On resource allocation in health care: The case of concierge medicine.

Resource allocation generally involves a tension between efficiency and equity, particularly in health care. The growth in exclusive physician arrangements using non-linear prices is leading to consumer segmentation with theoretically ambiguous welfare implications. We study concierge medicine, in which physicians only provide care to patients paying a retainer fee. We find limited evidence of selection based on health and stronger evidence of selection based on income. Using a matching strategy that leverages the staggered adoption of concierge medicine, we find large spending increases and no average mortality effects for patients impacted by the switch to concierge medicine.

Organoides de cérebro como modelos de doenças de Alzheimer e Parkinson: uma revisão narrativa sobre as perspectivas para medicina regenerativa e personalizada / Brain organoids as models of Alzheimer's and Parkinson's diseases: a narrative review on perspectives for regenerative and personalized medicine

Há muitos anos a cultura celular bidimensional (2D) é utilizada como modelo de estudo de doenças, possuindo grande importância na medicina regenerativa, apesar de ainda conter limitações significativas. A fim de contornar essas limitações, a cultura celular tridimensional (3D) propõe uma organização mais complexa e sustentável que pode ser produzida a partir de células-tronco adultas (ASCs), células-tronco embrionárias (ESCs) ou células-tronco pluripotentes induzidas (iPSCs). A cultura 3D possibilitou o cultivo de células em um ambiente mais próximo do fisiológico, levando à formação de distintos tecidos órgãos-específicos. Em outras palavras, a cultura de células 3D possibilita a criação de estruturas orgânicas muito semelhantes aos órgãos de um ser humano, tanto estruturalmente, quanto funcionalmente. Desse modo, tem-se o que é chamado de organoides. O uso dos organoides tem crescido exponencialmente em ambientes in vitro, permitindo a análise e observação dos diversos fenômenos fisiológicos existentes. Como exemplo, pode-se citar os organoides cerebrais ("mini-brains") reproduzidos in vitro buscando delinear as peculiaridades e complexidades do cérebro humano, com o objetivo de compreender algumas disfunções neurológicas que acometem esse sistema, como as duas principais doenças neurodegenerativas: Doenças de Alzheimer e Parkinson. Portanto, os organoides cerebrais podem permitir notável avanço da medicina regenerativa aplicada a doenças neurodegenerativas, já que esses "mini-brains" podem ser produzidos a partir de células do próprio paciente. Isso permitirá intervenções personalizadas, como testagens farmacológicas, a fim de definir qual seria o melhor tratamento medicamentoso. Consequentemente, essa tecnologia pode permitir terapias mais eficientes e individualizadas - o que é fundamental para a Medicina Personalizada (AU).

For many years, two-dimensional (2D) cell culture has been used as a model to study diseases, having great importance in regenerative medicine, despite still having significant limitations. In order to circumvent these limitations, three-dimensional (3D) cell culture proposes a more complex and sustainable organization that can be produced from adult stem cells (ASCs), embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs). The 3D culture enabled the cultivation of cells in an environment closer to the physiological one, leading to the formation of different organ-specific tissues. In other words, 3D cell culture makes it possible to create organic structures very similar to the organs of a human being, both structurally and functionally. In this way, we have what are called organoids. The use of organoids has grown exponentially in in vitro environments, allowing the analysis and observation of the various existing physiological phenomena. As an example, we can mention the brain organoids ("mini-brains") reproduced in vitro, seeking to delineate the peculiarities and complexities of the human brain, in order to understand some neurological dysfunctions that affect this system, such as the two main neurodegenerative diseases: Alzheimer's and Parkinson's Diseases. Therefore, brain organoids may allow a remarkable advance in regenerative medicine applied to neurodegenerative diseases, as these "mini-brains" can be produced from the patient's own cells. This will allow for personalized interventions, such as drug testing, in order to define what would be the best drug treatment. Consequently, this technology can enable more efficient and individualized therapies - which is fundamental for Personalized Medicine (AU).

Strategies for Patient-Centered Communication in the Digital Age.

Recently, the major professional societies in Radiology have embarked upon a campaign to increase the patient-centeredness of Radiology. At the foundation of this initiative is direct communication between radiologist and patient, an area that has long been a deficiency for the field. Historically, there have been a number of barriers to effective radiologist-patient communication including logistical challenges, a negative impact on efficiency, and uncertainty of the role of the radiologist in discussing results with patients. The ubiquity of the internet and the wealth of applications that allow the safe transmission of robust information provide a number of opportunities for the radiologist. The purpose of this article is to review key web-based platforms that can improve communication, highlight unique initiatives being employed by thought leaders, and emphasize why radiologist-patient communication is paramount to the patient centered imaging experience.

La multiparidad en mujeres jóvenes y las acciones sanitarias locales vinculadas a la salud sexual y reproductiva en Cerrillos, Salta / Multiparity in young women and local health actions related to sexual and reproductive health in Cerrillos, Salta

INTRODUCCIÓN Las percepciones y prácticas en relación con la maternidad no siempre han sido suficientemente investigadas entre los equipos de salud y las mujeres jóvenes. OBJETIVOS Analizar las percepciones y prácticas sobre la maternidad en jóvenes multíparas, tanto de los miembros del equipo de salud del Hospital Santa Teresita, Cerrillos (Salta) como de las jóvenes de esa localidad. MÉTODOS Se aplicó la teoría fundamentada. RESULTADOS Existe un funcionamiento aislado. Los talleres se llevan a cabo a demanda. Hay desconocimiento o falta de utilización por parte del equipo de salud de consultorio. Se observa una posición crítica frente a la salud sexual y reproductiva (SSR) de la comunidad, sobre todo de los jóvenes. No surge como problemática la morbimortalidad. La mayoría de las mujeres desconoce la Ley de SSR. En general, el nivel de conocimiento de los métodos anticonceptivos (MAC) es bueno, gracias a la labor que se realiza en las escuelas; el segundo espacio en importancia corresponde a las amigas. Hay temor a los efectos secundarios de los MAC y una posición pasiva frente al profesional. Está además la concepción del deber de la mujer de dar hijos al hombre, así como la influencia del cónyuge y de la familia sobre sus decisiones. El inicio de las relaciones sexuales es en promedio a los 15 años, cuando se desconocen los MAC. El hombre aporta el dinero a partir de su trabajo y decide su uso; las mujeres manejan las asignaciones universales por hijo (AUH). DISCUSIÓN No existe un trabajo intersectorial ni interdisciplinario. La multiparidad conspira contra la realización personal fuera del ámbito doméstico, disminuye las expectativas de las mujeres y las reduce a ver a sus hijos felices. No hay acceso real a la Consejería en Salud Sexual y Reproductiva. Existe desigualdad de género y violación de los derechos de SSR en el hospital. Las representaciones sociales y las actitudes del equipo de salud afectan las percepciones de las mujeres y condicionan el acceso a las prácticas de SSR.

Defining the Place of Direct Primary Care in a Value-Based Care System.

INTRODUCTION: Direct primary care, one of several retainer-based practice models, is a niche practice type that offers an alternative to the traditional fee-for-service and insurance-based practices most prevalent in US health care. In Wisconsin, the prevalence of direct primary care practices is higher than in most other states. The market for direct primary care practice may be growing along with the industry shift to value-based care and an increase in physicians' desire to reduce the increasing administrative work and regulations that detract from patient care and increase burnout. Many physicians are seeking ways to reduce these burdens so they have more time with patients. Some are transitioning their practice to a retainer-based model, such as direct primary care, in which they collect a retainer from patients in exchange for more time, freer communication, and less paperwork. OBJECTIVE: The objective of this review is to provide information about the direct primary care practice model, possible drivers to this model of care, and its advantages and drawbacks for physicians and patients. This discussion also aims to evaluate the care model's place in the shift to value-based care, and key positions and policy from leading organizations. METHODS: A literature review was conducted to collect and analyze current evidence about the prevalence of retainer-based practices, the average fees associated with such models, the contributors to physician burnout that may lead to a transition to the direct primary care model, and the relevant ethical and policy considerations associated with direct primary care. DISCUSSION: Eighty-two percent of Wisconsin physicians report some level of burnout. Estimates demonstrate an increase in the number of direct primary care practices, and that Wisconsin is among the top 3 states with the highest number of direct primary care practices. The literature suggests that since the early stages of modern retainer-based models, patient fees have decreased and the patient base for these practices has expanded. The practice model is relatively rare, although there are indicators that its presence has increased in recent years. CONCLUSIONS: Physicians seeking strategies to reduce administrative burden, spend more time with patients, or simply streamline their practice may experience benefits in transitioning to a retainer practice such as direct primary care. There are foundational concepts about direct primary care, including advantages, drawbacks, and ethical considerations, to heed when transitioning to this model. There is a need for further research to quantify key data about direct primary care and its effects on patient outcomes and physician burnout and satisfaction.

Concierge Pharmacy: A Potential Arena for Senior Care Pharmacists.

Concierge pharmacy is an emerging area of practice that appears to be well suited for pharmacists who prefer flexibility in geriatric practice, a system in which patients pay a fee for personalized care and access to their pharmacists. Older adults are a natural population for concierge pharmacists because of their individual increasing medical needs. At this time, concierge pharmacists tend to provide care to individuals who can afford to pay out-of-pocket or who are auxiliary personnel in medical offices, which provides payment. Other reimbursement models exist, and each concierge pharmacist's practice will be unique. The largest barrier to unfettered pharmacy practice is the inability to practice autonomously. Pharmacists can look to nurse practitioners' moderately successful march toward nationwide independent practice as a model for their own bid to practice independently.

Hábito de fumar. Cómo abandonar este mal hábito a través de consejería por el médico de familia / Habit of smoking. How to give up this bad habit through counselling by the family doctor

Se exponen algunos consejos para facilitarle a los médicos de familia el abordaje de las personas dependientes del tabaco que acudan a su consulta con la intención de dejar de consumirlo(AU)

Some tips are presented to make it easier for family doctors to approach people dependent on tobacco who come to your practice with the intention of stopping it(EU)

Direct Primary Care Is About To Take Off - Or Maybe Not.

Direct primary care (DPC) occupies only a small niche in the health care payment system. But proponents say that federal legislation that would allow people to pay the monthly fee with health savings account dollars would help DCP take off.

Colon Cancer Screening in Concierge Practice.

OBJECTIVES: This study evaluated the effectiveness of the Center for Executive Medicine (CEM) concierge primary care practice on preventive colorectal cancer (CRC) screening rates relative to local and national comparator data. METHODS: We performed an electronic medical record search encompassing our entire patient population who are between the ages of 50 and 75 years to determine the rate of CRC screening. We compared this rate with the average rate of Medicare Advantage plans reported by our Independent Physician Association (IPA) in 2015 and national health plans reported by the National Committee for Quality Assurance in 2014. RESULTS: The CEM had a CRC screening rate of 90.2%, which was significantly higher than local IPA Medicare Advantage plans (63.3%) and National Committee for Quality Assurance national plans (57.7%-66.5%). CEM members were significantly more likely than were IPA members to undergo screening (odds ratio 1.425, 95% confidence interval 1.348-1.507, P < 0.0001). CONCLUSIONS: These results suggest that the CEM practice strategy and processes increase CRC screening rates.

Keeping candles lit: The role of concierge medicine in the future of primary care.

Universal coverage and financial sustainability are two competing aims in primary care. Patient empowerment and patient engagement have been suggested as essential ingredients of the recipe for innovative primary care models aimed at sustaining universal coverage. Concierge medicine is achieving a growing popularity among both scholars and practitioners as a direct primary care practice which allows to bridge the gap between patient empowerment and patient engagement. However, ethical and legal concerns hinder the diffusion of concierge models in the current primary care practices. This manuscript is aimed at providing an evidence synthesis of extant contributions in the field of concierge medicine in order to discuss its attributes and to examine its expected effects on universal coverage and sustainability. For this purpose, a systematic literature review involving 29 manuscripts was performed. The findings of this study pointed out that concierge models could play a significant role in enhancing the access to primary care and in improving the sustainability of the healthcare service system. However, the existing institutional arrangements which regulate the access to primary care should be revised to allow more spaces for the implementation of concierge practices.