Welcome to Recovery Month! In celebration of primary care’s role in addiction care, we are featuring a show about caring for patients with addiction. Our guests this week are Adele Ojeda, the office based opioid treatment (or OBOT) nurse for Barre Family Health Center and Dr. Stephen Martin. Dr. Martin is Associate Professor of Family Medicine and Community Health at University of MA Medical School and a faculty physician at Berry Family Health Center, and affiliate faculty for the HMS Center for Primary Care. They share their experiences caring for patients with OUD in the primary care setting, and we also discuss an article Dr. Martin published with several colleagues in Annals of Internal Medicine in November 2018 entitled The Next Stage of Buprenorphine Care for Opioid Use Disorder that focuses on a number of widely accepted, yet not evidence-based, and potentially harmful practices in buprenorphine care. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.
This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.
Our guest this week is Dr. Margot Kushel, a Professor of Medicine at UCSF and Director of the UCSF Center for Vulnerable Populations, as well as the Director of the UCSF Benioff Homelessness and Housing Initiative. Dr. Kushel’s research focuses on homelessness among older adults and the adverse health effects associated with homelessness. She developed and continues to follow the HOPE HOME cohort, an ongoing longitudinal cohort study examining the causes and effects of homelessness among adults 50 and over in Oakland, CA. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.
Our guest this week is Dr. Steven Woolf. He is the C. Kenneth and Dianne Wright Distinguished Chair in Population health and Health Equity at VCU as well as Director Emeritus and Senior Advisor to the VCU Center on Society and Health. He joins us this week to talk about his work improving our understanding of the increasing death rates among mid-life Americans, on which he published a crucial paper about in 2018 in BMJ, entitled Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics, as well as authoring in an extensive report entitled US Health in International Perspective: Shorter Lives, Poorer Health. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.
Christopher Morley joins us this week to talk about prior authorizations, or PAs – a bureaucratic headache well known to anyone in primary care in which a physician’s office must complete additional paperwork or phone calls to a patient’s insurance company in order to get a medication or procedure covered by the insurance. This used to be a fairly rare occurrence, but it has dramatically increased in frequency over the last 20 years or so. Dr. Morley set out with some colleagues to try to quantify how much the PA process may cost, and moreover, to help us all think about who pays those costs in reality – ultimately, it is our patients. Dr. Morley is the Chair of the Department of Public Health and Preventive Medicine at SUNY Upstate Medical University, as well as the Vice Chair for Research in the Department of Family Medicine. He is a medical social scientist with principal interests in health disparities, particularly those that occur in primary care settings; health workforce development and medical education. Review of Systems is a podcast hosted by Audrey Provenzano featuring conversations about the changing healthcare landscape from the Harvard Center for Primary Care. Check out our website, primarycare.hms.harvard.edu to find our podcast library, subscribe in your favorite podcast app, and find us at @rospodcast and @audreymdmph Tweet us feedback and suggestions or email us at reviewofsystemspod@gmail.com. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues.
Our guest this week is Stacey Chang. He is the executive Director of the Design Institute for Health at Dell Medical School. He joins us today to talk about design in medicine and how we can use design thinking as a tool to improve healthcare, and in particular how he and colleagues went about designing a series of clinics at Dell Medical School without any waiting rooms! I hope you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.
What happens when a medical complex young person turns 18, and then, suddenly, they make their own medical decisions rather than their parents? How does one navigate the sometimes very thorny issues of sexual health and fertility? What about insurance issues? This week, we have a very special show for you featuring a number of guests on this topic talking about the Weitzman Family Bridges Adult Transition Program at Boston Children’s Hospital and how the program addresses these questions. We have Kitty O’Hare, a practicing med-peds primary care physician and Assistant Professor of Medicine and Pediatrics, Harvard Medical School; Ahmet Uluer, the Medical Director of the Weitzman Family Bridges Adult Transition Program; Amy, a patient who helped give input in the design of the program, helped to write the transition in care guide One Step at a Time, and has gone on to become a nurse; Susan Shanske, MSW, LICSW, the Director of Transitional Care Support; and Julia Roboff, a Nurse Practitioner with the program. Thanks for listening!
In this reprise episode, Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop me a line at contactATrospod.org.
This week, we are joined by Allison Hess, VP of Health for the Steele Institute for Innovation at Geisinger to talk about Geisinger’s Fresh Food Farmacy, a program that provides food insecure patients with poorly controlled diabetes access to fresh healthy foods as part of a comprehensive diabetes care plan. Read more about the Fresh Food Farmacy and also check out the feature about their program on Care Zooming, a social enterprise company aimed at connecting healthcare professionals and disseminating innovative programs. Tweet us your thoughts at @RoSpodcast or you can email us at contactATrospod.org.
This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.
This week, we have two amazing guests, Cheryl Pritlove and Elizabeth Metraux. They are joining us to talk about gender disparities in medicine. Cheryl Pritlove is a Research Scientist at the Applied Health Research Centre at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Ontario, Canada. She is a qualitative methodologist and health equity researcher with specific interests in gender disparities. Please read her recent Lancet article The good, the bad, and the ugly of implicit bias that we discuss on the show. Elizabeth Metraux is the founder of the Boston-based start-up, Women Writers in Medicine, with a mission to break glass ceilings using the power of the pen. Formerly at the National Institutes of Health, she worked in the Office of the NIH Director as communications lead for Workforce Diversity. Prior to jumping into healthcare, she served in the Middle East and Central Asia in civil society development through the State Department, USAID, and a number of local NGO’s and media outlets. Elizabeth’s work has appeared in The New England Journal of Medicine, Health Affairs, STAT, Medium, and more. She regularly speaks across the country, hosts the healthcare podcast “Relational Rounds,” and the live storytelling series, “Scrubs, Spirits, and Stories: Tales from the Trenches of Healthcare,” both sponsored by Primary Care Progress. We’d love to hear from you! Please tweet at us @RoSpodcast or @HMSPrimaryCare or drop us a line at contact@rospod.org. This interview has been lightly edited for length and clarity.
Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest last week and this week for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.
Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest this week and next for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.
Utibe Essien, a Health Equity researcher, primary care physician in the VA Pittsburgh Health System, and Assistant Professor of Medicine at University of Pittsburgh School of Medicine joins us this week. Dr. Essien studies racial disparities in healthcare, and recently published a major study in JAMA Cardiology, demonstrating significant racial disparities in the management of atrial fibrillation. He also recently published an important commentary about the dramatic racial disparities in outcomes seen among pregnant and postpartum women in the United States. We talk about his research, and how it is connected with some of the larger instances of racial discrimination and high-profile deaths of predominantly black men that we see so often and have become part of our discourse about racial discrimination in our country. We also read and discuss the poem Martin Luther King Jr Mournes Trayvon Martin by Lauren Alleyne. Follow Utibe on twitter at @UREssien, me @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email us at contactATrospod.org. Thanks for listening!
This week, we have a very special collaborative show with the Harvard T.H. Chan School of Public Health’s podcast, This Week in Health. We are featuring perspectives on gun violence from the trauma bay of the emergency room with Megan Ranney, and from public health, with David Hemenway. Megan Ranney, MD MPH is currently an Associate Professor in the Department of Emergency Medicine at Rhode Island Hospital/Alpert Medical School of Brown University and also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine, a non-partisan philanthropy focused on filling the funding gap for high-quality, medically-focused, firearm injury research. David Hemenway is Professor of Health Policy, is Director of the Harvard Injury Control Research Center at the TH Chan School of Public Health. Dr. Hemenway teaches classes on injury and on economics. Dr. Hemenway has written widely on injury prevention, including articles on firearms, violence, suicide, child abuse, motor vehicle crashes, fires, falls and fractures. This interview has been lightly edited for length and clarity.
This week, Thomas Kim, David Rosenthal, and Audrey Provenzano bring you a journal club episode. Audrey talks about: Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults: A Randomized Clinical Trial by Adam Sacarny, PhD, Michael L. Barnett, MD, MS, Jackson Le, PharmD, Frank Tetkoski, RPh, David Yokum, PhD & Shantanu Agrawal, MD. David Rosenthal talks about Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A randomized Control trial By Shreya Kangovi , Nadita Mitra, Lindsey Norton, Rory Harte, Xinzi Zhao, Tamala Carter, David Grande, and Judith Long. Thomas Kim brings us a discussion of Women from racial or ethnic minority and low socioeconomic backgrounds receive more prenatal education: Results from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System by Minh N. Nguyen PhD, Mohammad Siahpush PhD, Brandon L. Grimm PhD, Gopal K. Singh PhD & Melissa K. Tibbits PhD. If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.
How long have we all, collectively in healthcare, spent on hold with medical records departments, listening to mind-numbing muzac or assembled around the fax machine, waiting for your patient’s crucial imaging reports or culture results from another hospital to come through? Way too long. Difficulty accessing medical records can be extremely difficult, which we explore today with two guests. Ilana Yurkiewicz is a physician and writer, and recently published an article on Undark, entitled Paper Trails: Living and Dying with Fragmented Medical Records, which explores how poor communication of medical records resulted in harm to one of her patients. Carolyn Lye, a medical student and law student at Yale, also joins us; she is lead author of an article published in JAMA Open, entitled Assessment of US Hospital Compliance With Regulations for Patients’ Requests for Medical Records, which studied the difficulties patients experience in requesting medical records through a secret shopper study model. They both join us today to talk about how difficult it is to access medical records. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.
In this reprise episode, our guests are Sarah Dauber, Ph.D & Lindsey Vuolo JD, MPH of Center on Addiction, a science-based non-profit, non-partisan organization dedicated to finding and promoting solutions to end addiction. They join us to discuss policies that affect how pregnant women with substance use disorders may or may not access care and how we can better align policy with evidence-based care of women with substance use disorders. Lindsey is the associate director of health law and policy at Center on Addiction and specializes in legal, regulatory and policy work related to addiction prevention and treatment with a focus on health care system reform. Sarah is the associate director of adolescent and family research at Center on Addiction. Her work is focused on evaluating the implementation of empirically-supported interventions for substance use and co-occurring mental health and family risk in usual care settings. In addition, a primary focus of her work is on developing and testing strategies for improving access to quality substance use and mental health treatment for pregnant and postpartum women. You can find the Vice article we discussed about Melissa here. You can find the data on policies surrounding pregnant women and substance use disorders that we discussed here. Be sure to go back in your feed or click here and here for the first two shows in this series featuring a program providing SUDs care to pregnant women at Lynn Community Health Center. Please tweet us @RoSPodcast or @HMSPrimarycare, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!
Our guest this week is Dr. Mark Friedberg. Mark is a senior physician policy researcher at the RAND corporation and a practicing primary care physician at Brigham and Women’s Hospital, where he trained in primary care after attending medical school at Harvard. RAND is a non-profit, non-partisan research organization that develops solutions to public policy challenges to make communities healthier and more prosperous. Mark’s research covers a range of topics but focuses in particular on quality measurement and pay for performance. He joins us today to talk about his work, and in particular an exhaustive report he recently published with colleagues from RAND and also the AMA, looking at the effects of alternative payment models on the practice of medicine in the US, a follow up study from work initially done in 2014. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. Follow Mark and Audrey on twitter, and tweet your feedback and suggestions to us at Review of Systems. Or, you can email me at contactATrospod.org. Thanks for listening!
In this reprise series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about their experience forming their team called the Sunflower team at Lynn Community Health Center, which provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period. They developed this care program while participating in the Harvard Center for Primary Care’s Advancing Teams in Community Health program. Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.