Family Medicine

Automated EHR workflows substantially increase recognition and treatment of urinary incontinence

Across 43 primary care practices, 72,009 women completed an automated urinary incontinence (UI) screen during annual visits, median age 54 years. About 9% reported bothersome UI and interest in information, triggering an online education module plus clinician alerts and order sets. UI diagnoses increased immediately by 0.51 per 100 encounters and continued rising by 0.55 per 100 encounters annually after implementation. Pelvic floor physical therapy referrals showed similar gains, with a 0.38 per 100 encounters step increase and further annual growth. 1

Telemedicine episodes cost far less and generate fewer follow-up visits than in-person care

This target trial emulation compared 163,308 ambulatory telemedicine and in-person visits for 10 common conditions in one health system. After propensity matching, mean 30-day episode charges were $96.60 for telemedicine vs $509.21 for in-person visits, a $412.62 difference. Telemedicine episodes had 23% fewer follow-up visits within 30 days than in-person care, despite similar clinical indications. Episode charges were similar across modalities for some mental and behavioral diagnoses, suggesting condition-specific economics. 2

Lay CHWs using mobile support improve BP control versus facility-based hypertension care

In rural Lesotho, 547 adults with uncontrolled hypertension from 103 villages were randomized to lay community health worker (CHW) care or usual referral. CHWs used mobile decision support to independently prescribe and titrate fixed-dose amlodipine–hydrochlorothiazide; controls were referred to health facilities. At 12 months, BP control (<140/90 mm Hg) was achieved in 58% of intervention vs 48% of control participants. The adjusted odds of BP control were higher with CHW-led care (OR 1.52, 95% CI 1.01-2.29), without meaningful safety differences. 3