Clinician Response to the 2021 USPSTF Recommendation for Colorectal Cancer Screening in Average Risk Adults Aged 45-49 Years.

Introduction: In 2021, the USPSTF lowered the recommended age of colorectal cancer (CRC) screening initiation from 50 to 45 years. This study assessed clinician response to the updated guideline in a major health system.

Methods: This was a retrospective cohort study of average-risk, CRC screening-naïve adults aged 45-50 years with a primary care appointment between July 2018 and February 2023.

Building expert consensus regarding sharing of individual research results in Alzheimer's disease research: a Delphi study protocol.

Introduction: Informed decisions to enrol in the clinical investigations of Alzheimer's disease and related dementias (ADRD) require careful consideration of complex risks and uncertain benefits. Decisions regarding whether to receive information about biomarker status are complicated by lack of scientific consensus regarding biomarkers as surrogate endpoints for Alzheimer's disease and how information about individual risk should be evaluated and shared with research participants. This study aims to establish stakeholder consensus regarding ethically optimal approaches to sharing individual results with ADRD research participants.

Antibiotic prescribing for respiratory tract infections in urgent care: a comparison of in-person and virtual settings.

Background: Little is known about antibiotic prescribing for respiratory tract infections (RTIs) in virtual versus in-person urgent care within the same health system.

Methods: This is a retrospective study using electronic health record data from Cleveland Clinic Health System. We identified RTI patients via ICD-10 codes and assessed whether the visit resulted in an antibiotic.

Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System.

Background: Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice.

Objective: To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record.

Design: Cross-sectional study.

Patient Portal Message Volume and Time Spent on the EHR: an Observational Study of Primary Care Clinicians.

Background: As patient-initiated messaging rises, identifying variation in message volume and its relationship to clinician workload is essential.

Objective: To describe the association between variation in message volume over time and time spent on the electronic health record (EHR) outside of scheduled hours.

Design: Retrospective cohort study.

Antibiotics on Demand: Advances in Asynchronous Telemedicine Call for Increased Antibiotic Surveillance.

The rapid growth of telehealth services has brought about direct-to-consumer telemedicine platforms, enabling patients to request antibiotics online without a virtual or face-to-face consultation. While telemedicine aims to enhance accessibility, this trend raises significant concerns regarding appropriate antimicrobial use and patient safety. In this viewpoint, we share our first-hand experience with 2 direct-to-consumer platforms, where we intentionally sought inappropriate antibiotic prescriptions for nonspecific symptoms strongly indicative of a viral upper respiratory infection.

Qualitative Analysis of Patient-Physician Discussions Regarding Anticoagulation for Atrial Fibrillation.

Importance: For patients with atrial fibrillation (AF), the decision to initiate anticoagulation involves the choice between warfarin or a direct oral anticoagulant (DOAC). How physicians engage patients in this decision is unknown.

Objective: To describe the content of discussions between patients with AF and physicians regarding choice of anticoagulation.

Physician Gender and Its Association With Patient Satisfaction and Visit Length: An Observational Study in Telemedicine.

Introduction Female physicians conduct longer visits than male physicians, with negative implications for their compensation. Yet patients often report higher satisfaction with female physicians. It is unknown whether satisfaction scores for female physicians are associated with their visit lengths.

Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation.

Background: Patients with atrial fibrillation (AF) must decide between warfarin and direct oral anticoagulants (DOACs), a decision involving important tradeoffs. Our objective was to understand whether physicians engage patients in informed decision making for anticoagulants.

Design: We performed an analysis of recorded conversations between physicians and anticoagulation-naïve patients in the Verilogue Point-of-Practice database.

Change in Physician Burnout between 2013 and 2020 in a Major Health System.

Objective: Assessing changes in physician burnout over time can offer insight into the causes of burnout. Existing studies are limited by using different samples of physicians at each time point. Our objective was to assess changes in burnout between 2013-2014 and 2019-2020 overall and within a cohort of physicians who took the survey twice.

Primary care physician referral practices regarding BRCA1/2 genetic counseling in a major health system.

Purpose: The United States Preventive Services Task Force recommends primary care physicians refer patients at high risk for BRCA1/2 mutations to genetic testing when appropriate. The objective of our study was to describe referrals for BRCA1/2 testing in a large integrated health system and to assess factors associated with referral.

Methods: This retrospective cohort study includes female patients between 18 and 50 years who had a primary care visit in the Cleveland Clinic Health System between 2010 and 2019.

Prescribing of anticoagulation for atrial fibrillation in primary care.

Atrial fibrillation (AF) is common in primary care patients. Many patients who could benefit from anticoagulation do not receive it. The objective of this study was to describe anticoagulation prescribing by primary care physicians.

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services.

Background: The coronavirus disease 2019 pandemic has contributed to growing demand for mental health services, but patients face significant barriers to accessing care. Direct-to-consumer(DTC) telemedicine has been proposed as one way to increase access, yet little is known about its pre-pandemic use for mental healthcare.

Objective: To characterize patients, providers, and their use of a large nationwide DTC telemedicine platform for mental healthcare.

Physicians' Views on Utilization of an Electronic Health Record-Embedded Calculator to Assess Risk for Venous Thromboembolism among Medical Inpatients: A Qualitative Study.

 Venous thromboembolism (VTE) causes preventable in-hospital morbidity. Pharmacologic prophylaxis reduces VTE in at-risk patients but also increases bleeding. To increase appropriate prescribing, a risk calculator to guide prophylaxis decisions was developed.

COVID-19 Is Associated With an Increase in Visits for Anxiety but Not Depression.

Background The coronavirus disease 2019 (COVID-19) pandemic has increased concerns about mental health. We conducted a time-series analysis to determine whether the percentage of primary care visits for anxiety and depression changed after COVID-19. Methodology We assessed the adjusted weekly change in the percentage of primary care visits for anxiety and depression between August 2019 and October 2020 at a large integrated health system.

Association between Opioids Prescribed to Medical Inpatients with Pain and Long-Term Opioid Use.

Objectives: Opioid receipt during medical hospitalizations may be associated with subsequent long-term use. Studies, however, have not accounted for pain, which may explain chronic use. The objective of this study was to identify the association between opioid exposure during a medical hospitalization and use 6 to 12 months later.

Patient and physician factors contributing to polypharmacy among older patients.

Objective: Polypharmacy, or use of multiple medications, is associated with patient factors. Less is known regarding variation in polypharmacy by individual physicians. The objective of this study was to assess patient and physician factors associated with polypharmacy among older patients.

Patient Experience in Virtual Visits Hinges on Technology and the Patient-Clinician Relationship: A Large Survey Study With Open-ended Questions.

Background: Patient satisfaction with in-person medical visits includes patient-clinician engagement. However, communication, empathy, and other relationship-centered care measures in virtual visits have not been adequately investigated.

Objective: This study aims to comprehensively consider patient experience, including relationship-centered care measures, to assess patient satisfaction during virtual visits.

Change in individual physicians' screening mammography completion rates following the updated USPSTF guideline supporting shared decision making: An observational cohort study.

Objective: To understand changes in physician screening practices in response to the 2009 U.S. Preventive Services Task Force recommendation supporting shared decision making (SDM) for mammography in women aged 40-49 years.