Latest news with #PCPs
Yahoo
23-07-2025
- Health
- Yahoo
If Your Body Feels Like It's Falling Apart After 45, It's Not In Your Head—It's A Medical Syndrome
"Hearst Magazines and Yahoo may earn commission or revenue on some items through these links." Of the more than 47 million women in the world who begin the menopause transition each year, more than 70 percent of them will experience musculoskeletal symptoms—and 25 percent will be disabled by them. Those startling stats are based on research by Vonda Wright, MD, an orthopaedic sports surgeon and author of Unbreakable. And yet, many women that Dr. Wright sees in her practice are only aware of more-talked-about symptoms like night sweats, hot flashes, and brain fog. The musculoskeletal symptoms—which includes arthritis, tendonitis, and osteopenia, and are linked to the drop in estrogen that happens during menopause—seem to come as a surprise. '[Women] come into my office and, without prompting, they'll say, 'I don't know what's happening, but I feel like I'm falling apart because it's not just one body part, it's multiple body parts,'' Dr. Wright says. Many of these female patients also mention being dismissed by their PCPs and having their issues chalked up to aging. "We are getting older, but that is not the end of the explanation," Dr. Wright says. She hopes that her paper—and giving these symptoms a name—helps to solve this problem: 'If the woman goes into a doctor's office and says, 'my knee hurts, my back hurts. I'm gaining weight'—that is a lot to talk about in 15 minutes. But with the power of nomenclature, a midlife woman who educates herself can say, 'I'm 46, I know my estrogen is going down. I think I have the musculoskeletal syndrome of menopause.' And that is something that you can wrap a conversation around versus trying to solve each problem individually.' This approach of using a name to label and identify a health issue has had success in the past. In 2012, a team of experts put forth the term genitourinary syndrome of menopause (GSM) to describe symptoms including genital dryness, pain during sex, and urinary urgency or recurrent urinary tract infections. Like with musculoskeletal symptoms, 'if you go in naming five or six things [related to the genital or urinary organs], it's overwhelming, but if you give a name to it, then we can research it, and then we can talk about it with a common language,' Dr. Wright says. Other experts in the field agree that publicizing a term like this and getting the information out to more women and providers is important: 'Coining this term 'musculoskeletal syndrome' gave patients validity that this is a real thing that happens in menopause,' says Paru David, MD, an internist in Women's Health Internal Medicine at Mayo Clinic Arizona. Dr. David sees many patients exhibiting the symptoms of this syndrome. '[They] will tell me 'I became postmenopausal and, overnight, I felt like I became an old lady... everything hurts.'' The good news is that understanding why this happens—and how to fight back—can help you treat or prevent these symptoms altogether. What Musculoskeletal Syndrome Actually Is The symptoms related to this syndrome all have to do with the loss of estrogen that leads to inflammation in the body. 'Estrogen is a potent anti-inflammatory, so without estrogen, we're highly inflamed,' Dr. Wright says. Estrogen sits on the receptors on every tissue in the body, including the musculoskeletal system, which includes tendon, ligament, bone, the discs in your back, cartilage, fat, muscle, and stem cells. Less of the hormone can lead to excruciating pain and loss of motion without an injury or event. Dr. Wright has patients come in knowing something is wrong but insisting nothing happened, exactly, to trigger it. 'As I explore their age and that they're perimenopausal, I know that means their estrogen has declined,' she says. How the Loss of Estogen Impacts the Body Tendons and ligaments: 'The ligaments and tendons become more brittle and are more susceptible to injuries such as tennis elbow, Achilles tendonitis, [and] plantar fasciitis,' Dr. Wright says. This weakening of the tendons and ligaments can also lead to tendon tears while lifting weights or playing sports—even if you lifted the same amount of weight you'd done in the past or didn't make any new moves, Dr. David says. Muscle: 'Although it's critical at this time of life to make muscle, we make it less effectively,' Dr. Wright says. In a 2024 systematic review in Muscles, researchers noted that the decline in estrogen during menopause leads to reduced muscle strength in addition to mass, although hormone replacement therapy (HRT) can mitigate some of this in addition to resistance training, and certain dietary interventions. (More on those soon.) Bone: Bone is dependent on estrogen for a process known as remodeling. 'Bone is in a consistent state of building and breaking down; every 10 years, we get a whole new skeleton,' Dr. Wright says. 'When the cells that break down bone [are] not controlled, then we have more breakdown than we do building, and that's when we become osteopenic, which is moderate loss of bone density, or osteoporotic, which means weak bone, [which] puts us in much more danger of fracture.' Dr. Wright says her personal 'hill to die on' is the fact that bone health is a lifelong concern. 'Yet none of us pay attention to our bones unless we're looking in the mirror at our gorgeous cheekbones or our clavicles,' she says. 'But the reality is that without estrogen, we're going to lose 15 to 20 percent of our bone density in the five to seven years surrounding perimenopause and menopause. And if we have not laid down enough bone by the time we're 30, which is very common, then we get to perimenopause and we rapidly start losing bone to the tune of one in two women will develop an osteoporotic fracture in their lifetime.' Joints: 'Before age 50, men have a much higher incidence of arthritis usually due to trauma,' Dr. Wright says. But after 50, women are the ones typically experiencing rapid progression of arthritis in the knee and hip, she adds. This is because cartilage—which helps with shock absorption—has estrogen receptors and without estrogen sitting in those receptors, the cartilage starts to break down. That leads to women over 50 dealing with joint pain in their hands, knees, and hips. Similarly, the gel-like cushions between the disks in your spine can break down and cause back pain, which impacts 50 percent of women, Dr. Wright says. Frozen shoulder—when the joint becomes stiff and starts to hurt for no apparent reason—is another condition she often sees in menopausal women. 'The other thing from an inflammatory standpoint that women experience, which I think is often mislabeled as fibromyalgia, is arthralgia, which is total-body pain due to inflammation,' Dr. Wright says. 'It's not one joint. It is your whole body [that] feels inflamed and painful.' How to Know If You Have Musculoskeletal Syndrome There's no quick and easy test for this syndrome. 'You can't really do an x-ray or imaging that confirms and says, 'this is definitely due to the loss of estrogen,'' says Dr. David. Instead you need to work with your provider to put together a full picture. If a woman is postmenopausal and not on hormones and says she cannot exercise the way she has in the past, or that she's dealing with more injuries or pain, and/or other symptoms like hot flashes and night sweats, those would be clear indicators, Dr. David says. Both doctors say that women tend to underreport symptoms—don't be one of them. 'Sometimes patients will say, 'oh, it's just in my mind,' and they're doubting themselves, but then when they come in, I tell them, no, this is a real thing that's happening due to that loss of estrogen,' Dr. David says. 'Don't feel like you can't come to your provider or to a menopause specialist to discuss this, because women need to have these things addressed.' How to Reverse (Or Prevent!) Musculoskeletal Syndrome 'What I want women to do to treat the musculoskeletal syndrome of menopause is multifactorial,' Dr. Wright says. Here, all the ways to empower yourself to prevent—and fight—back. 1. Stay educated. 'Number one, you have to be educated,' Dr. Wright notes. For this reason, she and her team decided to pay whatever money was necessary so that the paper on the syndrome would not be placed behind a paywall. 'I encourage people to print the paper, read the paper, print another one, take it to your doctor, [and] give it to five girlfriends so that everybody knows,' she says. 'The more literate you are in midlife, the more powerful you can be to feel better.' 2. Talk to your provider about hormone therapy—asap. "I encourage all of my patients to go on hormone optimization with estradiol [and], if they have a uterus, with micronized progesterone,' Dr. Wright says, adding that sometimes she gives them low-dose testosterone as well. 'Women just want to feel like themselves and do what they've always done, and these three things, I have found in my own life and [in] the women that I serve, can go a long way [in combatting] the root cause of some of the reasons we don't in midlife,' Dr. Wright says. Dr. David's patients, too, tell her they feel much better—they're joints and muscles don't hurt as much, for example—once they're on hormone therapy. That said, hormone optimization is a decision every woman needs to make for herself and with her provider, the doctors agree. But, Dr. Wright says to make that decision sooner rather than later. 'I think we should be making it in the critical decade, which in my book is 35 to 45 when most of us still have our estrogen flowing,' she says. That way, when you start feeling perimenopause, and possibly overwhelmed, you already know what you're going to do and where you're going to get it. 3. Start lifting heavy if you're not already. 'I have a lot of patients that think that they have to go into a gym and do heavy lifting, and I tell them small weights can really help preserve your bone density and probably help with keeping your muscle mass,' Dr. David says. 'Make sure that you're not doing more than what your body can do,' she says. 'Especially if you've had a period of time where you haven't done physical activity, you can't necessarily jump in and begin where you left off. You might have to build back up to that level.' 4. Follow the 80-20 rule of exercise. 'We can stop burning ourselves out with high-intensity interval training every day and do the 80-20 method,' Dr. Wright says. That means that 80 percent of the time, you work at a lower heart rate with activities like brisk walking, cycling, or using the indoor rower. Then, twice a week, you push your heart rate as high as your doctor says is safe for you—but for short (perhaps 30 seconds) periods of time with longer (say, one to two minutes) periods of recovery. Master these six exercises in your 60s for longevity Working at those ends of the spectrum, in addition to heavy lifting, is the key to changing body composition and maintaining muscle. Dr. David adds that stretching regularly is also important to prevent joint injuries. 5. Consider working with a physical therapist. If you're experiencing some of these symptoms already, working with a physical therapist can be very beneficial, Dr. Wright says, because they can assess you, understand where you are, understand your limitations, and then prescribe exercises that you can build upon. Dr. David, too, says finding a physical therapist that's educated around menopause can be a wise move during this time of life: 'I do get worried that sometimes patients will say, 'I just need to work out with a personal trainer, and that will really help me,' and they may not understand where you're coming from,' Dr. David says. 'A physical therapist, especially one who understands musculoskeletal syndrome, can understand where these patients are coming from, what they are able to do without harming themselves further, and then build upon that.' 6. Eat an anti-inflammatory diet. 'I prescribe anti-inflammatory nutrition,' says Dr. Wright. The key components of this, she says, are to avoid added sugar and to focus on protein and specifically fiber-rich carbs (e.g., whole fruit instead of fruit juice). 'For bone health, make sure that you're getting enough calcium [and] that you're getting enough vitamin D to help absorb that calcium,' Dr. David adds. The aforementioned 2024 review also notes that omega-3 fatty acids can be effective in supporting muscle health across all life stages. If this list has you feeling overwhelmed, fear not, Dr. Wright says. Just start with one thing. Maybe start by taking two walks this week, then cut back on sugar next week, then layer on protein, and finally, weight lifting. 'You layer on one at a time [and] it simply becomes your lifestyle,' she says. 'It's not a diet. It is not a six-week exercise program. It's just how you live—and all of these things will help your musculoskeletal pain stay in check.' And while the sooner you start some of these lifestyle habits, the better, it's also never too late: 'There is never an age when your body will not respond to the positive stress, the strategic stress, in the form of all the things on this list," Dr. Wright says. You Might Also Like Jennifer Garner Swears By This Retinol Eye Cream These New Kicks Will Help You Smash Your Cross-Training Goals
Business Wire
09-06-2025
- Health
- Business Wire
New Research Underscores the Important Role of Value-Based Care (VBC) in Improving Primary Care Access for Traditional Medicare Patients
WESTERVILLE, Ohio--(BUSINESS WIRE)--agilon health (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, today announced new research demonstrating the promising role of value-based care (VBC) in maintaining primary care for senior patients when supported by agilon health, a VBC-enablement company. The study was published in the May 2025 issue of Health Affairs Scholar. 'Primary care is foundational for Medicare beneficiaries, especially those with chronic conditions. Despite its importance, many senior patients, particularly ones with Traditional Medicare (TM), have difficulties finding a primary care provider (PCP) and establishing this enormously critical longitudinal relationship,' said Karthik Rao, MD, chief medical officer, agilon health. 'As PCPs play a key role in providing comprehensive care to patients, we wanted to examine the role of VBC in improving primary care access in this population.' Using claims data, researchers compared two groups of PCPs with TM patients in their panels: one group that received support from agilon health to adopt a VBC model and one group that maintained prevailing payment structures, primarily fee-for-service (FFS). Unlike FFS models that reward volume, VBC incentivizes PCPs to spend more time with patients and focus on their quality of care. The following results were observed in the study: After shifting to VBC, PCPs saw eight more new TM patients per year compared to the matched cohort of physicians who did not transition to the full-risk model, representing an approximate 35% relative increase in new TM patient volume, a statistically significant finding (P < 0.001). PCPs shifting to VBC kept their practices open to new TM patients for 0.7 more months per year on average – nearly one full month annually – compared to the other group (P < 0.001), a statistically meaningful increase in availability in the context of shrinking access and PCP workforce shortages nationally. 'This study provides timely, independent validation of agilon health's VBC approach, confirming its role in increasing availability of primary care access for Medicare patients, including TM patients who historically face more limited options,' added Dr. Rao. 'While agilon's model is built around supporting physicians in full-risk arrangements through Medicare Advantage (MA) and ACO REACH contracts, this study shows that our model can have an even greater impact on communities by helping PCPs improve access to care across all of their Medicare patients.' Study design Using FFS claims data from 2019 to 2023, researchers compared two groups of PCPs with at least 50 TM patients in their panels: 208 PCPs who received support to adopt a VBC model for TM and MA patients in 2022 ('adopters'), and 3,657 similar PCPs who maintained their existing payment models (FFS) ('nonadopters'). Researchers evaluated changes in two key outcomes between the two groups each year before, during and after VBC adoption. These outcomes included the number of new TM patients seen annually and the number of months each year that physician panels remained open to new TM patients. Researchers used difference-in-differences statistical methods to isolate the effect of joining the VBC model while accounting for other time-based trends. The primary study limitation was the nonexperimental design with a self-selected group of VBC-adopting PCPs. National trends in primary care and the promising role of VBC Access to primary care remains insufficient, despite its critical role in the U.S. healthcare system. Many areas are at risk of becoming 'primary care deserts,' and even well-resourced health systems have started restricting the acceptance of new patients, regardless of insurance type. Additionally, a national shortage of PCPs is projected to reach 57,000 by 2040. Compounding the issue, Medicare payments have dropped by 29% since 2001 after adjusting for physician practice costs. In response, some PCPs have been limiting new patient intake for TM beneficiaries. VBC models offer a promising path forward, leading to high-quality, cost-effective care. The Center for Medicare & Medicaid Innovation (CMMI) recently announced its goal to increase the share of Medicare beneficiaries in two-sided risk models. Unlike traditional FFS models, full-risk VBC arrangements provide PCPs with fixed payments based on patient demographics and complexity. In exchange, PCPs are held accountable for total medical spending and quality of care. These arrangements incentivize PCPs to proactively manage healthcare needs through efficient team-based approaches. By supporting care delivery transformation, it may also expand PCPs' capacity to serve more patients while maintaining high-quality care. About agilon health agilon health is the trusted partner empowering physicians to transform health care in our communities. Through our partnerships and purpose-built platform, agilon is accelerating at scale how physician groups and health systems transition to a value-based Total Care Model for their senior patients. agilon provides the technology, people, capital, process, and access to a peer network of 2,200+ primary care physicians that allow its physician partners to maintain their independence and focus on the total health of their most vulnerable patients. Together, agilon and its physician partners are creating the healthcare system we need – one built on the value of care, not the volume of fees. The result: healthier communities and empowered doctors. agilon is the trusted partner in 30 diverse communities and is here to help more of our nation's leading physician groups and health systems have a sustained, thriving future. For more information, visit and connect with us on LinkedIn.
Medscape
05-06-2025
- Health
- Medscape
AI Device Enhances Skin Cancer Diagnosis in Primary Care
An artificial intelligence (AI)–enabled handheld elastic scattering spectroscopy (ESS) device improved the sensitivity for skin cancer diagnosis and management by primary care physicians (PCPs), with better overall diagnostic accuracy. METHODOLOGY: ESS is a sampling technique that distinguishes between benign and malignant tissue without surgical biopsy and the ESS device is cleared by the US Food and Drug Administration for use by nondermatologist expert physicians. An AI-enabled handheld ESS device was developed to aid PCPs in the management of suspicious skin lesions. This companion study of the DERM-SUCCESS study conducted across 22 primary care sites in the United States evaluated the impact of the device on PCPs' diagnostic performance in the detection and management of skin cancer. The study involved 108 PCPs (65.7% men) who assessed 50 skin lesion cases (25 benign and 25 malignant) from 50 patients (median age, 59 years; 100% White individuals) in two phases: First, with visual assessment without using the handheld device, followed by an assessment using the device, separated by a 2-hour break. For each lesion, they provided a diagnosis, management decision, and level of confidence in their assessment. The validated device emitted light pulses over specific areas of a lesion to analyze lesion structure and classified lesions as 'Investigate Further' or 'Monitor,' with a 1-10 score reflecting the degree of similarity to malignant lesions. The coprimary endpoints were (1) the referral sensitivity of physicians, a measurement of the ability to appropriately refer malignant cases for further evaluation (management sensitivity) and (2) the referral sensitivity and specificity of physicians who knew the device results. Biopsy results served as the reference standard for both. TAKEAWAY: Management sensitivity was higher for physicians after using the AI-enabled device compared with when they did not have the device results (91.4% vs 82%; P = .0027). PCPs' diagnostic sensitivity also increased from 71.1% without the use of the AI device to 81.7% with the use of the AI device ( P = .0085). = .0027). PCPs' diagnostic sensitivity also increased from 71.1% without the use of the AI device to 81.7% with the use of the AI device ( = .0085). Device-aided management and diagnostic specificity decreased, though not significantly. The use of the device led to 11.8% more benign lesions being incorrectly referred but also led to 9.4% more malignant lesions being correctly referred. In physician management decisions, the proportion of high-confidence assessments increased from 36.8% without the use of the device to 53.4% after the use of the device, and the observed area under the curve performance improved from 0.708 to 0.762. PCPs using the device were better at detecting malignant lesions than by chance (odds ratio, 6.8; P < .0001). Most PCPs reported benefits from the device, including improved confidence in clinical assessments and management decisions. IN PRACTICE: 'The findings demonstrate that utilization of the ESS device output may improve physician performance in the management of suspicious lesions and referral of skin cancer to ensure timely diagnosis,' the authors of the study wrote. SOURCE: This study was led by Laura K. Ferris, of the Department of Dermatology at The University of North Carolina at Chapel Hill. It was published online on May 30, 2025, in Journal of Primary Care & Community Health . LIMITATIONS: The device could not directly affect how PCPs managed lesions owing to the study design because the device was experimental. Clinical information was provided, but the PCPs could not perform hands-on evaluations, which did not reflect real clinical practice but aligned with telemedicine. The study included only White patients, which limited the results for the assessment of different skin types. DISCLOSURES: This study was funded by DermaSensor, Inc. The authors declared no relevant conflicts of interest.
