Latest news with #primarycare
Medscape
2 days ago
- Health
- Medscape
PCPs as Frontline in Dyspnea
When a patient calls a primary care provider due to shortness of breath symptoms, recommending an in-office examination is generally warranted. Your patient may explain how they are out of breath from everyday activities like using stairs, getting winded from walking the dog, or just not being able to catch their breath. 'All new episodes of shortness of breath should be evaluated in real time by a clinician, ideally in person,' said Panagis Galiatsatos, MD, a pulmonologist and associate professor in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins School of Medicine in Baltimore. 'The only time I can see foregoing an immediate clinic visit is if a known cardiopulmonary diagnosis exists.' For example, if a diagnosis is already known (eg, chronic obstructive pulmonary disease [COPD]) and their dyspnea (shortness of breath) is in accordance with prior episodes of similar breathlessness, a phone call or virtual discussion could be enough. Such episodes could also be managed by an action plan that has already been discussed at prior clinic visits, Galiatsatos said. If a patient, already in the office for another concern, casually mentions episodes of shortness of breath, how should the primary doctor proceed? Even if dyspnea is mentioned nonchalantly, it warrants a thorough history and focused physical exam, especially if this is new or worsening. This could be an early sign of a more serious problem, according to Lijo Illipparambil, MD, a pulmonologist and assistant professor of clinical thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia. When discussing symptoms, Illipparambil recommends these questions: • Start the discussion related to context: When do episodes occur — exertion or rest? • How long have these symptoms been occurring? • Inquire about associated symptoms such as fatigue, chest tightness, wheezing, cough, or swelling. • Review exercise limitations: are they able to climb stairs, and if so, how many? Is walking across a room or doing daily chores causing them to be dyspneic? How can primary care doctors serve as frontline partners in managing patients' shortness of breath? Primary care doctors are essential in identifying early signs of cardiopulmonary disease. 'Generally, they are the first physicians who meet the patients and do most of the work-up initially,' said Illipparambil. 'They coordinate care, especially with specialists, provide lifestyle counseling, and monitor chronic conditions like COPD, asthma, and congestive heart failure.' In many ways, they are the real central component for care for patients with dyspnea, he said. 'They also have the advantage of longitudinal relationships, allowing them to notice changes over time and engage in shared decision-making to create sustainable health strategies and earlier intervention if needed,' Illipparambil explained. Assessment Protocol Usually, a thorough physical exam, including checking vital signs (especially oxygen saturation and heart rate) is next, according to Illipparambil. Additional testing should also be considered, including chest x-ray, EKG, and laboratory work-up, as well as referral to specialists if necessary. Red flags that warrant further testing include: • Dyspnea at rest: This is always a reason for further testing, according to Illipparambil. 'It is not normal to be short of breath at rest; it is most often a sign of significant impending decompensation,' he said. Worsening shortness of breath over days or weeks can demonstrate a progressive process, Illipparambil added. Difficulty walking short distances or performing basic activities (eg, walking in the supermarket, pushing a stroller), especially as a change from their baseline, can be a sign of an active problem. • Orthopnea or paroxysmal nocturnal dyspnea are signs of heart failure that need further investigation. • Unilateral leg swelling should always have a differential that includes deep venous thrombosis and, when a patient is short of breath, possible pulmonary embolism, Illipparambil said. Expert Assessments and Symptoms Consider the shortness of breath assessments below, according to Galiatsatos with Johns Hopkins. Airway diseases. COPD or asthma are examples. 'I would recognize due to inability to walk incline or when holding groceries, not walking through the grocery store, but once their arms are engaged, their breathlessness is noticeable,' he said. Cardiac rhythm issues. Especially at low heart rates, most people notice this breathlessness even after walking just a few dozen feet on a flat surface, he noted. Pulmonary embolism (lung blood clot). This tends to occur more acutely, and patients often describe a heaviness and discomfort in their chest. 'This is often accompanied by something that provoked the blood clot — long hours of sitting (for example, during a long flight) — or trauma to the legs,' Galiatsatos said. Heart failure. The key symptom here is the inability to lay down flat. Patients will note having to sleep with several pillows — propping their head and upper torso in an upright position — or abandoning their bed altogether in favor of a recliner, he explained. How can a primary doctor discuss lifestyle changes, medications, or strategies to reduce shortness of breath? The key is to be empathetic, collaborative, and goal oriented. 'This is indeed a delicate yet vital conversation,' Illipparambil said. There are several causes for shortness of breath and approaching patients this way can encourage openness and discussion. One thing that helps is the use of motivational interviewing techniques. For instance, Illipparambil recommends asking permission to discuss weight, tobacco use, or other lifestyle habits that may be affecting shortness of breath. Another approach is to focus on functions, such as walking without getting winded and changing habits toward a healthy lifestyle, rather than just the number on the scale. Offering resources and referrals for issues like nutrition, sleep, and physical therapy can also go a long way, Illipparambil said. 'Medications, of course, can help, especially inhalers in COPD and asthma patients,' he said. 'Antihypertensives, other medications that help modify heart disease, and goal-directed medical therapy have been shown to improve symptoms in patients with heart failure.' How does obesity affect with shortness of breath? Obesity is often linked to cardiopulmonary deconditioning, according to Trishul Siddharthan, MD, a pulmonologist and associate professor of medicine with the University of Miami Miller School of Medicine, Miami, and the University of Miami Health System. 'Extra weight is a significant cause of shortness of breath in the general population and interacts with respiratory diseases, like asthma, to worsen symptoms,' Siddharthan said. 'I think most patients understand how weight can impair respiratory status, particularly if they are having shortness of breath. Lifestyle changes and other strategies to cope are a shared decision. I ensure I address the underlying medical condition while addressing enablers and barriers to weight loss.'
Medscape
6 days ago
- Health
- Medscape
Food Allergies Tied to Increased Mental Health Risk in Kids
TOPLINE: Food allergies in children were associated with elevated risks for eating disorders, anxiety, and depression. These mental health risks varied from those seen in children with other chronic conditions such as asthma, atopic dermatitis, and type 1 diabetes. METHODOLOGY: Researchers conducted a retrospective study including data from 1,153,984 children aged 0-18 years from UK primary care practices between 2000 and 2021 to assess the link between food allergies and mental health outcomes. The participants were categorized into those with food allergies (n = 23,263; median age, 5 years; 43% girls); without food allergies (n = 1,130,721; median age, 8 years; 48% girls); and with asthma (n = 136,453; median age, 8 years; 43% girls), type 1 diabetes (n = 4835; median age, 11 years; 45% girls), or atopic dermatitis (n = 207,575; median age, 5 years; 51% girls) with no history of food allergies. All participants were followed up for at least 1 year and up to 20 years to assess the development of specified mental health conditions. TAKEAWAY: Children with food allergies had significantly higher risks of being diagnosed with eating disorders (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.42-2.41), anxiety (aHR, 1.35; 95% CI, 1.25-1.45), and depression (aHR, 1.24; 95% CI, 1.11-1.39) than children without food allergies. Children with food allergies had a significantly lower risk for depression than their peers with asthma (aHR, 0.77; 95% CI, 0.68-0.87) and those with type 1 diabetes (aHR, 0.64; 95% CI, 0.54-0.76). The risk for anxiety was significantly lower among children with food allergies than among those with asthma (aHR, 0.86; 95% CI, 0.79-0.91). IN PRACTICE: 'In light of these results, we recommend a holistic approach to FA [food allergy] management that integrates mental health screening and support into routine care,' the authors wrote. 'This could involve regular psychological assessments, educational programs about potential mental health risks for patients and families, and closer collaboration between allergists and mental health professionals,' they added. SOURCE: Natalie Flaks‑Manov, with KI Research Institute, Kfar Malal, Israel, was the lead author of the study, which was published online on July 16 in the European Journal of Pediatrics. LIMITATIONS: The study was potentially limited by its retrospective design and reliance on routine electronic health record data, lacking confirmation of mental health diagnoses by specialists or use of standardized tools. Additionally, data on both the severity of various conditions and family history of mental illness were missing. DISCLOSURES: The authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
6 days ago
- Health
- Medscape
Direct Primary Care Providers Get a Major Policy Win
Clinicians who provide 'direct primary care' (DPC) and their patients are gaining a major windfall from the recently passed federal budget reconciliation legislation. Thanks to the 'Big Beautiful Budget Bill,' patients will be able to dip into their health savings accounts (HSAs) to pay for DPC services, which are designed to offer relief from assembly-line medicine. DPC providers are enthusiastic about the change, which will go into effect on January 1. But a critic warns that DPC, which emphasizes smaller patient loads and longer appointments, squeezes other forms of primary care and hurts the poor. Here's a closer look at what the new policy means. What Is DPC? DPC is a healthcare delivery model that allows physicians to contract directly with patients or employers for a fixed monthly membership fee. The DPC membership fees typically cover unlimited routine primary care services and lab work plus preventive care, basic procedures, and vaccinations — but not prescription drugs or specialty services. There are no copays. This is in contrast to traditional employer health plans that involve multiple stakeholders who 'take a piece of the pie,' such as third-party administrators, pharmacy benefit managers, and insurance brokers, said healthcare attorney Barbara Zabawa, JD, of Kansas City, Kansas, in an interview. Why Do People Like It? DPC providers say the model allows them to escape the bureaucratic constraints of traditional healthcare systems. The providers also tout patient perks such as same- or next-day appointments, shorter wait times, and more personalized care. 'Generally, DPC physicians have a panel of between 600 and 800 patients. In typical FFS [fee for service] settings, the patient panels tend to range from between 2000 and 2500 per family physician,' the American Academy of Family Physicians (AAFP) says. Critics, however, say DPC hurts primary care access overall. In a 2018 JAMA commentary, two physicians wrote that 'DPC presents physicians with an incentive structure built on accepting healthier patients with limited healthcare needs and a willingness to pay a retainer fee. Practices directly benefit when targeting healthier patients and declining coverage to the ill.' In addition, they wrote, 'DPC practices once held accountable through value-based payment systems have no obligation to report or measure quality metrics.' Is DPC the Same as Concierge Care? The terms are often used interchangeably, said healthcare attorney Joanna Eimer of Glenview, Illinois, in an interview although she thinks of them as distinct. DPC is a kind of concierge care, she said, 'but there are a lot of concierge services that have grown and become bigger, different kinds of models that include other services as well besides direct primary care.' There are other differences. 'Concierge care' is also often used as shorthand for highly expensive, luxury health services that are marketed to ultra-wealthy people and may cost tens of thousands a year. And as the 2018 JAMA commentary noted, in contrast to concierge care, 'the DPC model traditionally does not 'double dip' by billing insurers.' What About Patients on Medicare? According to AAFP, 'primary care practices can continue to see Medicare beneficiaries, as long as the practice's retainer fee does not cover services already covered under Medicare.' What Does the New Legislation Do? It allows people with high-deductible health plans to use HSA funds to pay for qualifying DPC membership fees up to a limit of $150 a month for one person or $300 for a couple or family. The fees will no longer be considered ineligible health insurance payments. DPC arrangements may not cover prescription drugs (other than vaccinations), laboratory services 'not typically administered in an ambulatory primary care setting,' and procedures requiring general anesthesia are excluded. According to KFF , the change is expected to cost the federal government about $2.8 billion through 2034. 'This is a big, big win, a big boon for people trying to use their HSAs and be a part of these DDC arrangements who weren't allowed to take advantage of these savings before,' Eimer said. 'It gives them more flexibility.' How Big Is DPC? According to the DPC Coalition, more than 2300 DPC practices in 48 states and Washington, DC, serve more than 300,000 patients. The organization says that 'as of 2025, 34 states have enacted laws and regulations generally defining DPC as a medical service outside of state insurance regulations as well as offering varying levels of consumer protection.' Who's Behind All This? A bipartisan group of House representatives have pushed for changes in the HSA policy regarding DPC, including physician Kim Schrier, MD (D-WA). AAFP is a prominent supporter of DPC. Will This Change Encourage More DPC Use? It's unclear what the change in policy will mean for DPC, whose growth has skyrocketed in recent years and is expected to continue expanding at a rapid clip. However, plenty of Americans — one estimate puts the number at nearly half of private-sector workers — are enrolled in high-deductible health plans. For now, at least, the new regulations should reduce confusion among patients and clinicians. Amy Mechley, MD, a DPC provider in Cincinnati, said the existing law regarding DPC and HSAs could be interpreted in different ways, and she couldn't give her patients firm guidance about what to do. Some got frustrated. 'This is absolute move in the right direction so that they're more in charge of how they're going to finance their healthcare,' she said in an interview. Are There Direct Care Practices in Specialty Medicine? Yes. The legislation regarding HSAs doesn't affect them. Is Everyone Pleased? No. Stephanie Woolhandler, MD, MPH, a primary care physician and researcher with Hunter College in New York City, worried about the broader implications for healthcare equity. On one hand, she said, 'it's pretty easy to understand why patients who have the money would choose to buy their way out of the dysfunctional system. It's also easy to understand why doctors who are so frustrated with collecting insurance payments would want to walk away.' However, DPC 'actually worsens the situation for patients who don't have the money to pay extra since it tends to take doctors out of the primary care pool and has them taking care of a smaller number of patients.' She added that HSAs 'don't work very well for poor people because they often don't have any money to put in, or their employer doesn't put much in,' she said. But they're great for 'wealthy people in higher-tax brackets who are in very good health.' In the big picture, she said, 'by abandoning people who can't pay that extra fee for direct primary care, you're actually making the whole financing system worse, not better. We need to change the system, but this is going in the wrong direction.'
Yahoo
21-07-2025
- Health
- Yahoo
GP honoured for 35 years of helping the homeless
A GP from Leicester who has worked to improve the health of homeless people since 1990 has been given an honorary doctorate. Dr Nigel Hewett accepted an honorary Doctorate of Science award from the University of Leicester at a ceremony at De Montfort Hall on Thursday. In 2000, he set up the Leicester Homeless Primary Healthcare Service - which became Inclusion Healthcare - to provide services for homeless and other marginalised people. He was awarded an OBE in 2006 for services to homeless people and in 2009 he launched University College London Hospital's Pathway homelessness team. A lifelong Leicester resident, Dr Hewett said he was "delighted and humbled" by the honour. "Leicester has an outstanding primary health care service for people experiencing homelessness and asylum seekers," he said. "We should be proud to be national leaders in this field and this humbling award is a recognition of multidisciplinary team work over the decades." In 2010, he was a founder member of the Faculty for Homeless and Inclusion Health and became medical director of Pathway – a charity formed to support the faculty and improve the healthcare of homeless people and other excluded groups. Dr Hewett told the BBC: "I've always felt drawn to people on the margins of society and people who have had the most to gain from health care. "There's a thing called the inverse care law which suggests that the more you need medical care the harder it is to get it and homeless people are at the extreme end of that spectrum of deprivation." Homeless 'feel invisible' Dr Hewett said he saw one of his former patients while visiting the University of Sheffield. The patient had problems with heroin, but with the help of methadone went on a long-term detox and is now signing on for a PhD after completing a degree in criminology. "There's always a way back," Dr Hewett said. "You have to hang on to the wins in this work, because for most people they have age of death in the early 40s and it's often a very sad story." He added that homeless people often "talk of feeling invisible" and said "the rest of us can help, I think, by just making eye contact and saying hello". Follow BBC Leicester on Facebook, on X, or on Instagram. Send your story ideas to eastmidsnews@ or via WhatsApp on 0808 100 2210. More on this story Kasabian frontman receives honorary degree Council to keep new flats for homeless families Council to buy student flats to house homeless Related internet links University of Leicester Solve the daily Crossword
Yahoo
21-07-2025
- Health
- Yahoo
GP honoured for 35 years of helping the homeless
A GP from Leicester who has worked to improve the health of homeless people since 1990 has been given an honorary doctorate. Dr Nigel Hewett accepted an honorary Doctorate of Science award from the University of Leicester at a ceremony at De Montfort Hall on Thursday. In 2000, he set up the Leicester Homeless Primary Healthcare Service - which became Inclusion Healthcare - to provide services for homeless and other marginalised people. He was awarded an OBE in 2006 for services to homeless people and in 2009 he launched University College London Hospital's Pathway homelessness team. A lifelong Leicester resident, Dr Hewett said he was "delighted and humbled" by the honour. "Leicester has an outstanding primary health care service for people experiencing homelessness and asylum seekers," he said. "We should be proud to be national leaders in this field and this humbling award is a recognition of multidisciplinary team work over the decades." In 2010, he was a founder member of the Faculty for Homeless and Inclusion Health and became medical director of Pathway – a charity formed to support the faculty and improve the healthcare of homeless people and other excluded groups. Dr Hewett told the BBC: "I've always felt drawn to people on the margins of society and people who have had the most to gain from health care. "There's a thing called the inverse care law which suggests that the more you need medical care the harder it is to get it and homeless people are at the extreme end of that spectrum of deprivation." Homeless 'feel invisible' Dr Hewett said he saw one of his former patients while visiting the University of Sheffield. The patient had problems with heroin, but with the help of methadone went on a long-term detox and is now signing on for a PhD after completing a degree in criminology. "There's always a way back," Dr Hewett said. "You have to hang on to the wins in this work, because for most people they have age of death in the early 40s and it's often a very sad story." He added that homeless people often "talk of feeling invisible" and said "the rest of us can help, I think, by just making eye contact and saying hello". Follow BBC Leicester on Facebook, on X, or on Instagram. Send your story ideas to eastmidsnews@ or via WhatsApp on 0808 100 2210. More on this story Kasabian frontman receives honorary degree Council to keep new flats for homeless families Council to buy student flats to house homeless Related internet links University of Leicester
