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Policy Points The reinstitution of pre-COVID-19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow-up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender-affirming care, and substance use treatments.
RESUMO
Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants' locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant's real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas.
Assuntos
Transtornos Mentais , Psiquiatria , Humanos , Inteligência Artificial , Transtornos Mentais/terapia , Comitês de Ética em Pesquisa , PesquisadoresRESUMO
Once-daily oral tenofovir/emtricitabine is highly effective as pre-exposure prophylaxis (PrEP) against HIV but is dependent on adherence, which may be challenging for men who have sex with men (MSM) and use substances. Digital pill systems (DPS) permit the direct, real-time measurement of adherence, though user perceptions of data privacy in this context are unknown. Thirty prospective DPS users - HIV-negative MSM with non-alcohol substance use - completed in-depth qualitative interviews exploring preferences around privacy, access, and sharing of DPS adherence data. Participants discussed some concerns about the impact of DPS use on personal privacy, and emphasized the need for robust data protections in the technology. Participants were interested in having on-demand access to their adherence data, and were most willing to share data with primary care providers and long-term relationship partners. Future investigations exploring bioethical frameworks around DPS use are warranted, and user preferences should inform best practices for protecting DPS data.
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Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Adesão à Medicação , Privacidade , Estudos ProspectivosAssuntos
Exclusão Digital , Acessibilidade aos Serviços de Saúde , Acesso à Internet , Alfabetização Digital , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde , Humanos , Acesso à Internet/economia , Portais do Paciente , Telemedicina , Estados UnidosRESUMO
CONTEXT: The opioid epidemic is a major US public health crisis. Its scope prompted significant public outreach, but this response triggered a series of journalistic articles comparing the opioid epidemic to the crack cocaine epidemic. Some authors claimed that the political response to the crack cocaine epidemic was criminal justice rather than medical in nature, motivated by divergent racial demographics. METHODS: We examine these assertions by analyzing the language used in relevant newspaper articles. Using a national sample, we compare word frequencies from articles about crack cocaine in 1988-89 and opioids in 2016-17 to evaluate media framings. We also examine articles about methamphetamines in 1992-93 and heroin throughout the three eras to distinguish between narratives used to describe the crack cocaine and opioid epidemics. FINDINGS: We find support for critics' hypotheses about the differential framing of the two epidemics: articles on the opioid epidemic are likelier to use medical terminology than criminal justice terminology while the reverse is true for crack cocaine articles. CONCLUSIONS: Our analysis suggests that race and legality may influence policy responses to substance-use epidemics. Comparisons also suggest that the evolution of the media narrative on substance use cannot alone account for the divergence in framing between the two epidemics.
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Cocaína Crack , Direito Penal , Jornais como Assunto , Epidemia de Opioides , Saúde Pública , Terminologia como Assunto , Humanos , Drogas Ilícitas/legislação & jurisprudência , Política Pública , Fatores Raciais , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Estados Unidos , VocabulárioRESUMO
This Viewpoint describes the newly finalized Reproductive Privacy Rule, a HIPAA regulatory update intended to prevent law enforcement in abortion-restrictive states from obtaining reproductive care medical records to prosecute patients and physicians.
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Revelação , Serviços de Saúde Reprodutiva , Feminino , Humanos , Aborto Induzido/legislação & jurisprudência , Revelação/legislação & jurisprudência , Health Insurance Portability and Accountability Act/legislação & jurisprudência , Informações Pessoalmente Identificáveis/legislação & jurisprudência , Médicos/legislação & jurisprudência , Privacidade/legislação & jurisprudência , Serviços de Saúde Reprodutiva/legislação & jurisprudência , Telemedicina/legislação & jurisprudência , Estados Unidos , United States Dept. of Health and Human Services/legislação & jurisprudênciaRESUMO
This Viewpoint explains how exceptions can be used to connect patients via telehealth with a physician in another state, why this is a more practical and effective strategy, and what needs to happen for this to be a feasible solution.
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Acessibilidade aos Serviços de Saúde , Licenciamento , Telemedicina , Licenciamento/legislação & jurisprudência , Telemedicina/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudênciaRESUMO
This Viewpoint evaluates Texas' proposals to define the scope of the life exception for the state's abortion ban and argues that these approaches do not allow physicians to follow the national standards of care, avoid criminal liability, or have sufficient notice of what the law permits.
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Aborto Induzido , Aborto Espontâneo , Responsabilidade Legal , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Serviços de Planejamento Familiar , Responsabilidade SocialRESUMO
This Viewpoint discusses a proposed DHHS rule to address discrimination in clinical algorithms and the need for additional considerations to ensure the burden of liability for biased algorithms is not disproportionately placed on health care professionals.
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Algoritmos , Atenção à Saúde , Preconceito , Discriminação Social , Viés , Preconceito/prevenção & controle , Discriminação Social/prevenção & controle , Atenção à Saúde/métodos , Atenção à Saúde/normasRESUMO
This Viewpoint discusses how some pulse oximeters can provide incorrect oxygen saturation data for dark-skinned patients compared with light-skinned patients, describes the reasons that biased oximeters remained in use, and highlights why a rule recently proposed by the US Department of Health and Human Services may bring about needed change in the use of pulse oximetry for patients with dark skin.
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Direitos Humanos , Oximetria , Discriminação Social , Oximetria/instrumentação , Oximetria/normas , Discriminação Social/legislação & jurisprudência , Discriminação Social/prevenção & controle , Estados Unidos , Governo Federal , Direitos Humanos/legislação & jurisprudência , Direitos Humanos/normasRESUMO
This Viewpoint discusses why the legality of calling patients located in another state has suddenly been called into question.
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Atenção à Saúde , Telemedicina , Humanos , Atenção à Saúde/legislação & jurisprudência , Instalações de Saúde , Estados Unidos , Telemedicina/legislação & jurisprudênciaRESUMO
This Viewpoint discusses the legal risks physicians and health care facilities may incur by miscoding a surgical or chemical abortion as a miscarriage to conceal an abortion procedure.
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Aborto Induzido , Aborto Legal , Codificação Clínica , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Hospitais , Codificação Clínica/legislação & jurisprudência , Codificação Clínica/normas , Legislação Hospitalar , Legislação Médica , Responsabilidade LegalRESUMO
This Viewpoint lists the top 3 pediatric drugs and product shortages, considers the federal government's and manufacturers' ethical duty to protect children, reviews the causes for the shortages, and suggests policy changes that could help fill in the gap.
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Indústria Farmacêutica , Preparações Farmacêuticas , Criança , Humanos , Preparações Farmacêuticas/provisão & distribuiçãoAssuntos
Aborto Induzido , Direitos Civis , Health Insurance Portability and Accountability Act , Privacidade , Direitos Sexuais e Reprodutivos , Decisões da Suprema Corte , Aborto Induzido/legislação & jurisprudência , Direitos Civis/legislação & jurisprudência , Confidencialidade , Feminino , Health Insurance Portability and Accountability Act/legislação & jurisprudência , Humanos , Jurisprudência , Gravidez , Privacidade/legislação & jurisprudência , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Estados Unidos , Direitos da Mulher/legislação & jurisprudênciaAssuntos
Aprovação de Equipamentos , Técnicas e Procedimentos Diagnósticos/instrumentação , Equipamentos e Provisões , Regulamentação Governamental , Autocuidado/instrumentação , Confidencialidade , Equipamentos e Provisões/normas , Humanos , Responsabilidade Legal , Estados Unidos , United States Food and Drug AdministrationRESUMO
This Viewpoint examines the murky legal treatment of various health-related wearable or other general wellness products for patients, physicians, and manufacturers, and recommends solutions.