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Background: The SARS CoV-2 virus (COVID-19) and associated lockdown have impacted healthcare practice in the United States. Technology has played an emerging role in providing access to care while also reducing iatrogenic infection amongst patients and providers. This rapid adoption of technology has resulted in unintended consequences. Since COVID-19 lockdown, providers have noticed an increase in the volume of patient messages to request various clinical services from their primary care providers, which has placed further stress on an already overwhelmed healthcare system. However, quantitative information about the volume of electronic messages as a result of the COVID-19 lockdown is lacking. Methods: In one large academic healthcare system, all incoming inbox items (telephone calls, refill requests, and electronic messages) received by providers from patients were retrospectively analyzed between March 1, 2019 and March 31, 2021. Inbox item rates were evaluated as a ratio of items per patient encounters (in person or telemedicine) each week. Trends in inbox rates were assessed during the 12 months before lockdown in March 2020 and 12 months post-lockdown. Logistic regression was utilized to examine effects of post-COVID-19 lockdown on inbox message volume as compared to the pre-lockdown period. Results: There was an increase in total new inbox volume, from 2.07 before COVID lockdown and 2.87 items post-lockdown, although this was not statistically significant. However, the rate of patient-initiated messaging increased dramatically after lockdown and stabilized at a rate higher than pre-COVID-19 pandemic rates (RR 1.27, p-value < 0.001). Prescription refill requests and telephone calls spiked quickly and then returned to pre-pandemic levels. Conclusion: On average, if a provider saw 20 patients per day before COVID-19, they would expect to receive 40 new inbox items per day. Post-COVID they would expect to receive 57 new inbox items per day, with the majority being electronic messages. These messages require additional time that adds to the workload of administrators, staff and clinical providers typically devoted to healthcare responsibilities. Interventions are needed to reduce the amount of time that healthcare providers and staff spend on increasing rates of electronic patient requests., Presenters Jacqueline Hirth, James Langabeer, PhD, EdD, Roger Zoorob, MD, MPH, Michael Hansen, MD, MPH, MS, MPH, [...]

Substance misuse and substance use disorder continue to be major causes of morbidity and mortality, and family physicians are well positioned to provide evidence-based prevention and management for these conditions. Of people 12 years and older, 13% reported using a nonprescribed controlled substance in the past month, and 24% had at least one episode of binge drinking of alcohol, defined as five or more drinks for men and four or more drinks for women on one occasion. Benzodiazepines are used by 12% of the U.S. population. Clinicians should incorporate standardized screening and brief intervention for use of alcohol and other substances into routine care of adult patients, as well as referral to specialized treatment services when indicated. Use of nonstigmatizing, person-first language has been shown to positively affect care for patients with substance use disorders. Alcohol screening and brief intervention have been shown to reduce excessive drinking by 40% in patients at 6 months postintervention. Office-based treatment of alcohol use disorder with medications approved by the U.S. Food and Drug Administration, such as acamprosate and naltrexone, remains underutilized, presenting another opportunity for family physicians to positively affect the health of their patients and communities. With elimination of the X-waiver, any clinician with Schedule III prescriptive authority can treat opioid use disorder with buprenorphine in their office-based practice. Opioid overdose education and naloxone coprescribing are other tools family physicians can employ to combat the overdose crisis. (Am Fam Physician. 2024; 109(5):430–440. Copyright © 2024 American Academy of Family Physicians.) Substance misuse and substance use disorder continue to be major causes of morbidity and mortality, and family physicians are well positioned to provide evidence-based prevention and management for these conditions. Of people 12 years and older, 13% reported using a nonprescribed controlled substance in the past month, and 24% had at least one episode of binge drinking of alcohol, defined as five or more drinks for men and four or more drinks for women on one occasion. Benzodiazepines are used by 12% of the U.S. population. Clinicians should incorporate standardized screening and brief intervention for use of alcohol and other substances into routine care of adult patients, as well as referral to specialized treatment services when indicated. Use of nonstigmatizing, person-first language has been shown to positively affect care for patients with substance use disorders. Alcohol screening and brief intervention have been shown to reduce excessive drinking by 40% in patients at 6 months postintervention. Office-based treatment of alcohol use disorder with medications approved by the U.S. Food and Drug Administration, such as acamprosate and naltrexone, remains underutilized, presenting another opportunity for family physicians to positively affect the health of their patients and communities. With elimination of the X-waiver, any clinician with Schedule III prescriptive authority can treat opioid use disorder with buprenorphine in their office-based practice. Opioid overdose education and naloxone coprescribing are other tools family physicians can employ to combat the overdose crisis. [ABSTRACT FROM AUTHOR]

Background Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined. Objectives We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales. Methods We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020. Results Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with Enterobacterales (n  = 199) were mostly female (93.5%) with a mean age of 48.5 years. E. coli was the predominant uropathogen isolated (n  = 187/339; 55%) and had elevated trimethoprim/sulfamethoxazole (43.6%) and ciprofloxacin (29.5%) resistance, low nitrofurantoin (1.8%) resistance, and no fosfomycin resistance. Among E. coli , 10.6% were ESBL positive and 24.9% had MDR. Birth outside the U.S.A. prior (2 year) trimethoprim/sulfamethoxazole resistance, and diabetes mellitus were associated with trimethoprim/sulfamethoxazole resistance. Prior (60 day) fluoroquinolone use, prior ciprofloxacin resistance and both diabetes mellitus and hypertension were strongly associated with ciprofloxacin resistance. Prior fluoroquinolone use and a history of resistance to any studied antibiotic were associated with MDR, while pregnancy was protective. Conclusions We found elevated resistance to UTI-relevant antimicrobials and novel factors associated with resistance; these data can be incorporated into clinical decision tools to improve organism and drug concordance. [ABSTRACT FROM AUTHOR]

The publication of this supplement is funded by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $603,907, with 100 percent funding by the CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, or an endorsement by, the CDC/HHS or the U.S. government. This supplement is brought to you by the AAFP. Journal editors were not involved in the development of this content. [ABSTRACT FROM AUTHOR]

Objectives (a) Update previous descriptions of trends in ASSB; (b) determine if factors previously associated with ASSB are replicated by updated data; and (c) generate new hypotheses about the occurrence of ASSB and racial inequalities in ASSB mortality. Methods National Center for Health Statistics files (International Classification of Diseases, Tenth Edition) Code W75 to describe race-ethnicity-specific ASSB occurrence. Results (a) ASSB mortality continues to increase significantly; for 1999-2016, 4.4-fold for NHB girls (45.8 per 100,000 in 2016), 3.5-fold for NHB boys (53.8), 2.7-fold for NHW girls (15.8) and 4.0-fold for NHW boys (25.9); (b) F actors previously associated with ASSB (unmarried mothers and mothers with low educational attainment, low infant birth weight, low gestational age, lack of prenatal care, male infant, multiple birth, high birth order) continue to be associated with both overall ASSB and inequalities adversely affecting NHB; (c) (1) geographic differences and similarities in ASSB occurrence support hypotheses related to positive deviance; (2) lower ASSB mortality for births attended by midwives as contrasted to physicians generate hypotheses related to both medical infrastructure and maternal engagement; (3) high rates of ASSB among infants born to teenage mothers generate hypotheses related to the possibility that poor maternal health may be a barrier to ASSB prevention based on education, culture and tradition. Conclusions for Practice These descriptive data may generate new hypotheses and targets for interventions for reducing both ASSB mortality and racial inequalities. Analytic epidemiologic studies designed a priori to do so are required to address these hypotheses., Author(s): Joanna Drowos [sup.1] , Aaron Fils [sup.2] , Maria C. Mejia de Grubb [sup.3] , Jason L. Salemi [sup.3] , Roger J. Zoorob [sup.3] , Charles H. Hennekens [sup.1] [...]

Purpose: Recurrent cystitis guidelines recommend relying on a local antibiogram or prior urine culture to guide empirical prescribing, yet little data exist to quantify the predictive value of a prior culture. We constructed a urinary antibiogram and evaluated test metrics (sensitivity, specificity, and Bayes' positive and negative predictive values) of a prior gram-negative organism on predicting subsequent resistance or susceptibility among patients with uncomplicated, recurrent cystitis. Materials and Methods: We performed a retrospective database study of adults with recurrent, uncomplicated cystitis (cystitis occurring 2 times in 6 months or 3 times in 12 months) from urology or primary care clinics between November 1, 2016, and December 31, 2018. We excluded pregnant females, patients with complicated cystitis, or pyelonephritis. Test metrics were calculated between sequential, paired cultures using standard formulas. Results: We included 597 visits from 232 unique patients wherein 310 (51.2%) visits had a urine culture and 165 had gram-negative uropathogens isolated. Patients with gram-negative uropathogens were mostly females (97%), with a median age of 58.5 years. Our antibiogram found 38.0%, 27.9%, and 5.5% of Escherichia coli isolates had resistance to trimethoprim-sulfamethoxazole, ciprofloxacin, and nitrofurantoin, respectively. Prior cultures (within 2 years) had good predictive value for detecting future susceptibility to first-line agents nitrofurantoin (0.85) and trimethoprim-sulfamethoxazole (0.78) and excellent predictive values (≥0.90) for cefepime, ceftriaxone, cefuroxime, ciprofloxacin, levofloxacin, gentamicin, tobramycin, piperacillin-tazobactam, and imipenem. Conclusions: Considerable antibiotic resistance was detected among E coli isolates in patients with recurrent, uncomplicated cystitis. Using a prior culture as a guide can enhance the probability of selecting an effective empirical agent. [ABSTRACT FROM AUTHOR]