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Levothyroxine did not reduce fatigue in older patients with hypothyroidism
WASHINGTON – according to a new study.
The double-blind, randomized, placebo-controlled, parallel-group trial used subsets of data from the TRUST study. This new research, which was presented at the Annual Meeting of the Society of General Internal Medicine, provides further evidence that prescribing levothyroxine to older patients with subclinical hypothyroidism will not reduce fatigue.
Like the findings in the TRUST study, the new study, “Effect of Thyroid Hormone Replacement on Fatigability in Older Adults with Subclinical Hypothyroidism: A Randomized Placebo Controlled Trial,” showed that the use of levothyroxine in subclinical hypothyroidism was not effective in changing physical and mental fatigability in older adults.
“This study shows that levothyroxine treatment may not be necessary and results in high costs and side effects,” noted Mirah Stuber, MD, during her presentation of the findings at the meeting.
The new study examined the effect of levothyroxine on the tiredness of older adults but with a more detailed analysis of fatigue than the full TRUST study provided. In this new study, investigators used a new assessment tool, called the Pittsburgh Fatigability Scale (PFS), a 10-item self-administered questionnaire that can measure both physical and mental fatigability. Perceived fatigability anchors tiredness to a set of activities and has been shown to be a more sensitive measure than global fatigue, explained Dr. Stuber of the University of Chicago.
The scores range from 0-50, with higher scores indicating higher fatigability. The scales were divided between mental and physical activities and measured fatigue in relation to a defined activity of a specific duration and intensity. These activities included a leisurely 30-minute walk and participation in a 1-hour social activity.
This study involved 230 participants from Switzerland and Ireland, with a mean age of 73.4 years, who had persistent hypothyroidism. The population was randomized to 119 patients who were administered levothyroxine and 111 patients who received a placebo.
At baseline, the levothyroxine group had a mean physical PFS score of 14.7 ± 9.3, and the placebo group had a score of 11.1 ± 9.1. The baseline mean mental PFS score for the levothyroxine group was 7.4 ± 8.0, while it was 5.1 ± 6.9 for the placebo group.
After 12 months of the participants’ use of levothyroxine or placebo, the physical PFS scores increased for both the treatment and placebo groups. For the levothyroxine group, the mean physical PFS score was 14.8 ± 9.6, while it was 12.4 ± 9.3 for the placebo group (P = 0.88). The investigators found no significant differences between these scores for the levothyroxine and placebo groups.
The mean mental PFS score slightly decreased to 6.0 ± 7.8 for the levothyroxine group, while it slightly increased to 6.0 ± 8.0 for the placebo group (P = 0.26) at 12 months. The difference between the mental fatigability scores for the levothyroxine and placebo arms at 12 months was also not significant.
The physical fatigability between-group difference was 0.2 (95% confidence interval, –1.8 to 2.1; P = 0.88), while the mental fatigability difference was –1.0 (95% CI, –2.8 to 0.8; P = 0.26).
The study was funded by the European Union FP7 and the Swiss National Science Foundation. Merck KGaA, Darmstadt (Germany) provided levothyroxine and the placebo. Dr. Stuber has no conflicts of interest.
WASHINGTON – according to a new study.
The double-blind, randomized, placebo-controlled, parallel-group trial used subsets of data from the TRUST study. This new research, which was presented at the Annual Meeting of the Society of General Internal Medicine, provides further evidence that prescribing levothyroxine to older patients with subclinical hypothyroidism will not reduce fatigue.
Like the findings in the TRUST study, the new study, “Effect of Thyroid Hormone Replacement on Fatigability in Older Adults with Subclinical Hypothyroidism: A Randomized Placebo Controlled Trial,” showed that the use of levothyroxine in subclinical hypothyroidism was not effective in changing physical and mental fatigability in older adults.
“This study shows that levothyroxine treatment may not be necessary and results in high costs and side effects,” noted Mirah Stuber, MD, during her presentation of the findings at the meeting.
The new study examined the effect of levothyroxine on the tiredness of older adults but with a more detailed analysis of fatigue than the full TRUST study provided. In this new study, investigators used a new assessment tool, called the Pittsburgh Fatigability Scale (PFS), a 10-item self-administered questionnaire that can measure both physical and mental fatigability. Perceived fatigability anchors tiredness to a set of activities and has been shown to be a more sensitive measure than global fatigue, explained Dr. Stuber of the University of Chicago.
The scores range from 0-50, with higher scores indicating higher fatigability. The scales were divided between mental and physical activities and measured fatigue in relation to a defined activity of a specific duration and intensity. These activities included a leisurely 30-minute walk and participation in a 1-hour social activity.
This study involved 230 participants from Switzerland and Ireland, with a mean age of 73.4 years, who had persistent hypothyroidism. The population was randomized to 119 patients who were administered levothyroxine and 111 patients who received a placebo.
At baseline, the levothyroxine group had a mean physical PFS score of 14.7 ± 9.3, and the placebo group had a score of 11.1 ± 9.1. The baseline mean mental PFS score for the levothyroxine group was 7.4 ± 8.0, while it was 5.1 ± 6.9 for the placebo group.
After 12 months of the participants’ use of levothyroxine or placebo, the physical PFS scores increased for both the treatment and placebo groups. For the levothyroxine group, the mean physical PFS score was 14.8 ± 9.6, while it was 12.4 ± 9.3 for the placebo group (P = 0.88). The investigators found no significant differences between these scores for the levothyroxine and placebo groups.
The mean mental PFS score slightly decreased to 6.0 ± 7.8 for the levothyroxine group, while it slightly increased to 6.0 ± 8.0 for the placebo group (P = 0.26) at 12 months. The difference between the mental fatigability scores for the levothyroxine and placebo arms at 12 months was also not significant.
The physical fatigability between-group difference was 0.2 (95% confidence interval, –1.8 to 2.1; P = 0.88), while the mental fatigability difference was –1.0 (95% CI, –2.8 to 0.8; P = 0.26).
The study was funded by the European Union FP7 and the Swiss National Science Foundation. Merck KGaA, Darmstadt (Germany) provided levothyroxine and the placebo. Dr. Stuber has no conflicts of interest.
WASHINGTON – according to a new study.
The double-blind, randomized, placebo-controlled, parallel-group trial used subsets of data from the TRUST study. This new research, which was presented at the Annual Meeting of the Society of General Internal Medicine, provides further evidence that prescribing levothyroxine to older patients with subclinical hypothyroidism will not reduce fatigue.
Like the findings in the TRUST study, the new study, “Effect of Thyroid Hormone Replacement on Fatigability in Older Adults with Subclinical Hypothyroidism: A Randomized Placebo Controlled Trial,” showed that the use of levothyroxine in subclinical hypothyroidism was not effective in changing physical and mental fatigability in older adults.
“This study shows that levothyroxine treatment may not be necessary and results in high costs and side effects,” noted Mirah Stuber, MD, during her presentation of the findings at the meeting.
The new study examined the effect of levothyroxine on the tiredness of older adults but with a more detailed analysis of fatigue than the full TRUST study provided. In this new study, investigators used a new assessment tool, called the Pittsburgh Fatigability Scale (PFS), a 10-item self-administered questionnaire that can measure both physical and mental fatigability. Perceived fatigability anchors tiredness to a set of activities and has been shown to be a more sensitive measure than global fatigue, explained Dr. Stuber of the University of Chicago.
The scores range from 0-50, with higher scores indicating higher fatigability. The scales were divided between mental and physical activities and measured fatigue in relation to a defined activity of a specific duration and intensity. These activities included a leisurely 30-minute walk and participation in a 1-hour social activity.
This study involved 230 participants from Switzerland and Ireland, with a mean age of 73.4 years, who had persistent hypothyroidism. The population was randomized to 119 patients who were administered levothyroxine and 111 patients who received a placebo.
At baseline, the levothyroxine group had a mean physical PFS score of 14.7 ± 9.3, and the placebo group had a score of 11.1 ± 9.1. The baseline mean mental PFS score for the levothyroxine group was 7.4 ± 8.0, while it was 5.1 ± 6.9 for the placebo group.
After 12 months of the participants’ use of levothyroxine or placebo, the physical PFS scores increased for both the treatment and placebo groups. For the levothyroxine group, the mean physical PFS score was 14.8 ± 9.6, while it was 12.4 ± 9.3 for the placebo group (P = 0.88). The investigators found no significant differences between these scores for the levothyroxine and placebo groups.
The mean mental PFS score slightly decreased to 6.0 ± 7.8 for the levothyroxine group, while it slightly increased to 6.0 ± 8.0 for the placebo group (P = 0.26) at 12 months. The difference between the mental fatigability scores for the levothyroxine and placebo arms at 12 months was also not significant.
The physical fatigability between-group difference was 0.2 (95% confidence interval, –1.8 to 2.1; P = 0.88), while the mental fatigability difference was –1.0 (95% CI, –2.8 to 0.8; P = 0.26).
The study was funded by the European Union FP7 and the Swiss National Science Foundation. Merck KGaA, Darmstadt (Germany) provided levothyroxine and the placebo. Dr. Stuber has no conflicts of interest.
REPORTING FROM SGIM 2019
Program meets social needs of 90% of patients
WASHINGTON – An innovative screening and referral model using electronic health records (EHRs) helped patients overcome social determinants of health (SDOH) by providing them with resources they had requested, according to a study.
“Our goal was to find whether this pilot program is feasible to systematically screen and refer patients for social needs in ambulatory care,” said Pablo Buitron de la Vega, MD, of Boston Medical Center (BMC) at the annual meeting of the Society of General Internal Medicine.
The program, called THRIVE, helps clinicians better understand patients’ social needs through a screening process to improve their health. THRIVE uses EHRs to document patient needs related to SDOH by using ICD-10 codes. This facilitates accurate data reporting and provides insight into social impacts on a patient. This component also matches SDOH needs to referral resources. In this pilot program, patients were screened during their primary care visits.
As of December 2018, THRIVE has demonstrated feasibility across all of its clinics. Eighty-two percent of patients were screened for social needs; 86% of patients received an ICD-10 code to document their social needs in their medical files for diagnosis and billing; and
The observational survey screened 50,532 unique patients seeking care at BMC between July 2017 and December 2018. In this population, 70% were underserved minorities (with 60% black patients and 10% Hispanic patients), 50% were below the federal poverty level, and 30% did not speak English as their primary language.
Of the screened population, 28% (13,975) of the patients identified having one or more social need. In addition, 19% (9,714) of patients requested help with one or more of their needs. The most prevalent needs were food insecurity, housing/shelter, and education, with 11% of patients listing each of these as a need.
The pilot program has been scaled up to include all patients presenting to 13 ambulatory clinics in family medicine, obstetrics and gynecology, infectious diseases, and pediatrics at Boston Medical Center.
WASHINGTON – An innovative screening and referral model using electronic health records (EHRs) helped patients overcome social determinants of health (SDOH) by providing them with resources they had requested, according to a study.
“Our goal was to find whether this pilot program is feasible to systematically screen and refer patients for social needs in ambulatory care,” said Pablo Buitron de la Vega, MD, of Boston Medical Center (BMC) at the annual meeting of the Society of General Internal Medicine.
The program, called THRIVE, helps clinicians better understand patients’ social needs through a screening process to improve their health. THRIVE uses EHRs to document patient needs related to SDOH by using ICD-10 codes. This facilitates accurate data reporting and provides insight into social impacts on a patient. This component also matches SDOH needs to referral resources. In this pilot program, patients were screened during their primary care visits.
As of December 2018, THRIVE has demonstrated feasibility across all of its clinics. Eighty-two percent of patients were screened for social needs; 86% of patients received an ICD-10 code to document their social needs in their medical files for diagnosis and billing; and
The observational survey screened 50,532 unique patients seeking care at BMC between July 2017 and December 2018. In this population, 70% were underserved minorities (with 60% black patients and 10% Hispanic patients), 50% were below the federal poverty level, and 30% did not speak English as their primary language.
Of the screened population, 28% (13,975) of the patients identified having one or more social need. In addition, 19% (9,714) of patients requested help with one or more of their needs. The most prevalent needs were food insecurity, housing/shelter, and education, with 11% of patients listing each of these as a need.
The pilot program has been scaled up to include all patients presenting to 13 ambulatory clinics in family medicine, obstetrics and gynecology, infectious diseases, and pediatrics at Boston Medical Center.
WASHINGTON – An innovative screening and referral model using electronic health records (EHRs) helped patients overcome social determinants of health (SDOH) by providing them with resources they had requested, according to a study.
“Our goal was to find whether this pilot program is feasible to systematically screen and refer patients for social needs in ambulatory care,” said Pablo Buitron de la Vega, MD, of Boston Medical Center (BMC) at the annual meeting of the Society of General Internal Medicine.
The program, called THRIVE, helps clinicians better understand patients’ social needs through a screening process to improve their health. THRIVE uses EHRs to document patient needs related to SDOH by using ICD-10 codes. This facilitates accurate data reporting and provides insight into social impacts on a patient. This component also matches SDOH needs to referral resources. In this pilot program, patients were screened during their primary care visits.
As of December 2018, THRIVE has demonstrated feasibility across all of its clinics. Eighty-two percent of patients were screened for social needs; 86% of patients received an ICD-10 code to document their social needs in their medical files for diagnosis and billing; and
The observational survey screened 50,532 unique patients seeking care at BMC between July 2017 and December 2018. In this population, 70% were underserved minorities (with 60% black patients and 10% Hispanic patients), 50% were below the federal poverty level, and 30% did not speak English as their primary language.
Of the screened population, 28% (13,975) of the patients identified having one or more social need. In addition, 19% (9,714) of patients requested help with one or more of their needs. The most prevalent needs were food insecurity, housing/shelter, and education, with 11% of patients listing each of these as a need.
The pilot program has been scaled up to include all patients presenting to 13 ambulatory clinics in family medicine, obstetrics and gynecology, infectious diseases, and pediatrics at Boston Medical Center.
REPORTING FROM SGIM 2019
Key clinical point: It is feasible to identify and help those affected by the social determinants of health within the primary care setting.
Major finding: 90% of the patients who reported having a social need received resources for all of their needs.
Study details: Observational survey. 13,975 identified one or more social needs, 9,714 patients requested help with one or more needs.
Disclosures: Study sponsored by Boston Medical Center.
Having unmet social needs ups cardiovascular risk
WASHINGTON – according to a study.
“Although there have been great medical interventions and our technology keeps improving, we can’t prevent the burden of cardiovascular disease. It’s the social factors that are playing this role,” said Ana Palacio, MD, MPH, of the University of Miami during her presentation of the study findings at the annual meeting of the Society of General Internal Medicine.
“We need to address issues at the patient’s home, such as food, isolation, and transportation, to help them prevent cardiovascular risk,” she added.
The study was designed to determine how patient-reported social determinants of health (SDH) had an effect on the Framingham risk score (FRS). Researchers also wanted to assess the relationship between the SDH score and individual risk factors for cardiovascular health, including blood pressure, hemoglobin A1c, LDL cholesterol, body mass index, tobacco use, and physical activity.
Results showed that several SDH factors significantly increase the FRS score, including being born outside of the United States, living alone, having a high social isolation score, and having a low geocoded-based median household income (P less than .01). The calculated SDH score ranged from 0 to 59.
Higher SDH scores were associated with high FRS scores in the areas of poor blood pressure and diabetes control. Additionally, those who had financial strain, poor health literacy, stress, lack of education, and a low median household income were more likely to have a sedentary lifestyle. Black or Hispanic patients who were born outside the United States and had low median household income were at a higher risk of obesity.
The retrospective cohort study originally involved 11,113 primary care patients who received care at the University of Miami Health System between Sept. 16, 2016 and Sept. 10, 2017 and answered an SDH survey. Of this group, 2,876 patients completed the electronic health record data to compile a score. This population had a mean age of 53.8 years and was 61% female; 38% were Hispanic and 9% were black. The mean household income was $53,677 and 87% reported speaking English.
The study examined a total of 11 self-reported and census-based SDH factors. The self-reported factors were race/ethnicity, education, financial strain, stress, tobacco use and physical activity, social isolation, years living in the United States, health literacy, and delayed care. The remaining factors were based on an area deprivation index and census-driven median household income.
“The most surprising finding was how much weight the social factors have in adding to the Framingham risk score, in taking a patient from a medium score to a higher score because of their social environment,” said Dr. Palacio.
The study was funded by the Precision Medicine and Health Disparities Collaborative and was supported by the National Institute on Minority Health and Health Disparities and National Human Genome Research Institute of the National Institutes of Health.
WASHINGTON – according to a study.
“Although there have been great medical interventions and our technology keeps improving, we can’t prevent the burden of cardiovascular disease. It’s the social factors that are playing this role,” said Ana Palacio, MD, MPH, of the University of Miami during her presentation of the study findings at the annual meeting of the Society of General Internal Medicine.
“We need to address issues at the patient’s home, such as food, isolation, and transportation, to help them prevent cardiovascular risk,” she added.
The study was designed to determine how patient-reported social determinants of health (SDH) had an effect on the Framingham risk score (FRS). Researchers also wanted to assess the relationship between the SDH score and individual risk factors for cardiovascular health, including blood pressure, hemoglobin A1c, LDL cholesterol, body mass index, tobacco use, and physical activity.
Results showed that several SDH factors significantly increase the FRS score, including being born outside of the United States, living alone, having a high social isolation score, and having a low geocoded-based median household income (P less than .01). The calculated SDH score ranged from 0 to 59.
Higher SDH scores were associated with high FRS scores in the areas of poor blood pressure and diabetes control. Additionally, those who had financial strain, poor health literacy, stress, lack of education, and a low median household income were more likely to have a sedentary lifestyle. Black or Hispanic patients who were born outside the United States and had low median household income were at a higher risk of obesity.
The retrospective cohort study originally involved 11,113 primary care patients who received care at the University of Miami Health System between Sept. 16, 2016 and Sept. 10, 2017 and answered an SDH survey. Of this group, 2,876 patients completed the electronic health record data to compile a score. This population had a mean age of 53.8 years and was 61% female; 38% were Hispanic and 9% were black. The mean household income was $53,677 and 87% reported speaking English.
The study examined a total of 11 self-reported and census-based SDH factors. The self-reported factors were race/ethnicity, education, financial strain, stress, tobacco use and physical activity, social isolation, years living in the United States, health literacy, and delayed care. The remaining factors were based on an area deprivation index and census-driven median household income.
“The most surprising finding was how much weight the social factors have in adding to the Framingham risk score, in taking a patient from a medium score to a higher score because of their social environment,” said Dr. Palacio.
The study was funded by the Precision Medicine and Health Disparities Collaborative and was supported by the National Institute on Minority Health and Health Disparities and National Human Genome Research Institute of the National Institutes of Health.
WASHINGTON – according to a study.
“Although there have been great medical interventions and our technology keeps improving, we can’t prevent the burden of cardiovascular disease. It’s the social factors that are playing this role,” said Ana Palacio, MD, MPH, of the University of Miami during her presentation of the study findings at the annual meeting of the Society of General Internal Medicine.
“We need to address issues at the patient’s home, such as food, isolation, and transportation, to help them prevent cardiovascular risk,” she added.
The study was designed to determine how patient-reported social determinants of health (SDH) had an effect on the Framingham risk score (FRS). Researchers also wanted to assess the relationship between the SDH score and individual risk factors for cardiovascular health, including blood pressure, hemoglobin A1c, LDL cholesterol, body mass index, tobacco use, and physical activity.
Results showed that several SDH factors significantly increase the FRS score, including being born outside of the United States, living alone, having a high social isolation score, and having a low geocoded-based median household income (P less than .01). The calculated SDH score ranged from 0 to 59.
Higher SDH scores were associated with high FRS scores in the areas of poor blood pressure and diabetes control. Additionally, those who had financial strain, poor health literacy, stress, lack of education, and a low median household income were more likely to have a sedentary lifestyle. Black or Hispanic patients who were born outside the United States and had low median household income were at a higher risk of obesity.
The retrospective cohort study originally involved 11,113 primary care patients who received care at the University of Miami Health System between Sept. 16, 2016 and Sept. 10, 2017 and answered an SDH survey. Of this group, 2,876 patients completed the electronic health record data to compile a score. This population had a mean age of 53.8 years and was 61% female; 38% were Hispanic and 9% were black. The mean household income was $53,677 and 87% reported speaking English.
The study examined a total of 11 self-reported and census-based SDH factors. The self-reported factors were race/ethnicity, education, financial strain, stress, tobacco use and physical activity, social isolation, years living in the United States, health literacy, and delayed care. The remaining factors were based on an area deprivation index and census-driven median household income.
“The most surprising finding was how much weight the social factors have in adding to the Framingham risk score, in taking a patient from a medium score to a higher score because of their social environment,” said Dr. Palacio.
The study was funded by the Precision Medicine and Health Disparities Collaborative and was supported by the National Institute on Minority Health and Health Disparities and National Human Genome Research Institute of the National Institutes of Health.
REPORTING FROM SGIM 2019
Pilot program addresses social determinants of health
WASHINGTON –
The program, called SHAPE (Social Health Alliance to Promote Equity), was designed to screen patients across multiple social categories. In-house patient navigators, some bilingual, were trained on how to work with diverse populations and were able to address unmet patient needs through referrals to individualized resources. Physicians could refer patients to the following local community partners:
- The Child Center of NY.
- The INN – serving hungry & homeless Long Islanders.
- Maurice A. Deane School of Law – Hofstra Law.
- The Gitenstein Institute for Health Law and Policy.
The legal partners provided free assistance to patience with legal needs.
“By implementing a program where you address the nonmedical social needs, you will actually improve the overall health of the patient. You can’t just address the biomedical needs of your patients, you need to understand their home environment, their background, and social situations they’re going through to keep them healthy,” said Jane Lindahl at the annual meeting of the Society of General Internal Medicine. Ms. Lindahl is a research assistant at Cohen Children’s Medical Center at Northwell Health in New York.
The SHAPE program was conducted at two internal medicine and pediatric primary care clinics at Northwell Health, a large academic hospital system in New York. It was originally created in the pediatric practice in August 2016 and expanded to the internal medicine practice in June 2018. A medicolegal partnership was created as part of the program in October 2018.
The patient population comprised low-income, racially ethnic, primarily Medicaid and uninsured individuals, including a high number of documented and undocumented immigrants. While 927 patients were screened, 590 screened positive for social determinants of health (SDOH). Of those 590 patients, 190 patients connected with patient navigators for intake and accepted initial assistance and 74 patients were connected to resources.
Screening was based on patients’ completion of a one-page SDOH form in the waiting room of their physician’s office on the same day of their annual visit. There were 15 categories of social needs identified on the screen.
After the screening, the results were discussed with the patients and the necessary referrals were determined. The screening indicated that the largest needs for the patients were health/dental insurance (cited by 296 people), education (cited by 269 people), and health literacy (cited by 225 patients).
Those who had emergent social needs were referred to on-site social workers and providers to address such needs. The emergent social needs included being a victim of domestic violence, being homeless, having an imminent eviction, and having imminent deportation.
Those patients with nonemergent social needs received referral and follow-up processes within 48 hours.
After a referral was made, the patient navigator followed up every 2 weeks with the patient to check on the status of the referral and social needs. After this period, a final phone interview was conducted to get feedback on the patient’s experience and SDOH status.
Ms. Lindahl had no financial conflicts of interest to disclose. The program was funded by Robert Wood Johnson Foundation Clinical Scholars Grant, Health Leads, Collaborative to Advance Social Health Integration, N.Y. State Delivery System Reform Incentive Program, and United Hospital Foundation.
WASHINGTON –
The program, called SHAPE (Social Health Alliance to Promote Equity), was designed to screen patients across multiple social categories. In-house patient navigators, some bilingual, were trained on how to work with diverse populations and were able to address unmet patient needs through referrals to individualized resources. Physicians could refer patients to the following local community partners:
- The Child Center of NY.
- The INN – serving hungry & homeless Long Islanders.
- Maurice A. Deane School of Law – Hofstra Law.
- The Gitenstein Institute for Health Law and Policy.
The legal partners provided free assistance to patience with legal needs.
“By implementing a program where you address the nonmedical social needs, you will actually improve the overall health of the patient. You can’t just address the biomedical needs of your patients, you need to understand their home environment, their background, and social situations they’re going through to keep them healthy,” said Jane Lindahl at the annual meeting of the Society of General Internal Medicine. Ms. Lindahl is a research assistant at Cohen Children’s Medical Center at Northwell Health in New York.
The SHAPE program was conducted at two internal medicine and pediatric primary care clinics at Northwell Health, a large academic hospital system in New York. It was originally created in the pediatric practice in August 2016 and expanded to the internal medicine practice in June 2018. A medicolegal partnership was created as part of the program in October 2018.
The patient population comprised low-income, racially ethnic, primarily Medicaid and uninsured individuals, including a high number of documented and undocumented immigrants. While 927 patients were screened, 590 screened positive for social determinants of health (SDOH). Of those 590 patients, 190 patients connected with patient navigators for intake and accepted initial assistance and 74 patients were connected to resources.
Screening was based on patients’ completion of a one-page SDOH form in the waiting room of their physician’s office on the same day of their annual visit. There were 15 categories of social needs identified on the screen.
After the screening, the results were discussed with the patients and the necessary referrals were determined. The screening indicated that the largest needs for the patients were health/dental insurance (cited by 296 people), education (cited by 269 people), and health literacy (cited by 225 patients).
Those who had emergent social needs were referred to on-site social workers and providers to address such needs. The emergent social needs included being a victim of domestic violence, being homeless, having an imminent eviction, and having imminent deportation.
Those patients with nonemergent social needs received referral and follow-up processes within 48 hours.
After a referral was made, the patient navigator followed up every 2 weeks with the patient to check on the status of the referral and social needs. After this period, a final phone interview was conducted to get feedback on the patient’s experience and SDOH status.
Ms. Lindahl had no financial conflicts of interest to disclose. The program was funded by Robert Wood Johnson Foundation Clinical Scholars Grant, Health Leads, Collaborative to Advance Social Health Integration, N.Y. State Delivery System Reform Incentive Program, and United Hospital Foundation.
WASHINGTON –
The program, called SHAPE (Social Health Alliance to Promote Equity), was designed to screen patients across multiple social categories. In-house patient navigators, some bilingual, were trained on how to work with diverse populations and were able to address unmet patient needs through referrals to individualized resources. Physicians could refer patients to the following local community partners:
- The Child Center of NY.
- The INN – serving hungry & homeless Long Islanders.
- Maurice A. Deane School of Law – Hofstra Law.
- The Gitenstein Institute for Health Law and Policy.
The legal partners provided free assistance to patience with legal needs.
“By implementing a program where you address the nonmedical social needs, you will actually improve the overall health of the patient. You can’t just address the biomedical needs of your patients, you need to understand their home environment, their background, and social situations they’re going through to keep them healthy,” said Jane Lindahl at the annual meeting of the Society of General Internal Medicine. Ms. Lindahl is a research assistant at Cohen Children’s Medical Center at Northwell Health in New York.
The SHAPE program was conducted at two internal medicine and pediatric primary care clinics at Northwell Health, a large academic hospital system in New York. It was originally created in the pediatric practice in August 2016 and expanded to the internal medicine practice in June 2018. A medicolegal partnership was created as part of the program in October 2018.
The patient population comprised low-income, racially ethnic, primarily Medicaid and uninsured individuals, including a high number of documented and undocumented immigrants. While 927 patients were screened, 590 screened positive for social determinants of health (SDOH). Of those 590 patients, 190 patients connected with patient navigators for intake and accepted initial assistance and 74 patients were connected to resources.
Screening was based on patients’ completion of a one-page SDOH form in the waiting room of their physician’s office on the same day of their annual visit. There were 15 categories of social needs identified on the screen.
After the screening, the results were discussed with the patients and the necessary referrals were determined. The screening indicated that the largest needs for the patients were health/dental insurance (cited by 296 people), education (cited by 269 people), and health literacy (cited by 225 patients).
Those who had emergent social needs were referred to on-site social workers and providers to address such needs. The emergent social needs included being a victim of domestic violence, being homeless, having an imminent eviction, and having imminent deportation.
Those patients with nonemergent social needs received referral and follow-up processes within 48 hours.
After a referral was made, the patient navigator followed up every 2 weeks with the patient to check on the status of the referral and social needs. After this period, a final phone interview was conducted to get feedback on the patient’s experience and SDOH status.
Ms. Lindahl had no financial conflicts of interest to disclose. The program was funded by Robert Wood Johnson Foundation Clinical Scholars Grant, Health Leads, Collaborative to Advance Social Health Integration, N.Y. State Delivery System Reform Incentive Program, and United Hospital Foundation.
REPORTING FROM SGIM 2019
Lonely elderly patients suffer worse health outcomes
WASHINGTON – More lonely elderly patients suffered from health symptoms and received very aggressive end of life care than nonlonely elderly patients, according to a study presented at the annual meeting of the Society of General Internal Medicine.
“Loneliness and social isolation are very common problems, especially in older Americans, and inflict about 30%-40% of older Americans. But while we know that this may have implications for their quality [of] life and may actually lead to premature death, we know very little about the end of life experience,” said Nauzley Abedini, MD, MSc, a hospitalist in internal medicine at the University of Michigan, Ann Arbor.
The study sought to determine the association between loneliness and end of life experience as measured by symptom burden, intensity of care, and advance care planning in adults. The pooled cohort study used data from the Health and Retirement Study (HRS) to analyze older Americans (aged 50 years or more) who died between 2004 and 2014. Investigators conducted postmortem “exit interviews” with the next of kin after each participant’s death. There were 2,896 participants included in the survey. Of these participants, 34% (942) were lonely; the remaining 1,954 of elderly adults were classified as nonlonely.
Loneliness was defined using the three-item Revised University of California, Los Angeles, Loneliness Scale score from a decedent’s last HRS interview prior to death. These items included feeling left out, feeling isolated, and lacking companionship. Investigators used this data to create a loneliness variable on previously established cutpoints for “lonely” and “nonlonely” participants. The data was used from the most recent survey prior to death.
Results showed more lonely older adults suffered from health symptoms in the last year of life, compared with nonlonely older adults (69.1% vs. 59.5%; odds ratio, 1.52; 95% confidence interval, 1.30-1.78). These symptoms included being troubled by pain, having difficulty breathing, experiencing severe fatigue, and having periodic confusion.
Patients with loneliness associated with intensity of health care at the end of life were more likely to die in a nursing home than at home, compared with nonlonely adults (OR, 1.68; 95% CI, 1.25-2.27). The lonely patients also were more likely to use life support during their last 2 years of life (OR, 1.41; 95% CI, 1.16-1.70).
“For clinicians, we need to identify end of life as an additional vulnerable time for people who are lonely. Currently, most of our interventions in terms of screening for loneliness are in the outpatient setting, but I would argue that working in hospitals, hospices, nursing homes, and community organizations, where these folks are living and dying, would be useful places to screen for this,” Dr. Abedini said.
The authors had no disclosures.
WASHINGTON – More lonely elderly patients suffered from health symptoms and received very aggressive end of life care than nonlonely elderly patients, according to a study presented at the annual meeting of the Society of General Internal Medicine.
“Loneliness and social isolation are very common problems, especially in older Americans, and inflict about 30%-40% of older Americans. But while we know that this may have implications for their quality [of] life and may actually lead to premature death, we know very little about the end of life experience,” said Nauzley Abedini, MD, MSc, a hospitalist in internal medicine at the University of Michigan, Ann Arbor.
The study sought to determine the association between loneliness and end of life experience as measured by symptom burden, intensity of care, and advance care planning in adults. The pooled cohort study used data from the Health and Retirement Study (HRS) to analyze older Americans (aged 50 years or more) who died between 2004 and 2014. Investigators conducted postmortem “exit interviews” with the next of kin after each participant’s death. There were 2,896 participants included in the survey. Of these participants, 34% (942) were lonely; the remaining 1,954 of elderly adults were classified as nonlonely.
Loneliness was defined using the three-item Revised University of California, Los Angeles, Loneliness Scale score from a decedent’s last HRS interview prior to death. These items included feeling left out, feeling isolated, and lacking companionship. Investigators used this data to create a loneliness variable on previously established cutpoints for “lonely” and “nonlonely” participants. The data was used from the most recent survey prior to death.
Results showed more lonely older adults suffered from health symptoms in the last year of life, compared with nonlonely older adults (69.1% vs. 59.5%; odds ratio, 1.52; 95% confidence interval, 1.30-1.78). These symptoms included being troubled by pain, having difficulty breathing, experiencing severe fatigue, and having periodic confusion.
Patients with loneliness associated with intensity of health care at the end of life were more likely to die in a nursing home than at home, compared with nonlonely adults (OR, 1.68; 95% CI, 1.25-2.27). The lonely patients also were more likely to use life support during their last 2 years of life (OR, 1.41; 95% CI, 1.16-1.70).
“For clinicians, we need to identify end of life as an additional vulnerable time for people who are lonely. Currently, most of our interventions in terms of screening for loneliness are in the outpatient setting, but I would argue that working in hospitals, hospices, nursing homes, and community organizations, where these folks are living and dying, would be useful places to screen for this,” Dr. Abedini said.
The authors had no disclosures.
WASHINGTON – More lonely elderly patients suffered from health symptoms and received very aggressive end of life care than nonlonely elderly patients, according to a study presented at the annual meeting of the Society of General Internal Medicine.
“Loneliness and social isolation are very common problems, especially in older Americans, and inflict about 30%-40% of older Americans. But while we know that this may have implications for their quality [of] life and may actually lead to premature death, we know very little about the end of life experience,” said Nauzley Abedini, MD, MSc, a hospitalist in internal medicine at the University of Michigan, Ann Arbor.
The study sought to determine the association between loneliness and end of life experience as measured by symptom burden, intensity of care, and advance care planning in adults. The pooled cohort study used data from the Health and Retirement Study (HRS) to analyze older Americans (aged 50 years or more) who died between 2004 and 2014. Investigators conducted postmortem “exit interviews” with the next of kin after each participant’s death. There were 2,896 participants included in the survey. Of these participants, 34% (942) were lonely; the remaining 1,954 of elderly adults were classified as nonlonely.
Loneliness was defined using the three-item Revised University of California, Los Angeles, Loneliness Scale score from a decedent’s last HRS interview prior to death. These items included feeling left out, feeling isolated, and lacking companionship. Investigators used this data to create a loneliness variable on previously established cutpoints for “lonely” and “nonlonely” participants. The data was used from the most recent survey prior to death.
Results showed more lonely older adults suffered from health symptoms in the last year of life, compared with nonlonely older adults (69.1% vs. 59.5%; odds ratio, 1.52; 95% confidence interval, 1.30-1.78). These symptoms included being troubled by pain, having difficulty breathing, experiencing severe fatigue, and having periodic confusion.
Patients with loneliness associated with intensity of health care at the end of life were more likely to die in a nursing home than at home, compared with nonlonely adults (OR, 1.68; 95% CI, 1.25-2.27). The lonely patients also were more likely to use life support during their last 2 years of life (OR, 1.41; 95% CI, 1.16-1.70).
“For clinicians, we need to identify end of life as an additional vulnerable time for people who are lonely. Currently, most of our interventions in terms of screening for loneliness are in the outpatient setting, but I would argue that working in hospitals, hospices, nursing homes, and community organizations, where these folks are living and dying, would be useful places to screen for this,” Dr. Abedini said.
The authors had no disclosures.
REPORTING FROM SGIM 2019
Pilot program trains residents in telemedicine
WASHINGTON – while still providing the same quality of care during clinic visits, according to the results of a new pilot program.
While telephone visits have been shown to be an effective alternative to face-to-face visits for physicians, residents are not trained to perform telemedicine.
“We have no structured training program on how to teach these residents these skills. We assume that the same skills needed in the clinic are applicable through telephone medicine and we’re not sure about that yet,” Jenna L. Laughlin, DO, said at the annual meeting of the Society of General Internal Medicine.
The pilot study took place at Christiana Care Health System, Wilmington, Del., from October 2016 through December 2018. Nine residents were enrolled in the study, but only six participated.
The objective of the pilot was to demonstrate the feasibility of adding telephone visits into the internal medicine residency practice. This feasibility was measured by templating, scheduling, and supervision, noted Dr. Laughlin, an internist at Christiana Care Health System in Newark, Del. Templating was a term used to describe the designing of the program. For example, the researcher templated 1-hour telephone visit blocks, meaning they designed this structure to integrate into the resident’s training program.
Each resident had 1 hour within the weekly schedule to conduct telephone visits. First-year residents were allowed to do one telephone visit during that hour, second-year residents could do two telephone visits within the hour, and third-year residents could do three telephone visits in that hour.
“There were some challenges associated with scheduling and templating, such as initial schedule templates and a high utilization learning curve,” said Dr. Laughlin, lead author of the study and the program’s leader.
Some didn’t schedule enough telemedicine visits; those residents were assigned to acute clinic visits during the times that they should have been practicing telemedicine.
The program’s second objective was to evaluate the resident experience of scheduled telemedicine visits. This included provider-patient continuity and patient ownership.
The six residents who were surveyed about their experiences said these telephone visits increased their patient ownership and allowed them to build rapport with patients. They said the level of supervision they received was appropriate.
In terms of continuity of care, out the 273 telephone visits scheduled, 179 (65%) were with the patient’s primary care provider and 71 (26.0%) were within the primary care provider’s firm.
“As we build primary care practices in the future, there will be many alternative methods of working with our patients, compared to the traditional face-to-face encounters. I think these are increasingly going to be something that our medical residents need for their future,” Dr. Laughlin said.
The authors reported no conflicts of interest.
WASHINGTON – while still providing the same quality of care during clinic visits, according to the results of a new pilot program.
While telephone visits have been shown to be an effective alternative to face-to-face visits for physicians, residents are not trained to perform telemedicine.
“We have no structured training program on how to teach these residents these skills. We assume that the same skills needed in the clinic are applicable through telephone medicine and we’re not sure about that yet,” Jenna L. Laughlin, DO, said at the annual meeting of the Society of General Internal Medicine.
The pilot study took place at Christiana Care Health System, Wilmington, Del., from October 2016 through December 2018. Nine residents were enrolled in the study, but only six participated.
The objective of the pilot was to demonstrate the feasibility of adding telephone visits into the internal medicine residency practice. This feasibility was measured by templating, scheduling, and supervision, noted Dr. Laughlin, an internist at Christiana Care Health System in Newark, Del. Templating was a term used to describe the designing of the program. For example, the researcher templated 1-hour telephone visit blocks, meaning they designed this structure to integrate into the resident’s training program.
Each resident had 1 hour within the weekly schedule to conduct telephone visits. First-year residents were allowed to do one telephone visit during that hour, second-year residents could do two telephone visits within the hour, and third-year residents could do three telephone visits in that hour.
“There were some challenges associated with scheduling and templating, such as initial schedule templates and a high utilization learning curve,” said Dr. Laughlin, lead author of the study and the program’s leader.
Some didn’t schedule enough telemedicine visits; those residents were assigned to acute clinic visits during the times that they should have been practicing telemedicine.
The program’s second objective was to evaluate the resident experience of scheduled telemedicine visits. This included provider-patient continuity and patient ownership.
The six residents who were surveyed about their experiences said these telephone visits increased their patient ownership and allowed them to build rapport with patients. They said the level of supervision they received was appropriate.
In terms of continuity of care, out the 273 telephone visits scheduled, 179 (65%) were with the patient’s primary care provider and 71 (26.0%) were within the primary care provider’s firm.
“As we build primary care practices in the future, there will be many alternative methods of working with our patients, compared to the traditional face-to-face encounters. I think these are increasingly going to be something that our medical residents need for their future,” Dr. Laughlin said.
The authors reported no conflicts of interest.
WASHINGTON – while still providing the same quality of care during clinic visits, according to the results of a new pilot program.
While telephone visits have been shown to be an effective alternative to face-to-face visits for physicians, residents are not trained to perform telemedicine.
“We have no structured training program on how to teach these residents these skills. We assume that the same skills needed in the clinic are applicable through telephone medicine and we’re not sure about that yet,” Jenna L. Laughlin, DO, said at the annual meeting of the Society of General Internal Medicine.
The pilot study took place at Christiana Care Health System, Wilmington, Del., from October 2016 through December 2018. Nine residents were enrolled in the study, but only six participated.
The objective of the pilot was to demonstrate the feasibility of adding telephone visits into the internal medicine residency practice. This feasibility was measured by templating, scheduling, and supervision, noted Dr. Laughlin, an internist at Christiana Care Health System in Newark, Del. Templating was a term used to describe the designing of the program. For example, the researcher templated 1-hour telephone visit blocks, meaning they designed this structure to integrate into the resident’s training program.
Each resident had 1 hour within the weekly schedule to conduct telephone visits. First-year residents were allowed to do one telephone visit during that hour, second-year residents could do two telephone visits within the hour, and third-year residents could do three telephone visits in that hour.
“There were some challenges associated with scheduling and templating, such as initial schedule templates and a high utilization learning curve,” said Dr. Laughlin, lead author of the study and the program’s leader.
Some didn’t schedule enough telemedicine visits; those residents were assigned to acute clinic visits during the times that they should have been practicing telemedicine.
The program’s second objective was to evaluate the resident experience of scheduled telemedicine visits. This included provider-patient continuity and patient ownership.
The six residents who were surveyed about their experiences said these telephone visits increased their patient ownership and allowed them to build rapport with patients. They said the level of supervision they received was appropriate.
In terms of continuity of care, out the 273 telephone visits scheduled, 179 (65%) were with the patient’s primary care provider and 71 (26.0%) were within the primary care provider’s firm.
“As we build primary care practices in the future, there will be many alternative methods of working with our patients, compared to the traditional face-to-face encounters. I think these are increasingly going to be something that our medical residents need for their future,” Dr. Laughlin said.
The authors reported no conflicts of interest.
REPORTING FROM SGIM 2019