and list prices in 6 other high-income countries.
本研究分析了美国医疗保险谈判价格与其他6个高收入国家谈判前的净价格、上限价格和标价的比较。
{"title":"Drug Prices Negotiated by Medicare vs US Net Prices and Prices in Other Countries","authors":"Olivier J. Wouters, Sean D. Sullivan, Emma M. Cousin, Nico Gabriel, Irene Papanicolas, Inmaculada Hernandez","doi":"10.1001/jama.2024.22582","DOIUrl":"https://doi.org/10.1001/jama.2024.22582","url":null,"abstract":"This study analyzes how prices negotiated by Medicare in the US compare with net prices before negotiation, ceiling prices, and list prices in 6 other high-income countries.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Michael Ho, Thomas J. Glorioso, Larry A. Allen, Richard Blankenhorn, Russell E. Glasgow, Gary K. Grunwald, Amber Khanna, David J. Magid, Joel Marrs, Sylvie Novins-Montague, Steven Orlando, Pamela Peterson, Mary E. Plomondon, Lisa M. Sandy, Joseph J. Saseen, Katy E. Trinkley, Shawni Vaughn, Joy Waughtal, Sheana Bull
ImportancePoor medication adherence is common. Text messaging is increasingly used to change patient behavior but often not rigorously tested.ObjectiveTo compare different types of text messaging strategies with usual care to improve medication refill adherence among patients nonadherent to cardiovascular medications.Design, Setting, and ParticipantsPatient-level randomized pragmatic trial between October 2019 to April 2022 at 3 US health care systems, with last follow-up date of April 11, 2023. Adult (18 to <90 years) patients were eligible based on diagnosis of 1 or more cardiovascular condition(s) and prescribed medication to treat the condition. Patients who did not opt out and had a 7-day refill gap were randomized to 1 of 4 study groups.Intervention(s)Generic text message refill reminders (generic reminder); behavioral nudge text refill reminders (behavioral nudge); behavioral nudge text refill reminders plus a fixed-message chatbot (behavioral nudge + chatbot); usual care.Main Outcomes and MeasuresPrimary outcome was refill adherence based on pharmacy data using proportion of days covered at 12 months. Secondary outcomes were clinical events of emergency department visits, hospitalizations, and mortality.ResultsAmong 9501 enrolled patients, baseline characteristics across the 4 groups were comparable (mean age, 60 years; 47% female [n = 4351]; 16% Black [n = 1517]; 49% Hispanic [n = 4564]). At 12 months, the mean proportion of days covered was 62.0% for generic reminder, 62.3% for behavioral nudge, 63.0% for behavioral nudge + chatbot, and 60.6% for usual care (P = .06). In adjusted analysis, when compared with usual care, mean proportion of days covered was 2.2 percentage points (95% CI, 0.3-4.2; P = .02) higher for generic reminder, 2.0 percentage points (95% CI, 0.1-3.9; P = .04) higher for behavioral nudge, and 2.3 percentage points (95%, 0.4-4.2; P = .02) higher for behavioral nudge + chatbot, none of which were statistically significant after multiple comparisons correction. There were no differences in clinical events between study groups.Conclusions and RelevanceText message reminders targeting patients who delay refilling their cardiovascular medications did not improve medication adherence based on pharmacy refill data or reduce clinical events at 12 months. Poor medication adherence may be due to multiple factors. Future interventions may need to be designed to address the multiple factors influencing adherence.Trial RegistrationClinicalTrials.gov Identifier: NCT03973931
{"title":"Personalized Patient Data and Behavioral Nudges to Improve Adherence to Chronic Cardiovascular Medications","authors":"P. Michael Ho, Thomas J. Glorioso, Larry A. Allen, Richard Blankenhorn, Russell E. Glasgow, Gary K. Grunwald, Amber Khanna, David J. Magid, Joel Marrs, Sylvie Novins-Montague, Steven Orlando, Pamela Peterson, Mary E. Plomondon, Lisa M. Sandy, Joseph J. Saseen, Katy E. Trinkley, Shawni Vaughn, Joy Waughtal, Sheana Bull","doi":"10.1001/jama.2024.21739","DOIUrl":"https://doi.org/10.1001/jama.2024.21739","url":null,"abstract":"ImportancePoor medication adherence is common. Text messaging is increasingly used to change patient behavior but often not rigorously tested.ObjectiveTo compare different types of text messaging strategies with usual care to improve medication refill adherence among patients nonadherent to cardiovascular medications.Design, Setting, and ParticipantsPatient-level randomized pragmatic trial between October 2019 to April 2022 at 3 US health care systems, with last follow-up date of April 11, 2023. Adult (18 to &amp;lt;90 years) patients were eligible based on diagnosis of 1 or more cardiovascular condition(s) and prescribed medication to treat the condition. Patients who did not opt out and had a 7-day refill gap were randomized to 1 of 4 study groups.Intervention(s)Generic text message refill reminders (generic reminder); behavioral nudge text refill reminders (behavioral nudge); behavioral nudge text refill reminders plus a fixed-message chatbot (behavioral nudge + chatbot); usual care.Main Outcomes and MeasuresPrimary outcome was refill adherence based on pharmacy data using proportion of days covered at 12 months. Secondary outcomes were clinical events of emergency department visits, hospitalizations, and mortality.ResultsAmong 9501 enrolled patients, baseline characteristics across the 4 groups were comparable (mean age, 60 years; 47% female [n = 4351]; 16% Black [n = 1517]; 49% Hispanic [n = 4564]). At 12 months, the mean proportion of days covered was 62.0% for generic reminder, 62.3% for behavioral nudge, 63.0% for behavioral nudge + chatbot, and 60.6% for usual care (<jats:italic>P</jats:italic> = .06). In adjusted analysis, when compared with usual care, mean proportion of days covered was 2.2 percentage points (95% CI, 0.3-4.2; <jats:italic>P</jats:italic> = .02) higher for generic reminder, 2.0 percentage points (95% CI, 0.1-3.9; <jats:italic>P</jats:italic> = .04) higher for behavioral nudge, and 2.3 percentage points (95%, 0.4-4.2; <jats:italic>P</jats:italic> = .02) higher for behavioral nudge + chatbot, none of which were statistically significant after multiple comparisons correction. There were no differences in clinical events between study groups.Conclusions and RelevanceText message reminders targeting patients who delay refilling their cardiovascular medications did not improve medication adherence based on pharmacy refill data or reduce clinical events at 12 months. Poor medication adherence may be due to multiple factors. Future interventions may need to be designed to address the multiple factors influencing adherence.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT03973931?id=NCT03973931&amp;amp;rank=1\">NCT03973931</jats:ext-link>","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses California’s new law that will further strengthen tobacco control and whether the FDA and other states will follow California’s example.
本观点讨论了加州的新法律将进一步加强烟草控制，以及FDA和其他州是否会效仿加州的做法。
{"title":"California’s Visionary Tobacco Bill—Will the FDA Follow?","authors":"Sven E. Jordt, Sairam V. Jabba","doi":"10.1001/jama.2024.22986","DOIUrl":"https://doi.org/10.1001/jama.2024.22986","url":null,"abstract":"This Viewpoint discusses California’s new law that will further strengthen tobacco control and whether the FDA and other states will follow California’s example.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajesh T. Gandhi, Raphael J. Landovitz, Paul E. Sax, Davey M. Smith, Sandra A. Springer, Huldrych F. Günthard, Melanie A. Thompson, Roger J. Bedimo, Constance A. Benson, Susan P. Buchbinder, Brenda E. Crabtree-Ramirez, Carlos del Rio, Ellen F. Eaton, Joseph J. Eron, Jennifer F. Hoy, Clara Lehmann, Jean-Michel Molina, Donna M. Jacobsen, Michael S. Saag
ImportanceNew data and new antiretroviral drugs and formulations continue to become available for the prevention and management of HIV infection.ObjectiveTo provide updated recommendations for HIV treatment and clinical management and HIV prevention.MethodsA panel of volunteer expert physician scientists were appointed to provide updated consensus recommendations for 2024. Relevant evidence in the literature since the last report was identified from PubMed and Embase searches (which initially yielded 3998 unique citations, of which 249 were considered relevant); from ongoing monitoring of the literature by the panel members; from data submitted by product manufacturers; and from studies presented at peer-reviewed scientific conferences between June 2022 and October 2024.FindingsAntiretroviral therapy continues to be recommended for all individuals with HIV. For most people with HIV, initial regimens composed of an integrase strand transfer inhibitor (InSTI), specifically bictegravir or dolutegravir, with 2 (and in some cases 1) nucleoside or nucleotide reverse transcriptase inhibitors are recommended. Recommendations are made for those with particular clinical circumstances, such as pregnancy and active opportunistic diseases, as well as for those unable to take InSTIs. Regimens may need to be changed for virologic failure, adverse effects, convenience, or cost, among other reasons. Long-acting injectable therapy is available for those who prefer not to take daily oral medications and for people struggling with adherence to daily therapy. Recommendations are provided for laboratory monitoring, management of substance use disorders and weight changes, as well as use of statins for cardiovascular disease prevention. For HIV prevention, oral (daily or intermittent) and injectable long-acting medications are effective options for people at increased likelihood of HIV exposure. Further, new tools for maintaining health and well-being among people with HIV, such as doxycycline postexposure prophylaxis to avert sexually transmitted infection, and strategies to treat substance use disorders, are recommended. Disparities in HIV acquisition and care access are discussed and solutions proposed.ConclusionsNew approaches for treating and preventing HIV offer additional tools to help end the HIV epidemic, but achieving this goal depends on addressing disparities and inequities in access to care.
{"title":"Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel","authors":"Rajesh T. Gandhi, Raphael J. Landovitz, Paul E. Sax, Davey M. Smith, Sandra A. Springer, Huldrych F. Günthard, Melanie A. Thompson, Roger J. Bedimo, Constance A. Benson, Susan P. Buchbinder, Brenda E. Crabtree-Ramirez, Carlos del Rio, Ellen F. Eaton, Joseph J. Eron, Jennifer F. Hoy, Clara Lehmann, Jean-Michel Molina, Donna M. Jacobsen, Michael S. Saag","doi":"10.1001/jama.2024.24543","DOIUrl":"https://doi.org/10.1001/jama.2024.24543","url":null,"abstract":"ImportanceNew data and new antiretroviral drugs and formulations continue to become available for the prevention and management of HIV infection.ObjectiveTo provide updated recommendations for HIV treatment and clinical management and HIV prevention.MethodsA panel of volunteer expert physician scientists were appointed to provide updated consensus recommendations for 2024. Relevant evidence in the literature since the last report was identified from PubMed and Embase searches (which initially yielded 3998 unique citations, of which 249 were considered relevant); from ongoing monitoring of the literature by the panel members; from data submitted by product manufacturers; and from studies presented at peer-reviewed scientific conferences between June 2022 and October 2024.FindingsAntiretroviral therapy continues to be recommended for all individuals with HIV. For most people with HIV, initial regimens composed of an integrase strand transfer inhibitor (InSTI), specifically bictegravir or dolutegravir, with 2 (and in some cases 1) nucleoside or nucleotide reverse transcriptase inhibitors are recommended. Recommendations are made for those with particular clinical circumstances, such as pregnancy and active opportunistic diseases, as well as for those unable to take InSTIs. Regimens may need to be changed for virologic failure, adverse effects, convenience, or cost, among other reasons. Long-acting injectable therapy is available for those who prefer not to take daily oral medications and for people struggling with adherence to daily therapy. Recommendations are provided for laboratory monitoring, management of substance use disorders and weight changes, as well as use of statins for cardiovascular disease prevention. For HIV prevention, oral (daily or intermittent) and injectable long-acting medications are effective options for people at increased likelihood of HIV exposure. Further, new tools for maintaining health and well-being among people with HIV, such as doxycycline postexposure prophylaxis to avert sexually transmitted infection, and strategies to treat substance use disorders, are recommended. Disparities in HIV acquisition and care access are discussed and solutions proposed.ConclusionsNew approaches for treating and preventing HIV offer additional tools to help end the HIV epidemic, but achieving this goal depends on addressing disparities and inequities in access to care.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses the potential advantages of injectable preexposure prophylaxis (PrEP) drugs such as lenacapavir for persons unable to adhere to daily oral HIV PrEP and highlights ways in which lenacapavir and expanded PrEP options could offer tailored and effective ways to better meet the diverse needs of at-risk individuals.
{"title":"Is Lenacapavir Needed for Individuals Adherent to Daily Oral PrEP?","authors":"Xin Niu, Paul K. Drain","doi":"10.1001/jama.2024.22995","DOIUrl":"https://doi.org/10.1001/jama.2024.22995","url":null,"abstract":"This Viewpoint discusses the potential advantages of injectable preexposure prophylaxis (PrEP) drugs such as lenacapavir for persons unable to adhere to daily oral HIV PrEP and highlights ways in which lenacapavir and expanded PrEP options could offer tailored and effective ways to better meet the diverse needs of at-risk individuals.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses the increasing popularity of taking a gap year between college and medical school and raises questions about the perceived necessity of this trend, its financial and other costs, and the potential disadvantage it may pose to underrepresented minority applicants.
{"title":"Gap Years—Unbridled Good or Unwarranted Cost?","authors":"Richard M. Schwartzstein, Sammer Marzouk","doi":"10.1001/jama.2024.19750","DOIUrl":"https://doi.org/10.1001/jama.2024.19750","url":null,"abstract":"This Viewpoint discusses the increasing popularity of taking a gap year between college and medical school and raises questions about the perceived necessity of this trend, its financial and other costs, and the potential disadvantage it may pose to underrepresented minority applicants.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses the importance of teaching health policy to medical students so they can be informed on the everyday policy issues that patients may ask them about or for which their specialty societies may ask them to lobby.
{"title":"Medical Education’s Learning Opportunity","authors":"Atul Grover","doi":"10.1001/jama.2024.17049","DOIUrl":"https://doi.org/10.1001/jama.2024.17049","url":null,"abstract":"This Viewpoint discusses the importance of teaching health policy to medical students so they can be informed on the everyday policy issues that patients may ask them about or for which their specialty societies may ask them to lobby.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Appendix presents 2023 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them.
{"title":"Graduate Medical Education, 2023-2024","authors":"John S. Andrews, Chris Mathews","doi":"10.1001/jama.2024.21756","DOIUrl":"https://doi.org/10.1001/jama.2024.21756","url":null,"abstract":"This Appendix presents 2023 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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