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.