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After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden.We used 2021 data from the National Electronic Health Records Survey. We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after-hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients.We included 1801 office-based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on after-hours documentation (odds ratio = 1.44, 95% confidence interval 1.06-1.95).MIPS participation may increase after-hours documentation burden among US office-based physicians, suggesting that physicians may require additional resources to more efficiently report data.

As patients, members of the public, and professional stakeholders engage in co-producing health-related research, an important issue to consider is trauma. Trauma is very common and associated with a wide range of physical and behavioural health conditions. Thus, it may benefit research partnerships to consider its impact on their stakeholders as well as its relevance to the health condition under study. The aims of this article are to describe the development and evaluation of a training programme that applied principles of trauma-informed care (TIC) to patient- and public-engaged research.A research partnership focused on addressing trauma in primary care patients ('myPATH') explicitly incorporated TIC into its formation, governance document and collaborative processes, and developed and evaluated a free 3-credit continuing education online training. The training was presented by 11 partners (5 professionals, 6 patients) and included academic content and lived experiences.Training participants (N = 46) positively rated achievement of learning objectives and speakers' performance (ranging from 4.39 to 4.74 on a 5-point scale). The most salient themes from open-ended comments were that training was informative (n = 12) and that lived experiences shared by patient partners were impactful (n = 10). Suggestions were primarily technical or logistical.This preliminary evaluation indicates that it is possible to incorporate TIC principles into a research partnership's collaborative processes and training about these topics is well-received. Learning about trauma and TIC may benefit research partnerships that involve patients and public stakeholders studying a wide range of health conditions, potentially improving how stakeholders engage in co-producing research as well as producing research that addresses how trauma relates to their health condition under study.The myPATH Partnership includes 22 individuals with professional and lived experiences related to trauma (https://www.usf.edu/cbcs/mhlp/centers/mypath/); nine partners were engaged due to personal experiences with trauma; other partners are community-based providers and researchers. All partners contributed ideas that led to trauma-informed research strategies and training. Eleven partners (5 professionals, 6 patients) presented the training, and 12 partners (8 professionals, 4 patients) contributed to this article and chose to be named as authors.

PURPOSE: The effects of COVID-19 have been understudied in rural areas. This study sought to (1) identify cancer screening barriers and facilitators during the pandemic in rural and urban primary care practices, (2) describe implementation strategies to support cancer screening, and (3) provide recommendations. METHODS: A qualitative study was conducted (N = 42) with primary care staff across 20 sites. Individual interviews were conducted through videoconference from August 2020 to April 2021 and recorded, transcribed, and analyzed using deductive and inductive coding (hybrid approach) in NVivo 12 Plus. Practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system–owned clinics, and academic medical centers across 10 states including urban (55%) and rural (45%) sites. Staff included individuals serving in the dual role of health care provider and administrator (21.4%), health care administrator (23.8%), physician (19.0%), advanced practice provider (11.9%), or resident (23.8%). The interviews assessed perceptions about cancer screening barriers and facilitators, implementation strategies, and future recommendations. RESULTS: Participants reported multilevel barriers to cancer screening including policy-level (eg, elective procedure delays), organizational (eg, backlogs), and individual (eg, patient cancellation). Several facilitators to screening were noted, such as home-based testing, using telehealth, and strong partnerships with referral sites. Practices used strategies to encourage screening, such as incentivizing patients and providers and expanding outreach. Rural clinics reported challenges with backlogs, staffing, telehealth implementation, and patient outreach. CONCLUSION: Primary care staff used innovative strategies during the pandemic to promote cancer screening. Unresolved challenges (eg, backlogs and inability to implement telehealth) disproportionately affected rural clinics.

Breast cancer is one of the leading causes of death among women residing in the United States. Early detection through mammogram screening can decrease the morbidity and mortality associated with the disease. For women with diabetes, however, incidence and mortality rates of breast cancer are increased.This was a retrospective examination, identifying orders and completion of mammogram among patients with and without diabetes, 2015 to 2019, through the electronic health record. Diabetes and other factors were identified as possible predictors of completion.Of the 16,688 patients who were included in this study, only 54.5% successfully completed mammography orders prescribed by their primary care physician. The 40 to 49 age group had the highest order completion rate at 57.6%. The prevalence of diabetes in this sample was 21.3%. Overall, 51.6% of patients with diabetes completed mammogram orders compared with 55.3% of patients without diabetes.Patients with diabetes were significantly less likely to complete mammogram screenings (51.6%) compared with patients without diabetes (55.3%), despite there being an increased incidence of breast cancer among patients with diabetes. Factors such as the lack of access to treatment centers, affordability, patient education, among others may have contributed to low completion rates.

Viewing laboratory test results is patients’ most frequent activity when accessing patient portals, but lab results can be very confusing for patients. Previous research has explored various ways to present lab results, but few have attempted to provide tailored information support based on individual patient’s medical context. In this study, we collected and annotated interpretations of textual lab result in 251 health articles about laboratory tests from AHealthyMe.com. Then we evaluated transformer-based language models including BioBERT, ClinicalBERT, RoBERTa, and PubMedBERT for recognizing key terms and their types. Using BioPortal’s term search API, we mapped the annotated terms to concepts in major controlled terminologies. Results showed that PubMedBERT achieved the best F1 on both strict and lenient matching criteria. SNOMED CT had the best coverage of the terms, followed by LOINC and ICD-10-CM. This work lays the foundation for enhancing the presentation of lab results in patient portals by providing patients with contextualized interpretations of their lab results and individualized question prompts that they can, in turn, refer to during physician consults.

Background: In the United States, about half of all pregnancies are unplanned. Unplanned pregnancy carries increased risks to patient and fetus and is increased independently by both poverty and being a racial or ethnic minority. The purpose of this study was to examine the percentage and types of contraceptives used by patients at the student-run Building Relationships and Initiatives Dedicated to Gaining Equality (BRIDGE) Healthcare Clinic and determine if clinic staff provided appropriate annual contraceptive counseling. Methods: A retrospective chart review was performed for all active BRIDGE patients that were female and aged 18-60 between 2015 and 2020. Information collected included demographics, obstetric history, tobacco use, medical history of deep vein thrombosis (DVT) or hypertension, and contraception use. Results: Of 145 patients reviewed, 77.2% used contraception at some point during the study period. Surgical contraception was the most common form used. No patients with a documented history of DVT or tobacco use used estrogen-containing contraception during the study period. One patient out of the twenty with documented hypertension used an estrogen-containing form of contraception for one year. Conclusions: Overall, our clinic counseled the majority of patients of child-bearing age on contraception use. Contraception use in our population is above the national average and is appropriately prescribed.

Patients are becoming increasingly active consumers of health information on the internet with urologic concerns being no exception. Our objective was to explore online search trends for topics related to men's health and identify information-seeking patterns related to news and media coverage of these topics. We used Google Trends ( http://google.com/trends ) to explore search trends for various search terms related to men's health in the United States over a 5-year period. Search queries provided graphs depicting search volume as a function of time, geographical data, and related topics and queries. Isolated spikes in search volume were further explored to identify a related event. Erectile dysfunction was the most-searched topic over the last 5 years in the United States. Prostate cancer and benign prostatic hyperplasia were the second and third most-searched topics, respectively. Other popular topics involved symptoms or pathologies of the testicles and penis. Most topics had relatively stable search volumes, with the exceptions of premature ejaculation and Peyronie's disease. Several observed spikes in search volume were attributable to singular events, mostly in the form of online article publications or social media posts. We believe it may be helpful for providers to stay informed of cultural events relating to medical conditions to anticipate patient concerns.

Background Providing patients with medical records access is one strategy that health systems can utilize to reduce medical errors. However, how often patients request corrections to their records on a national scale is unknown. Objectives We aimed to develop population-level estimates of patients who request corrections to their medical records using national-level data. We also identified patient-level correlates of requesting corrections. Methods We used the 2017 and 2019 Health Information National Trends Survey and examined all patient portal adopters. We applied jackknife replicate weights to develop population-representative estimates of the prevalence of requesting medical record corrections. We conducted a multivariable logistic regression analysis to identify correlates of requesting corrections while controlling for demographic factors, health care utilization patterns, health status, technology/internet use patterns, and year. Results Across 1,657 respondents, 125 (weighted estimate: 6.5%) reported requesting corrections to their medical records. In unadjusted models, greater odds of requesting corrections were observed among patients who reported their race/ethnicity as non-Hispanic black (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.10–4.43), had frequent portal visits (OR: 3.92, 95% CI: 1.51–10.23), and had entered data into the portal (OR: 7.51, 95% CI: 4.08–13.81). In adjusted models, we found greater odds of requesting corrections among those who reported frequent portal visits (OR: 3.39, 95% CI: 1.24–9.33) and those who reported entering data into the portal (OR: 6.43, 95% CI: 3.20–12.94). No other significant differences were observed. Conclusion Prior to the Information Blocking Final Rule in April 2021, approximately 6.5% of patients requested corrections of errors in their medical records at the national level. Those who reported higher engagement with their health, as proxied by portal visit frequency and entering data into the portal, were more likely to request corrections.

OBJECTIVES Reports of medical student mentorship prevalence range between 26% and 77%. This broad range likely reflects the tendencies of studies to focus on specific populations of medical students. There is little consensus about the characteristics of mentoring relationships among medical students. The primary goal of this study was to determine the reported prevalence of mentorship among medical students in the United States. The secondary goals were to assess the desired qualities of and barriers to successful mentoring from a medical student perspective. METHODS A cross-sectional online survey was administered via Qualtrics to all medical students at participating accredited medical schools from July 2018 to March 2019. The questionnaire contained a subsection of questions that assessed the existence of mentoring, facilitators, and barriers in finding a mentor, and the desired qualities of a successful mentor. RESULTS With a 94% completion rate, 369 (69%) of 532 medical students reported having a mentor. Adjusted analysis showed that fourth-year medical students were significantly more likely to have a mentor compared with first-year (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.49-4.73, P = 0.001), second-year (OR 2.07, 95% CI 1.14-3.76, P = 0.016), and third-year medical students (OR 2.16, 95% CI 1.2-3.90, P = 0.011). Compassion (64%) was the most commonly reported quality in a successful mentoring relationship. Lack of time from mentor (75%) was the most commonly reported barrier. CONCLUSIONS This study may serve as a guide to fostering more supportive mentoring relationships. Each mentoring relationship should be tailored to the needs of the mentee, however.

The 21st Century Cures Act has expanded patients' access to portals through smartphone applications (apps). To date, the prevalence of patient portal smartphone apps use is unclear, especially on a national scale.Using the 2019 Health Information National Trends Survey, we assessed factors associated with patient portal adopters accessing their records through a smartphone app. Multivariable logistic regression models were conducted and we reported results using predicted probability.Across a weighted sample of 75,324,288 respondents, 39 % reported using a smartphone app to access their health records. Adults with smartphone-only internet (40.0 %; 95 % CI: 35.4-33.3) were more likely to use a smartphone app compared to adults with home internet access (30.6 %; 95 % CI: 27.9-44.7).Optimizing the implementation and delivery of patient portal content via smartphone apps may improve their reach to patients.

BACKGROUND Background: While overall portal adoption has steadily increased over time, a digital divide has persisted, suggesting new implementation strategies may be needed. The 21st Century Cures Act has expanded patients’ access to portals through mobile applications (apps). To date, there have been limited studies examining adoption and use of patient portal mobile apps, especially on a national scale. OBJECTIVE Objectives: This study has two objectives: 1) to assess which patients were most likely to use patient portal mobile apps, and 2) to assess whether patient portal mobile app use are associated with patient portal feature use (i.e., secure messaging, downloading medical records, viewing test results) in a national survey of U.S. adults. METHODS Methods: Using the 2019 and 2020 Health Information National Trends Survey, we examined whether patient portal adopters accessed their portal through a mobile app compared to website-only access. Multivariable logistic regression models were conducted to assess factors associated with mobile app adoption and whether mobile app adoption was associated with patient portal feature use, controlling for digital access (e.g., device ownership), demographic factors, health status, and social determinants of health. RESULTS Results: The final sample consisted of 2,771 respondents, who had reported patient portal use in the last year, where 962 (34.7%) were classified as mobile portal app users and 1,809 (65.3%) were classified as non-users. In multivariable analyses, factors significantly associated with greater odds of mobile portal app use included owning a wearable activity monitor (OR: 1.49; 95% CI: 1.08 - 2.06). In contrast, age over 65 was associated with significantly lower odds of mobile portal app use. Controlling for other factors, mobile portal use was associated with significantly higher odds of secure messaging (OR: 1.58, 95% CI 1.13 - 2.22), using the portal to download medical records (OR: 2.33, 95% CI: 1.59 - 3.43), and viewing test results in the portal (OR: 1.95, 95% CI: 1.11 - 3.43). Other factors, such as lower educational attainment and lack of a usual source of care, were negatively associated with patient portal feature use. CONCLUSIONS Conclusions: Patient portal mobile app access may improve overall portal adoption and use. Optimizing the implementation and delivery of patient portal content via mobile apps may be one modifiable area that health care organizations can use to improve their reach to patients, including those who previously were not able to access the portal due to home internet constraints. CLINICALTRIAL Not applicable

Objective This study aimed to understand the association between primary care physician (PCP) proficiency with the electronic health record (EHR) system and time spent interacting with the EHR. Materials and Methods We examined the use of EHR proficiency tools among PCPs at one large academic health system using EHR-derived measures of clinician EHR proficiency and efficiency. Our main predictors were the use of EHR proficiency tools and our outcomes focused on 4 measures assessing time spent in the EHR: (1) total time spent interacting with the EHR, (2) time spent outside scheduled clinical hours, (3) time spent documenting, and (4) time spent on inbox management. We conducted multivariable quantile regression models with fixed effects for physician-level factors and time in order to identify factors that were independently associated with time spent in the EHR. Results Across 441 primary care physicians, we found mixed associations between certain EHR proficiency behaviors and time spent in the EHR. Across EHR activities studied, QuickActions, SmartPhrases, and documentation length were positively associated with increased time spent in the EHR. Models also showed a greater amount of help from team members in note writing was associated with less time spent in the EHR and documenting. Discussion Examining the prevalence of EHR proficiency behaviors may suggest targeted areas for initial and ongoing EHR training. Although documentation behaviors are key areas for training, team-based models for documentation and inbox management require further study. Conclusions A nuanced association exists between physician EHR proficiency and time spent in the EHR.

► Seizures with postpartum onset ► Posttraumatic stress disorder ► History of depression.

BACKGROUND Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. OBJECTIVE To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. METHODS We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impacts on clinical and health care delivery outcomes. RESULTS Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. CONCLUSIONS Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.

Background and Objectives: Schools of medicine in the United States may overstate the placement of their graduates in primary care. The purpose of this project was to determine the magnitude by which primary care output is overestimated by commonly used metrics and identify a more accurate method for predicting actual primary care output. Methods: We used a retrospective cohort study with a convenience sample of graduates from US medical schools granting the MD degree. We determined the actual practicing specialty of those graduates considered primary care based on the Residency Match Method by using a variety of online sources. Analyses compared the percentage of graduates actually practicing primary care between the Residency Match Method and the Intent to Practice Primary Care Method. Results: The final study population included 17,509 graduates from 20 campuses across 14 university systems widely distributed across the United States and widely varying in published ranking for producing primary care graduates. The commonly used Residency Match Method predicted a 41.2% primary care output rate. The actual primary care output rate was 22.3%. The proposed new method, the Intent to Practice Primary Care Method, predicted a 17.1% primary care output rate, which was closer to the actual primary care rate. Conclusions: A valid, reliable method of predicting primary care output is essential for workforce training and planning. Medical schools, administrators, policy makers, and popular press should adopt this new, more reliable primary care reporting method.

Tetracycline derivatives are antibiotics such as minocycline and doxycycline that have been commonly utilized for inflammatory dermatological conditions such as acne and rosacea. Hyperpigmentation of the skin, nails, thyroid, oral mucosa, teeth, and bones is a known but rare side effect of prolonged tetracycline use. The hyperpigmentation typically takes months to years to develop. There may also be residual changes to the skin after discontinuation of the medication. For this reason, the time tetracyclines are used should be minimized and patients should be monitored for the skin findings. Subungual discoloration carries a broad differential including infectious, inflammatory, metabolic, malignant or systemic diseases. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration. We report on a case of a patient who has been on long-term minocycline use for adult acne management. He was initially on minocycline for six years, but due to minocycline-induced hyperpigmentation of his ears and fingernails, he had switched to doxycycline. One year later, the skin hyperpigmentation of the ears regressed; however, the blue subungual hyperpigmentation of his hands progressively become more prominent without any other significant symptoms.

Objectives Acid suppression therapy (AST), composed of proton pump inhibitors (PPIs), histamine-2 receptor blockers, and antacids, is one of the most common medication groups used in the United States. Long-term AST is concerning, however, because it is linked with an increased risk of community-acquired pneumonia, Clostridium difficile infections, bone fractures, and nutritional deficiencies. The potentially harmful biological and economic consequences associated with the improper use of acid suppression medications presents a great deal of risk to those in underserved communities. We sought to determine the prevalence of AST in an underserved population and the common diagnoses and symptoms associated with therapy. In addition, we studied the frequency of suboptimal usage of PPIs in an indigent care population and the potential factors related to high-risk behaviors. Methods The study was a cross-sectional study using a survey that was distributed to participants during their regularly scheduled visits to a public sector provider of health care for low-income patients. Results Of the 176 participants surveyed, 70 (40%) were using AST. Esophagitis and gastroesophageal reflux disease were the most prevalent in our sample population. PPIs were the most common acid suppression medication used in our population. Of those using PPIs, 85% were never instructed to cease use. Of the 27 patients with PPI prescriptions, 26 used it in a suboptimal manner, and of those without prescriptions, 7 used it in a suboptimal manner. Conclusions ASTs are prevalent in low-income populations, and patients are not being managed appropriately to minimize their risk for complications of AST.

I have found that negativity can flood thoughts and conversations. I have been taught, however, that instead of cursing the darkness, I should light a candle. There are many positives that need to be exposed to help us move forward amid this global pandemic. Hope this brings a positive light to readers during these tough times.

Objectives To assess patients' knowledge of blood pressure (BP) and their comfort level with using technology, including a Bluetooth-enabled BP device and pharmacist telemonitoring. The secondary objective was to discover if pharmacist interventions improved BP readings. Setting The study took place in Pharmacy Plus and the Family Medicine Department at the University of South Florida in Tampa, FL. Practice description The pharmacists within Pharmacy Plus and the Family Medicine Department are part of the interdisciplinary team providing care to patients and seeking to achieve optimal patient outcomes. Pharmacy Plus breaks away from the traditional behind-the-counter model using innovative technology to create a personalized experience for patients. Practice innovation During this pilot study, the patients received a Bluetooth-enabled BP monitor and were asked to obtain their BP readings at least once daily for 6 weeks. The patients' electronic health records automatically captured the BP readings, which were reviewed by the study pharmacists. The patients had an appointment with the pharmacists once weekly via a telehealth platform through which they were counseled on their weekly average BP, BP goals, lifestyle modifications, and proper use of the devices. Evaluation The patients completed a prestudy survey assessing their baseline knowledge of BP, comfort level when using technology, and ease in working with pharmacists. Reliability and satisfaction in using the BP device and telehealth communication with pharmacists were also assessed poststudy. Results Twelve patients enrolled, with 9 completing the study. There was a statistically significant increase in patients' knowledge of BP and an improvement in the recommended lifestyle modifications. In addition, comfort level regarding communication with the pharmacist was statistically significantly improved. The patients responded positively to using the Bluetooth-enabled BP monitor and telehealth for receiving health care services. Conclusion Using Bluetooth-enabled BP monitors that report results in real time into electronic health records, along with pharmacist interventions within a team-based care model, may result in improved BP control and patient outcomes.

Background The purpose is to determine the clinicopathologic factors related to survival and recurrence of primary resected pelvic soft tissue sarcomas (STS). Methods Demographic/clinical variables were recorded. Results Thirty-five pts were identified. Median follow-up was 24.2 months. There were 23 (65.7%) high/intermediate-grade and 12 (34.3%) low-grade tumors included in the final analysis. Eight patients (22.9%) received neoadjuvant therapy. Margins were grossly negative in 27 (77.1%, 17-R0, 10-R1) and grossly positive (R2) in 8 (22.9%). Adjuvant therapy was used in 13 patients (37.1%). The 2- and 3-year RFS was 56.5% and 51.3%, with 14 patients recurring at a median time of 16 months (6-local, 8-distant). All distant recurrences were in high-grade tumors. There were no differences in RFS for margins (R0 vs. R1), neoadjuvant/adjuvant therapy, size (≥10 vs.