Confronting Complacency in the Face of Calamity: Mobilizing for the Home Front War Against Diabetes

by Dean Schillinger, MD


Please see the recent thoughtpiece in the Journal of Endocrinology and Diabetes.

Their Values and Ours

By Alicia Fernandez, MD

A really important Perspective piece was published recently in the NEJM, and I am proud to say that one of our colleagues, Margot Kushel, was senior author. 

Cautionary tale of health disparities in the age of precision medicine

by Kirsten Bibbins-Domingo, PhD, MD, MAS

 

Many of us do not routinely read the genetic literature, but for those of us interested in health disparities, a study in this week’s NEJM and its implications are critically important. 

Science and Public Health on Trial

by Dean Schillinger, MD

Our purpose in writing this piece was to alert the scientific, clinical, and public health communities about the outcome of the landmark decision regarding warning notices on advertisements for sugar sweetened beverages (SSBs) and explain its legal underpinnings. We also wanted to show this as an exemplar of how industry-misappropriated scientific language and scientific methods to hijack science and public health and obfuscate scientific truth and introduce controversy regarding associations between their products (in this case SSBs) and health harms (in this case obesity, diabetes, and tooth decay). Finally, we wanted to highlight the importance of such policy efforts for improving the health of at-risk populations, including children, ethnic minorities, and individuals with limited health literacy.

Click below to read the full JAMA viewpoint:

http://jama.jamanetwork.com/article.aspx?articleID=2542158

Citizen Engagement in Precision Public Health

By Courtney Lyles, PhD and Kirsten Bibbins-Domingo, MD, PhD

At the Precision Public Health Summit held this week at UCSF (sponsored by the Bill and Melinda Gates Foundation and the White House Office of Science, Technology, and Policy: see), we were inspired by many great discussions and ideas.  While the field is still figuring out how to define and conceptualize the core elements of “precision public health,” a broad interpretation that is relatively simple and straightforward includes:  a discipline for using the best methodologies and datasets to tailor interventions (from medical screenings and treatments, to community wellness and prevention programs, to science-informed advocacy and policy) that better meet the needs and priorities of local communities and individuals. 

Digital literacy and what it means for healthcare

by Courtney Lyles, PhD

Should healthcare organizations be taking a major role in increasing the overall digital literacy of their patients? 

In my last post I talked about how most patients in our health system, the SFHN, want to use the internet to manage their health care and health, but don’t have the proficiency they need to be able to do so. I wanted to take that idea one step further. If our patients often can look something up on Google but don’t know how to use an email account (which is often required for signing up to access your electronic health record online) – should we be providing them with basic technology classes?  The answer I keep coming back to is “yes,” and here are a few reasons why:

Connecting the dots: Health information technology expansion and health disparities

By Courtney Lyles, PhD, Dean Schillinger, MD and Urmimala Sarkar, MD, MPH

Check out our newest essay in PLOS Medicine outlining how health technology could be better designed and implemented to meet the needs of diverse patient populations:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852

The future is already here, it just not very evenly distributed.

By Courtney Lyles, PhD

The title of this blog post is a quote by science fiction author William Gibson (who coined the phrase many years ago, by the way).  And I think it is spot on in a number of ways.  It is clear that so many seemingly futuristic technologies have already been developed: from using your smartphone to passively track your activity and mood, to the development of a sensor to test blood glucose through the skin without drawing blood.  But the reality that is so clear to us working in the safety net is that most of these tools are not distributed to those who need it most, and sometimes even only make their way to our settings after they become somewhat obsolete in the tech space.

State of the research on online patient portals

By Courtney Lyles, PhD

My main area of research over the past few years has focused on getting diverse patient groups to engage in accessing their medical record information online, through websites called online patient portals that are linked to electronic health record systems in hospitals/clinics. Portals typically involve allowing patients access to viewing their test results, visit summaries, and sometimes emailing with providers. Because most healthcare systems (with the exception of places like Kaiser) have only just recently created these portal websites as a part of the Meaningful Use certification process, there is a huge need for research studying their use and effectiveness. 

This post includes my thoughts about what we know and don’t know from the research to date, especially in light of two recent systematic reviews on 1) the effect of portals on outcomes  and 2) how patients with chronic disease and their providers view using an online portal.  (Apologies in advance that it is a very research-specific post!)

Nutrition and the Tax Code

By Hilary Seligman, MD & Marydale Debor, JD

On December 31, 2014, the Internal Revenue Service issued the long-awaited final ruling implementing Section 501 (r) of the Patient Protection and Affordable Care Act of 2010 (ACA). This section of the Internal Revenue Code deals with the conditions hospitals must meet in order to retain their nonprofit health status.  In an exciting development, this new code directs attention to the elimination of “root causes of disease,” especially among medically underserved, minority, and vulnerable populations.

Prostate Health Support Group for African American Men

By Nynikka R. A. Palmer, DrPH, MPH

Prostate cancer among African American men is one of the most intractable cancer disparities. African American men bear an excess burden of prostate cancer across all stages of management, including presentation, diagnosis, treatment, survival, and quality of life.

On point: Broadening pain management options with acupuncture

By Maria T. Chao, DrPH, MPA

As I think about the year ahead, one change that I’m really excited about is the prospect of acupuncture for patients at San Francisco General Hospital (SFGH). In the US, pain management is the leading reason that patients seek care from acupuncturists. Acupuncture utilization has increased by 50% over the past decade, but is not commonly used by non-Asian minority populations and those with limited income. Barriers to use include high out-of-pocket costs and limited access to services.

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.  

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.

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.

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.