COVID-19 has revealed many vulnerabilities in our societal structure. One particular vulnerability is the risk inherent in our use of congregate institutions to house and treat people. This includes the risks of inpatient psychiatric facilities. Inadvertently, the pandemic has surfaced critical questions that we should seek to answer even when the virus is under control: What is the right… Read More »
Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More »
As of late, rural health has been a hot topic and buzzword in the public health and health policy spheres. Health Affairs recently published an entire issue related to topics on rural health. The American Journal of Public Health recently issued a call for manuscripts for a special issue dedicated entirely to rural health. Rural… Read More »
This month, the website www.ACEsAware.org is set to launch. It will train healthcare workers to screen for Adverse Childhood Experiences (known as ACEs) in primary care clinics, but is that scope too narrow? Should school workers be included too? The website is part of the work of Dr. Nadine Burke Harris in her new role… Read More »
This month, The Medical Care Blog is hosting a series of posts about the importance of school health. Following up on our 2016 series on the childhood roots of inequity (read the first in the series here), we are dedicating our Thursdays this month to posts that reflect on the health challenges that confront schools.… Read More »
Fresh Voices is our series of special commentaries in Medical Care that began as blog posts. Series Introduction: Lines LM, Williams JA. Introducing Fresh Voices: Commentaries from The Medical Care Blog. Medical Care. 2018;56(9):755. September 2018: Burrus O, Gupta C, Ortiz A, et al. Principles for Developing Innovative HIV Digital Health Interventions: The Case of… Read More »
Although the term health equity is widely used, a common understanding of this term is lacking. Viewing health equity through the lenses of allostatic load and intersectionality could help. This blog post considers three case scenarios, all of which are composites of actual cases that have occurred within the United States, to explore ideas of… Read More »
This will be the last post of 2018 for us here at The Medical Care Blog. We would like to take this opportunity, as we do every year, to recognize YOU – our reader – as well as our contributors. We are really proud of the work we’ve done this year, and we hope you’ve… Read More »
The October edition of Health Wonk Review is now up at Joe Paduda’s Managed Care Matters blog. This month, our featured post is the excellent commentary by new contributor Dr. Ranit Mishori titled The Social Determinants of Health? What about the Political Determinants of Health? Enjoy!
Last Tuesday I saw eight patients in my morning clinic; I felt like I did a lot. I saw Ms. S, a sixty-two-year-old lady with high blood pressure and diabetes; we chatted about her cats while I checked her feet and titrated her insulin. I treated my 9:30 am patient with some antibiotics for a… Read More »
For two years in a row, the United States has experienced a decrease in life expectancy, which researchers have largely attributed to the opioid epidemic. Life expectancy for the United States population was 78.6 years in 2016, a decrease of 0.1 year from 2015 [PDF]. Age-specific death rates between 2015 and 2016 increased for younger… Read More »
On this page, we feature collections of posts and special series of posts. The Childhood Roots of Health Inequity In 2015, the Health Equity Committee of the APHA Medical Care Section organized a special invited panel session at the APHA Annual Meeting in Denver. We then produced a special series of blog posts about each… Read More »
“Neonatal abstinence syndrome” (NAS) sounds deceptively innocuous, given that it is literally infant drug withdrawal. It is usually caused by prenatal exposure to opioids but can also result from maternal consumption of other substances, like alcohol and antianxiety medications. Common symptoms include excessive high-pitched crying, fever, sweating, irritability, vomiting, diarrhea, rapid breathing, sleep disturbances, and poor… Read More »
The pursuit of health equity – ensuring equal access to opportunities that enable all communities to lead healthy lives – is a critical task for the U.S. The direct and indirect medical costs associated with sickness and premature death resulting from health care inequities are enormous (estimated to be $230 billion and $1.24 trillion, respectively,… Read More »
This post is the final one in our 4-part series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2, part 3]. Our fourth presenter, Dr. Jennifer Manly, is Associate Professor of Neuropsychology in Neurology at the Gertrude H. Sergievsky Center and the… Read More »
This post is the third in our series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2]. Our third presenter, Kerith Conron, ScD, MPH, is currently the Blachford-Cooper Distinguished Scholar and Research Director at The Williams Institute of UCLA’s School… Read More »
Children who grow up in stressful environments, without adequate adult support, are at much greater risk of developing heart disease, cancer, and many other diseases as adults. This is partly because of the coping behaviors that people use to deal with stress, but also because of the cumulative effects of toxic stress. Thus, many of… Read More »
In my medical practice, lacking the tools to communicate meaningfully with other providers who are caring for my patients is a daily frustration. This is only magnified when it comes to caring for my most vulnerable patients who have difficulty communicating for themselves, such as those suffering from substance use disorders (SUDs), so I was… Read More »
According to the 2013 Medical Expenditure Panel Survey, hospital inpatient expenses account for a large portion (nearly 30%) of total health care expenses and health care spending is highly concentrated among a relatively small proportion of individuals. The top 1% of spenders accounted for 21.5% of total expenditures while the lower 50% accounted for just… Read More »
Food is life. A consistent, nutritious diet can improve overall health and protect against chronic conditions. But not everyone can access or afford a nutritious diet. In 2022, 1 in 8 households in the U.S. and 1 in 6 households with children were food insecure. Black and Latinx households experience more than double the rates… Read More »
Welcome to the July 2023 episode of the Healthy Intersections podcast! This month, we talk about the state of Florida with Lauren Pierce, who formerly worked at the Florida Department of Public Health and is a long-term resident of Tallahassee. We debut the brand new RTI Rarity™ interactive national dashboard and focus on northern Florida,… Read More »
Last month, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced its newest alternative payment model for primary care, Making Care Primary (MCP). MCP builds upon lessons learned from previous CMS primary care models: the Comprehensive Primary Care Initiative, the Comprehensive Primary Care Plus (CPC+) initiative, the Maryland Primary Care Program, and Primary… Read More »
Welcome to the June 2023 episode of the Healthy Intersections podcast! This month, we sit down again with Carol Schmitt, Chief Scientist at RTI International, along with Juliet Sheridan, to talk about another of the RTI Rarity interactive state maps. This time, we are looking at North Carolina. We talk about historical redlining, climate change,… Read More »
Originally published April 6, 2023; updated April 24, 2023 to add audio links. Welcome! April 2023 marks a new milestone for the Healthy Intersections Podcast (HIP), sponsored by the American Public Health Association’s Medical Care Section. I’m taking on the role of the main producer of HIP. We’re also moving to a video AND audio… Read More »
The pursuit of health equity requires public health and medical professionals to become adept at policy in their health advocacy work. The American Public Health Association (APHA), in fact, defines policy work as one of its 10 essential public health services. APHA says professionals should be capable of “creating, championing and implementing policies, plans and laws”.… Read More »
White paper, grey literature, black box warning. The nature of our medical research, presentation, reporting, and publication has defined the values associated with colors. A white paper is defined as an “authoritative” report on a subject. Grey literature is described as being “non-conventional, fugitive, and sometimes ephemeral.” And a “black box” warning alerts physicians and… Read More »
The Medical Care Blog regularly welcomes and features the voices of students from public health, medicine and other health professional fields. Most of our student contributors are earlier in their careers than the health care providers, public health professionals, and academic researchers who contribute to our dialogue most often. But they are frequently experts in… Read More »
COVID-19 has exposed the cracks in the foundation of America’s rural community health system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers. As a result, short-term relief to stabilize rural health systems and long-term strategies… Read More »
For decades, peer-reviewed journals have been a critical pathway for disseminating and advancing scientific knowledge. However, curbing the spread of misinformation requires evidence translation by experts into plain English. The rapidly evolving knowledge base on COVID-19 shines a spotlight on the issue. For example, a recent article in the New England Journal of Medicine offered… Read More »
Value-based care is all the rage in health care system transformation. Promising in concept, value-based care initiatives aim to reward value over volume, shifting our understanding and practice of delivery and payment reform. These efforts received governmental support in 2015 via the Medicare Access and CHIP Reauthorization Act (MACRA), which launched a myriad of quality… Read More »
“A book lying idle on the shelf is wasted ammunition.” – Henry Miller, The Books in My Life (1952) The Medical Care Blog is home to many strong opinions. In the last year, contributors have written provocatively about the political determinants of health, highlighted the per-mile cost of President Trump’s wall in numbers of children who… Read More »
Individuals experiencing homelessness are among the most medically, socially, economically, and politically vulnerable in our society. Because of this, patterns of service use by these individuals can often serve as indicators of the safety net capacity and overall wellness of the systems of care we have in place – like “canaries in the coal mine.”… Read More »
In a recent letter to state Medicaid directors, officials at the Centers for Medicare and Medicaid Services (CMS) encouraged states to implement work requirements in Medicaid, writing that “a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes.” In response, 10 Republican-led states have… Read More »