How Can Non-English Speaking Patients 'Meaningfully Use' Patient Portals?

By Neda Ratanawongsa, MD, MPH

 “For Spanish press 1, for Cantonese press 2, for Mandarin press 3, for Taishanese press 4, for Vietnamese press 5 …” 

My exam room phone doesn’t have enough buttons for all the languages I need to serve my patients.   In a typical clinic session, I use an interpreter for half of my clinic visits and phone calls to patients.   It is this amazing linguistic and cultural diversity that drew me to be a primary care provider at the General Medicine Clinic.

The Center of the Storm: Homelessness and Health

by Margot Kushel, MD

As the Bay Area is deluged with the biggest rainstorm in a decade, most of the region’s schools were cancelled and many workplaces allowed for flexibility, so that people could stay safe and dry in their homes. Churches and homeless service agencies opened their doors to provide temporary shelter for members of our community who are homeless. But the storm of the decade was another blow to those who have already been struck by the perfect storm of rising housing prices, loss of support for affordable housing, and lack of availability of living wage jobs for those without specialized skills.  

Ebola and Immigrant Fears

by Alicia Fernandez, MD

Here is a thought experiment:  Imagine that Thomas Duncan, the unfortunate Texas Ebola patient, had been undocumented in addition to uninsured when he presented to a private hospital in Dallas.

Be sure to consider the impact on his decision making in seeking health care.  Now, imagine the media response.  Imagine the impact on policy makers.

Hold those thoughts.

Insights from mainstream media

By Robert Brody, MD

People Magazine is an unusual source for a blog such as this - we are more likely to comment on articles in more academic journals.  But I believe the following from People.com about a young woman, a UCSF patient, who had to leave California for another state to get the care she wanted, and especially the video in which she tells the story herself, is a powerful reminder about work that still needs to be done to make patient-centered end of life care in the form of death with dignity legal and accessible in this state.

http://www.people.com/article/Brittany-Maynard-death-with-dignity-compassion-choices

Leaving No One Behind: The International Day of Older Persons

By Anna Chodos, MD, MPH

I am wondering if Mr. Rose knows that today is the UN’s 24^th celebration of the International Day of Older Persons (IDOP). The theme is “Leaving No One Behind: Promoting a Society for All.”

He does not talk to many people in a given day.  He lives on his own in a single-room occupancy (a bed and a small bathroom) in one of the many housing units for low-income adults in San Francisco.  At 75, he is one of its oldest residents.  When I visited him there for a home medical visit, he showed me his small fridge full of microwave pizzas and orange soda, which is what he can buy from the drug store near him.  He has difficulty walking, so he gets what he can from the nearest place that sells food.  He is fiercely independent so has refused help from a city in-home support worker that could help him with shopping.  And he said he did not have any friends or family who could help out.  But, he said, he did not feel lonely.

From randomized trials to the real world

By Urmimala Sarkar, MD, MPH

Often, at scientific conferences, the most important learning happens in the question and answer period. I spoke at the American Diabetes Association conference earlier this year, presenting results of an observational study we did on medication adherence and diabetes. We found that if people starting using the online patient portal (sometimes called the personal health record), to order their medication refills, they were more likely to take their medication regularly. Dr. Katherine Newton of Group Health Research Institute spoke before me, describing a randomized study showing that a clinical pharmacist-led blood pressure management program did not lower blood pressure any more than usual care by an outpatient provider.

Challenges and opportunities for technology use in safety net settings

by Courtney Lyles, PhD

As a health services researcher, I have been interested in ways to engage individuals with their health or healthcare management – particularly ways that fit into their everyday lives outside of the doctor’s office or hospital.  That’s why the buzz about health information technology seems so promising to me: the potential to provide practical and customizable information/feedback at the right moment.  In addition, the financial incentives are starting to align to promote health technologies.  With the rollout of federal healthcare reform in the past few years, it has become clear that technology will be a fundamental, not tangential, part of healthcare in the near future. 

Yet when I think about patients receiving care in safety net systems like SFGH, I see both opportunities and challenges during this transition to technology-enhanced healthcare.

The war at home against diabetes disparities

by Dean Schillinger, MD

During the recent decade-long Iraq and Afghanistan wars, 1,500 US soldiers lost a limb in combat. This tragedy was widely covered in the media and helped mobilize efforts to reduce exposure to threats in the Near East theatre, expedite troop withdrawals, and improve rehabilitation services for veterans. In that same period of time, over 1.5 million US residents suffered amputations as a result of Type 2 diabetes (DM2). While the number of amputations occurring on the home front as a result of DM2 exceeds that of the overseas front by a factor of 1,000, there is little public awareness of this war being waged at home. While clinicians, patients and families fight thousands of life- and limb-threatening battles on a daily basis, there is scant evidence that the US clinical and scientific community has truly mobilized for a public health war against DM2.

Unnecessary Testing: One Doctor's Experience

by Soraya Azari, MD

I am an extremely fortunate person - not only am I awaiting the arrival of my first child, but I've had a relatively uncomplicated pregnancy.  I say "relatively" because there has been one unpleasant aspect: having to do extra, unnecessary testing.  To explain, a bit of background: during pregnancy it is common to measure a fundal height, which represents the distance from the pubic bone to the top of where the uterus is felt.  This numerical height should roughly equal the number of weeks that have elapsed in the pregnancy.  For example, at 20 weeks gestation, the height from the pubic bone to the top of the uterus should be 20 centimeters.   

An Interview with Urmimala Sarkar, MD, MPH

Associate Professor Urmimala Sarkar was recently interviewed by Dr. Robert Wachter for WebM&M, an online journal and forum about patient safety and health care quality.

Below is the text from their discussion, reprinted with permission of Agency for Healthcare Research and Quality (AHRQ) WebM&M:
"In conversation with Urmimala Sarkar, MD, MPH [interview]." AHRQ WebM&M [serial online]. July/August 2014. Available at: http://webmm.ahrq.gov/perspective.aspx?perspectiveID=161.

In case you missed it…. Why we fill out prior authorization forms for colchicine….

by Kirsten Bibbins-Domingo, MD, PhD

I recently finished several weeks of outpatient attending and spent a good bit of time filling out prior authorization forms for medications not covered under the formulary of our insurers.  Many of these “prior auths” were for colchicine – or more correctly for the new brand name drug Colcrys.

Primary Care Updates from SGIM!

As a primary care doctor, I can say it takes a lot of time to stay updated on the world of internal medicine.  Fortunately, many annual conferences feature " update talks," which showcase the most recent and significant studies in internal medicine.  For those of you that may have missed the Society for General Internal Medicine conference (SGIM), here are some of my key take-home pearly from various update talks.  Of course, I encourage providers to look up the original source material for additional information.   

Innovations in Safety Net Primary Care - Specialty Care Collaboration

 

by Neda Ratanawongsa, MD

When my 4-year old asked me why I was staying at work last Tuesday evening, I told him, “To learn about how doctors can work together to take care of people.” 

I’m a primary care provider at the General Medicine Clinic at SFGH. Although I wish I could provide my patients with all of their care within my clinic’s walls, I rely on colleagues in medical and surgical specialties to help care for my patients’ concerns around diabetes, heart disease, arthritis, broken bones, and eyes.  When my patients and I need that help, I want the same quick access to specialists’ advice that my in-laws receive in their health networks. However, safety net health systems often experience long wait times for visits because there is such a high need for specialty clinics with limited appointment slots.  The referral system can also be confusing to patients because of communication barriers; over half of my patients speak a language other than English as their first language and have limited health literacy.  

Denti-Cal Benefits Return to California - Hooray!!

A friend who is a social worker recently informed me that Medi-Cal is reinstating coverage for dental services in the state of California. As a primary care doctor in an urban safety net hospital, all I can say is "HOORAY!!"

Preventing Death from Opioid Overdose: Important Facts About Naloxone 

Most people are now aware of the burgeoning epidemic of unintentional overdose due to prescription opioids.  This has been well-publicized by the national news media (NY Times section here; Wall Street Journal feature here), and well-known to the public due to several prominent celebrity deaths linked to prescription opioids (for example, Heath Ledger, Michael Jackson, and Philip Seymour Hoffman who reportedly received prescription opioids before transitioning to heroin).  Prescription opioids or opioid pain relievers include many familiar medications that are prescribed for pain including oxycodone (Oxycontin), morphine, hydromorphone (Dilaudid), and hydrocodone (Norco, Vicodin).   

Introducing the Next Generation of Leaders in Primary Care for the Underserved!

Friday, March 21st was an exciting day because we learned who our next class of primary care residents will be!  Our program -SFPC- is the San Francisco General Primary Care Track, which is part of the Univ of California, San Francisco Internal Medicine Residency.  We recruit medical students that are interested in primary care for underserved populations.

Without further ado... our new 8 residents!

Welcome to Mission: Health Equity!

Who We Are: Faculty from the Division of General Internal Medicine (DGIM) at the University of California, San Francisco (UCSF) who are based at San Francisco General Hospital & Trauma Center (SFGH), the city's public hospital.
For more information about the Department of General Internal Medicine, click here, and SFGH, here.

What We Care About: We are interested in issues that affect vulnerable populations.  The population we serve is "vulnerable" because our patients struggle with poverty, inadequate housing, food insecurity, lack of health coverage, trauma and violence, and poor health literacy.  These forces often result in striking health disparities, or unequal health outcomes.  Our mission is to use research, advocacy, education, and outstanding clinical care to achieve equitable health outcomes.  Additionally, we seek to identify and harness individual and community resilience factors that strengthen communities.
We strongly value primary care and multidisciplinary, team-based care for our patients, and are excited by the current climate of primary care transformation.  We closely collaborate with specialty colleagues to provide comprehensive care to our patients.

What We Will Post: 

• Commentary on medical, public health, and social science research related to vulnerable populations 
• Opinions on health policy related to underserved groups
• Updates on innovations in medical education oficiency, and poor health literacy.  These forces often result in striking health disparities, or unequal health outcomes.  Our mission is to use research, advocacy, education, and outstanding clinical care to achieve equitable health outcomes.  Additionally, we seek to identify and harness individual and community resilience factors that strengthen communities.