NEJM - Health Policy and Reform

New England Journal of Medicine, Volume 380, Issue 18, Page 1685-1688, May 2019.

BACKGROUND: Physicians with poor malpractice liability records may pose a risk to patient safety. There are long-standing concerns that such physicians tend to relocate for a fresh start, but little is known about whether, how, and where they continue to practice. METHODS: We linked an extract of the National Practitioner Data Bank to the Medicare Data on Provider Practice and Specialty data set to create a national cohort of physicians 35 to 65 years of age who practiced during the period from 2008 through 2015...

BACKGROUND: The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS: In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12...

Angiotensin-receptor blockers (ARBs) are one of four drug classes recommended for the initial treatment of hypertension. These medications are commonly used not only for hypertension — a condition present in 45.6% of U.S. adults — but also for heart failure and chronic kidney disease. On January..

BACKGROUND: The United States is undergoing a crippling opioid epidemic, spurred in part by overuse of prescription opioids by adults 25 to 64 years of age. Of concern are long-duration and high-dose initial prescriptions, which place the patients and their friends and relatives at heightened risk for long-term opioid use, misuse, overdose, and death. METHODS: We estimated the incidence of initial opioid prescriptions in each month between July 2012 and December 2017 using administrative-claims data from across the United States (accessed through Blue Cross-Blue Shield [BCBS] Axis); monthly incidence was estimated as the percentage of enrollees who received an initial opioid prescription among those who had not used opioids (i...

This interactive graphic allows viewers to explore data — gathered by Reed F. Beall, Thomas J. Hwang, and Aaron S. Kesselheim — on the time required for investigational drugs to reach important U.S. milestones, such as new drug applications, FDA approval, expiration of market exclusivity, and..

Public–private partnerships in global health have achieved remarkable successes in key areas in which governments and nongovernmental organizations acting alone have struggled. Gavi, the Vaccine Alliance, which was founded as a public–private partnership, has saved millions of lives by making..

Ms. G. a 39-year-old pregnant farmworker, presented as a new patient to a community health clinic. She told her new family physician, Dr. D. that she had already received an ultrasound, pelvic exam, and screenings for glucose tolerance and communicable diseases at another clinic in a nearby state,..

I recently cared for a patient, Ms. Clark, admitted with a cardiac complication of a primary pancreatobiliary process. The details of her pathology, however, are less relevant than the attitudes of her clinicians: we were caught in an endless loop of passing the buck. We on the primary cardiology..

I am racist. I would love to believe otherwise and can find evidence that I am not — my career dedicated to caring for underserved women of color, my support of colleagues and trainees who are people of color, my score on the implicit-association test. My mission as a white physician is to be..

"Keep in mind these data are reflective of patients’ perception of their care; whether or not we, as providers, agree, that perception is legitimate." As the medical director of patient experience at the Mayo Clinic in Arizona, I’ve repeated this line countless times to clinicians and practice..

In my addiction medicine practice, patients with opioid use disorder (OUD) have asked me to help them discontinue use of buprenorphine or methadone before upcoming jail stays for pending or new charges, even when they are doing well on their current treatment. Because treating OUD with medications..

On Christmas Day about a decade ago, Thor Sundt, now chief of cardiac surgery at Massachusetts General Hospital, was urgently summoned to transplant a heart into a young man with ischemic heart disease. Sundt’s satisfaction with the man’s hemodynamic stability turned to horror when, the next day,..

I have been fired by a patient — explicitly and to my face — just once. It happened during my first year after residency, and although I can no longer recall the patient’s name, I can still see her pretty face, carefully styled hair, and barely contained terror. Certainly, I remember when she stood..

Mr. O. a 43-year-old man with severe, destructive rheumatoid arthritis, had been receiving acetaminophen–hydrocodone at low doses from his primary care provider (PCP) for 15 years. He worked in an auto-parts factory in southeastern Michigan, and pain control was essential to maintaining his..

In November 2018, the Food and Drug Administration (FDA) proposed issuing a ban on menthol-flavored cigarettes, which, noted FDA Commissioner Scott Gottlieb, "represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes" and "disproportionately and..

BACKGROUND: Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge. METHODS: We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months...

Though medicine can inure us to the extraordinary, on a Saturday night about a year ago, I witnessed something striking: a group of doctors, on call for Brigham and Women’s Hospital’s "Shock Team," got on the phone to talk to each other. The team had been created for patients just like the one they..

The emergence of new direct-acting antiviral drugs (DAAs) has revolutionized the treatment of hepatitis C virus (HCV); these more effective and better tolerated drugs allow for cure rates exceeding 90%. The price of these new therapies, however, is prohibitive in many countries, so creative..

High prices can restrict access to medicines in rich and poor countries alike. Australia’s approach to providing direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) suggests that, under certain conditions, innovative approaches to payment can remove price as a barrier to..