Prenatal Care via Telehealth.

During the COVID-19 pandemic, providers and patients explored the use of telehealth on a wide and rapid scale. Reflecting on how prenatal providers and pregnant patients used telehealth during the pandemic and afterward, we review existing and new lessons learned from the pandemic. This article summarizes international and national guidelines on prenatal care, presents practice examples on how telehealth and remote patient monitoring were used during the COVID-19 pandemic, and offers lessons learned and suggestions for future care.

United States Family Medicine research collaborations associated with higher citation and funding rates.

INTRODUCTION Among academic medical disciplines, Family Medicine (FM) research is notable for its breadth of health-care content areas, making it particularly susceptible to interdisciplinary collaboration. AIM This study characterises the degree and typology of such collaborations, and determines whether collaboration patterns are associated with citation frequency and funding. METHODS This cross-sectional study describes collaboration patterns for publications from 2015 indexed in Web of Science and authored by faculty from United States (US) departments of family medicine (DFMs). We determined mean number of total and FM authors per publication, and percentage of publications with FM first or last authors. Publications were categorised by inclusion of non-FM faculty author(s) and number of DFMs represented. RESULTS Overall, 919 FM faculty from 109 DFMs authored a total of 1872 unique publications in 2015. There was an average of 6.8 authors per publication with 1.4 authors being FM faculty. FM faculty were first author on 26.2% and last author on 29.2% of publications. Of all publications, 0.9% were single FM Author; 1.0% were same DFM; 0.3% were multiple DFMs; 72.4% were single FM Author+non-FM; 19.3% were same DFM+non-FM; 6.0% were multiple DFMs+non-FM. FM publications with non-FM faculty authors showed higher citation rates, higher rates of funding, and lower rates of having no funding source. DISCUSSION Most FM publications involved non-FM faculty authors. Collaborations involving non-FM authors were correlated with higher impact publications and projects that were more likely to have been funded.

Lessons Learned During COVID-19 That Can Move Telehealth in Primary Care Forward.

INTRODUCTION: Our university hospital-based primary care practices transitioned a budding interest in telehealth to a largely telehealth-based approach in the face of the COVID-19 pandemic. INITIAL WORK: Implementation of telehealth began in 2017. Health system barriers, provider and patient reluctance, and inadequate reimbursement prevented widespread adoption at the time. COVID-19 served as the catalyst to accelerate telehealth efforts. IMPLEMENTATION: COVID-19 resulted in the need for patient care with "social distancing." In addition, due to the pandemic, the Centers for Medicare and Medicaid Services and other insurers began expanded reimbursement for telehealth. More than 2000 providers received virtual health training in less than 2 weeks. In March 2020, we provided 2376 virtual visits, and in April 5293, which was more than 75 times the number provided in February; 73% of all visits in April were virtual (up from 0.5% in October 2019). As COVID-19 cases receded in May, June, and July, patient demand for virtual visits decreased, but 28% of visits in July were still virtual. LESSONS LEARNED: Several key lessons are important for future efforts regarding clinical implementation: (1) prepare for innovation, (2) cultivate an innovation mindset, (3) standardize (but not too much), (4) technological innovation is necessary but not sufficient, and (5) communicate widely and often.

Integrating behavioral health and primary care: a qualitative analysis of financial barriers and solutions.

The objective of this study was to characterize financial barriers and solutions for the integration of behavioral health in primary care at the practice and system levels. Semi-structured interviews were conducted March-August of 2015 with 77 key informants. Initially a broad thematic coding approach was used, and data coded as "financing" was further analyzed in ATLAS.ti using an inductive thematic approach by three coders. Themes identified included the following: fragmentation of payment and inadequate investment limit movement toward integration; the evidence base for integration is not well known and requires appropriately structured further study; fee-for-service limits the movement to integration-an alternative payment system is needed; there are financial considerations beyond specific models of payment, including incentivizing innovation, prevention, and practice transformation support; stakeholders need to be engaged and aligned to support this process. There was consensus that the current fragmented, fee-for-service system with inadequate baseline reimbursement significantly hinders progression toward integrated behavioral health and primary care. Funding is needed both to support integrated care and to facilitate the transition to a new model. Multiple suggestions were offered regarding interim solutions to move toward an integrated model and ultimately global payment. Payment, in terms of both adequate amount and model, is a significant obstacle to integrating behavioral health and primary care. Future policy efforts must focus on ensuring stakeholder collaboration, multi-payer alignment, increasing investment in behavioral health and primary care, and moving away from fee-for-service toward a global and value-based payment model.

Morel-Lavallée Lesion of the Knee in a Recreational Frisbee Player.

Traumatic swelling/effusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. Imaging, including plain radiography, ultrasound, and magnetic resonance imaging (MRI), is preferred modality. Aspiration of a local fluctuating mass may help with the diagnosis and management of some of these conditions. We present a case of a 26-year-old gentleman with superomedial Morel-Lavallée lesion (MLL) of the knee with history of a fall during a Frisbee game. His MLL was successfully treated with therapeutic aspiration and compression wrap without further sequelae. MLL is a rare condition consisting of a closed degloving injury caused by pressure and shear stress between the subcutaneous tissue and the superficial fascia or bone. Most commonly, MLL is found over the greater trochanter and sacrum but in rare cases can occur in other regions of the body. In most cases, concurrent severe injury mechanisms and concomitant fractures are present. MLL due to sports injuries are very rare. Therapeutic strategies may vary from compression wraps and aspiration to surgical evacuation.