30-Second Takeaway
- Produce prescriptions for food-insecure adults with diabetes did not improve glycemic control or utilization versus usual care.
- A digital, multifaceted stewardship program sharply reduced outpatient ARI antibiotic use in rural primary care without safety trade-offs.
- Long-term wildfire smoke PM2.5 exposure modestly increased cardiovascular hospitalizations among older adults, especially at moderate exposure levels.
- High telehealth reliance in VHA primary care correlated with slightly worse preventive and chronic care metrics versus hybrid models.
- In HFrEF, early SGLT2 inhibitor use and fluid restriction were each linked to lower mortality or hospitalizations in separate analyses.
Week ending February 21, 2026
What’s new for general internists this month: food-as-medicine setbacks, safer diabetes prescribing, and evolving heart failure and telehealth care
Produce prescriptions for food-insecure adults with diabetes failed to improve glycemic outcomes
In this pragmatic RCT of 2,155 food-insecure adults with diabetes, a $80/month produce prescription worsened HbA1c slightly versus usual care at 12 months. The adjusted between-group HbA1c difference was 0.20 percentage points (95% CI, 0.05%-0.35%), favoring usual care. There were no significant differences in emergency department visits, inpatient visits, blood pressure, or BMI between groups. Engagement was modest, with only 30% using at least 80% of their monthly benefit, limiting potential clinical impact. These findings challenge assumptions that produce debit-card programs alone improve cardiometabolic outcomes in primary care populations.
Digitally enabled stewardship cut ARI antibiotic prescribing in rural primary care
A cluster RCT in 34 rural township hospitals in China tested a comprehensive, digital antibiotic stewardship program for acute respiratory infections. The program combined clinician training, EMR-embedded guidelines with prompts, monthly peer-feedback, and patient education via smartphone app. Antibiotic use fell to 26% of ARI visits in intervention sites versus 71% in controls, an adjusted risk difference of -39 percentage points. Thirty-day hospitalizations for respiratory illness or sepsis did not increase, suggesting no major safety signal with reduced prescribing. This model illustrates how integrated digital tools and feedback can sharply reduce outpatient antibiotic overuse for ARIs.
Long-term wildfire smoke PM2.5 exposure modestly increased CVD hospitalizations in Medicare beneficiaries
A cohort of 65.2 million U.S. Medicare beneficiaries (≥65 years) linked 3-year wildfire smoke PM2.5 exposure with first cardiovascular hospitalization risk. Using quasi-Poisson models, risk rose nonlinearly, peaking at moderate exposure levels of 0.26–0.32 μg/m3. At these levels, relative risks were 1.04 for overall CVD, 1.07 for ischemic heart disease, and 1.06 for arrhythmias versus very low exposure. Cerebrovascular admissions increased steadily with higher exposure, and lower socioeconomic status appeared to confer greater vulnerability. Clinically, older adults in wildfire-prone regions represent a higher-risk group where exposure-reduction counseling and CVD risk optimization may matter.
High reliance on primary care telehealth in VHA linked to small declines in quality measures
This retrospective VHA cohort included 744,599 veterans with at least three primary care visits during 2022–2023. Patients were categorized by telehealth share of primary care: none, low, intermediate, or high (≥50%). Low and intermediate telehealth use produced similar cardiovascular and behavioral quality outcomes compared with all in-person care. High telehealth use was associated with lower influenza vaccination, statin adherence, and depression screening rates versus in-person care. The largest deficits involved services inherently requiring in-person contact, supporting hybrid rather than predominantly virtual primary care models.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.