Annals of Internal Medicine最新文献

Clinical impact ratings: GIM/FP/GP: [Formula: see text] Geriatrics: [Formula: see text] Infectious Disease: [Formula: see text] Pulmonology: [Formula: see text].

Iron deficiency anemia (IDA) is caused by iron deficiency, a common yet underrecognized clinical entity. Populations at greatest risk include children, menstruating and pregnant persons, and people of low socioeconomic status. Timely diagnosis and management of iron deficiency are key to preventing IDA and require thorough assessment of the underlying cause and appropriate iron repletion through either oral or parenteral therapy. Blood transfusion does not provide adequate elemental iron but is sometimes indicated along with iron therapy in patients with cardiovascular compromise, active bleeding, or severe anemia where more rapid correction is warranted. Alternative causes of anemia can be differentiated by red blood cell morphology and reticulocyte count and should be considered if anemia persists despite adequate repletion of iron stores.

Background: Health care systems are investing significant resources in social needs screening and intervention programs.

Purpose: To understand characteristics contributing to implementation of social needs screening and intervention programs in primary care.

Data sources: CINAHL, Cochrane, Ovid, PubMed, and Scopus (January 2015 to April 2025).

Study selection: U.S.-based programs using structured tools to screen adult patients for at least 1 Healthcare Effectiveness Data and Information Set measure (food insecurity, transportation, and housing insecurity) and addressing social needs in primary care settings.

Data extraction: Program characteristics; screening and intervention implementation processes; and patient screening, intervention, clinical, and health care use outcomes.

Data synthesis: The review included 23 studies. Seventeen reported on screening outcomes, 11 in populations characterized by a particular condition or health care use and 6 in the general population. Programs with the highest percentage of patients screened focused on fewer than 500 patients with a particular condition or health care use and received support from additional staff or volunteers (4 of 17 studies). Of patients screened, 10.1% to 100% reported a social need. Eleven studies reported on receipt of assistance or resources, with a higher percentage of patients receiving assistance or resources among programs that targeted a smaller population. Few studies reported clinical and health care use outcomes, with mixed findings.

Limitations: Few studies had complete reporting of screening and intervention rates and outcomes. Program characteristics and other screening and intervention processes varied across and within studies.

Conclusion: Social needs programs focused on smaller, targeted populations were more likely to screen and assist a higher percentage of patients. Programs with adequate staffing may also screen a higher proportion of patients. However, evidence is mixed, particularly for clinical and health care use outcomes. Considerable differences among screening and intervention programs preclude simple suggestions for universal implementation.

Primary funding source: Live Well Intramural Pilot Grant Program. (PROSPERO: CRD42023431151).

Clinical impact ratings: GIM/FP/GP: [Formula: see text] Public Health: [Formula: see text].