RESUMEN
This JAMA Forum discusses 3 key steps for restructuring the acquisition of health data to enable more timely access to the data and more timely public health action, similar to the successes seen with the COVID-19 pandemic response in the US.
Asunto(s)
Economía , Humanos , Estados UnidosRESUMEN
Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.
Asunto(s)
Accesibilidad a los Servicios de Salud , Concesión de Licencias , Trastornos Relacionados con Opioides , Humanos , Estados Unidos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Tratamiento de Sustitución de Opiáceos , Política de Salud , Entrevistas como Asunto , Gobierno Estatal , Investigación CualitativaRESUMEN
This JAMA Forum discusses the promise and pitfalls of using large language models and artificial intelligence (AI) in the diagnosis of patients.
Asunto(s)
Inteligencia Artificial , PolíticasRESUMEN
INTRODUCTION: Vaccine pharmacovigilance is an essential component of vaccine safety programs. Vaccine pharmacovigilance refers to detecting uncommon adverse events following immunization (AEFI), determining whether they are due to the vaccine or are only a coincidence, and, for those AEFI considered related to vaccination, characterizing them further. When AEFI are due to vaccination, it is important to characterize the attributable risk and ascertain the biological mechanism causing the adverse reaction to inform efforts to prevent or mitigate the risk. A robust post-authorization safety system is necessary for vaccine decision-making, clinical recommendations, vaccine compensation, and vaccine communication and confidence. AREAS COVERED: This paper describes the key characteristics of vaccine pharmacovigilance programs, reviews US vaccine pharmacovigilance for routine vaccination programs, COVID-19, and H1N1, and makes recommendations for improving future vaccine safety systems. EXPERT OPINION: The key characteristics of vaccine pharmacovigilance programs include passive surveillance, active surveillance, clinical investigation and special studies, and causality assessment. Recent examples illustrate the strengths of US pharmacovigilance systems, including systems for passive and active surveillance, as well as areas for improvement, including study of pathogenesis, consistent funding, and leadership. We make recommendations that would, if implemented, further strengthen the vaccine safety system for future routine and pandemic immunizations.
Asunto(s)
COVID-19 , Subtipo H1N1 del Virus de la Influenza A , Vacunas , Humanos , Estados Unidos/epidemiología , Farmacovigilancia , Sistemas de Registro de Reacción Adversa a Medicamentos , COVID-19/prevención & control , Vacunación/efectos adversos , Inmunización , Vacunas/efectos adversosRESUMEN
This JAMA Forum discusses declining time and space for appreciation of what has been accomplished in clinical medicine and health policy.
RESUMEN
This JAMA Forum discusses ways the opioid settlement funds could be used to save lives today and in the future, aspects of the decisions surrounding funding, and the importance of measuring progress.
Asunto(s)
Analgésicos Opioides , Industria del Tabaco , Analgésicos Opioides/efectos adversosRESUMEN
This JAMA Forum discusses the ways that US community pharmacies can build on the flexibility during the COVID-19 response to care for patients with HIV, hypertension, and opioid use disorder and improve access to reproductive health care.
Asunto(s)
COVID-19 , Farmacias , Humanos , Salud PúblicaRESUMEN
In the days since Texas federal judge Matthew J. Kacsmaryk invalidated the approval by the US Food and Drug Administration (FDA) of mifepristone, a medication used to terminate pregnancy, a shock wave of concern has swept through many people, organizations, and companies that work closely with the agency. The strong opposition reflects the high stakes not only for pregnant persons and for the FDA, but also for the scientific process of drug development and public access to safe and effective medications. Twists and turns in the case are already happening. A federal appeals court stayed the full suspension of mifepristone, but permitted multiple restrictions on its availability. Then the Supreme Court, which recently overturned the constitutional right to abortion, kept the status quo in place for a few days while considering the government's appeal. The results of the legal battle will be enormously consequential for reproductive health care-and far beyond, for innovation, science, and health.
Asunto(s)
Abortivos Esteroideos , Aborto Inducido , Aprobación de Drogas , Mifepristona , Femenino , Humanos , Embarazo , Aborto Inducido/legislación & jurisprudencia , Texas , Estados UnidosRESUMEN
Policy Points The critical task of preparedness is inseparable from the regular work of advancing population health and health equity.
Asunto(s)
COVID-19 , Defensa Civil , Humanos , Salud PúblicaRESUMEN
This JAMA Forum discusses innovative efforts in various states to improve public health by providing more funding and programs with input and support for reform from local residents, businesses, and community organizations.
Asunto(s)
Salud PúblicaRESUMEN
Early detection and ongoing monitoring of infectious diseases depends on diagnostic testing. The US has a large, diverse system of public, academic, and private laboratories that develop new diagnostic tests; perform routine testing; and conduct specialized reference testing, such as genomic sequencing. These laboratories operate under a complex mix of laws and regulations at the federal, state, and local levels. The COVID-19 pandemic exposed major weaknesses in the nation's laboratory system, some of which were seen again during the global mpox outbreak in 2022. In this article we review how the US laboratory system has been designed to detect and monitor emerging infections, describe what gaps were revealed during COVID-19, and propose specific steps that policy makers can take both to strengthen the current system and to prepare the US for the next pandemic.
Asunto(s)
Enfermedades Transmisibles Emergentes , Pandemias , Humanos , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , COVID-19 , Laboratorios , Pandemias/prevención & control , PolíticasRESUMEN
This JAMA Forum discusses the $1.7 trillion omnibus bill passed in December 2022 and the areas of pandemic preparedness and the public health system it addresses and misses.
Asunto(s)
Salud Pública , PolíticaRESUMEN
Physicians are trending towards practice consolidation nationally; however, changes in dermatology practice size remain to be assessed. The objective of this study was to analyze trends in dermatology practice size from 2012 to 2020 using a large-scale Medicare physician database. We performed a retrospective cross-sectional analysis using 2012 and 2020 data obtained from the Physician Compare Database. Responses from dermatologists were analyzed for trends in practice size, with a sub-analysis to examine differences among different regions, gender, and years of experience. The proportion of dermatologists in solo practice decreased from 26.1% in 2012 to 15.6% in 2020 (p < 0.001). Dermatologists were 40% less likely to be practicing in solo practice and 36% more likely to be in a practice with 10 or more members in 2020 (p < 0.001). These findings were consistent among all regions and genders examined. Additionally, in 2020, dermatologists with 30 or more years in practice were 7.5 times more likely to be in solo practice compared to dermatologists with 0-9 years in practice (p < 0.001). There is a trend of dermatologists working for larger practices, which is consistent with a larger nationwide trend of expanding physician practices. This shift in practice settings should be closely monitored to analyze the effect on healthcare efficiency, cost, and delivery.
Asunto(s)
Dermatología , Médicos , Anciano , Humanos , Masculino , Femenino , Estados Unidos , Estudios Transversales , Medicare , Estudios RetrospectivosRESUMEN
This JAMA Forum discusses the Biden administration's recently released National Biodefense Strategy and recommends that the implementation of this national strategy be accompanied by recommendations from the Commonwealth Fund Commission.