30-Second Takeaway
- EHR nudges and standardized pathways can quickly improve vaccination and concussion care processes in busy clinics.
- Behavior-focused self-management and complex care models improve function and may reduce mortality in high-need patients.
- Patients with chronic illness and social risk factors still face financial and access barriers to preventive and COVID-19 care.
- Pharmacist-led deprescribing appears safe and can reduce inappropriate medications, though effects on hard outcomes remain uncertain.
- Low-cost outreach models, including students, can help close cancer screening gaps and detect clinically important abnormalities.
Week ending January 10, 2026
Practical levers in primary care to boost prevention, chronic care, and medication safety
Multicomponent EHR nudges modestly increase in-visit influenza vaccination in older adults
Across 47 primary care clinics, a multicomponent nudge package increased influenza vaccination during visits for adults ≥50 years. The package combined previsit text reminders, automatic pended vaccine orders, and monthly peer-comparison feedback for clinicians. Vaccination completion was 31.4% with nudges versus 26.4% with usual care, an absolute increase of 5.1 percentage points. Bidirectional texting for patients at high risk of noncompletion did not outperform standard text reminders. These findings support low-burden EHR-based nudges to raise in-visit flu vaccination without complex two-way messaging workflows.
Self-management–focused physiotherapy improves function in chronic low back pain
Thirteen outpatient physiotherapy clinics implemented an enhanced transtheoretical model intervention (ETMI) for chronic low back pain. ETMI emphasized reassurance, addressing unhelpful beliefs, and recreational physical activity while avoiding passive modalities and prescribed exercises. Compared with usual physiotherapy, ETMI produced greater functional improvement and reduced fear-avoidance but similar pain reduction. ETMI patients also required fewer physiotherapy sessions, suggesting greater efficiency. Family physicians can encourage referrals to, or emulate, ETMI-style counseling to reinforce active self-management and limit low-value passive care.
Complex care program lowers 180-day mortality in high-cost, seriously ill adults
In an integrated system, 1445 seriously ill, high-cost adults were empaneled to a complex care program (CCP). Propensity-matched comparison with usual primary care showed lower 180-day mortality for CCP patients (hazard ratio 0.71; 95% CI 0.61-0.82). CCP patients had more comorbidities and greater frailty than the broader eligible population yet still derived survival benefit. This replication cohort supports structured complex care teams as a strategy to reduce short-term mortality in high-need adults.
Patients with chronic conditions more often pay out of pocket for preventive services
Using 2017–2020 claims from over 1.2 million insured patients, preventive services frequently generated out-of-pocket costs despite ACA protections. Patients with ambulatory care–sensitive chronic conditions (ACSCs) more often faced cost-sharing than those without chronic conditions. Preventive services for ACSC patients incurred cost-sharing in about 18% of cases, versus about 16% without ACSCs. Propensity-matched analyses showed higher probability and higher expected preventive out-of-pocket spending among ACSC patients. Clinicians should warn chronically ill patients about possible billing surprises and support appeals when preventive services are misclassified.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.