Impacts of a medical-legal partnership on clinical capacity to address social determinants of health.

BACKGROUND: Social determinants of health (SDOHs) impacts on an individual's health outcomes have become more evident, and clinical providers are vital in helping patients address those needs. Providers are experiencing high-stress levels related to patient care, resulting in a diminished capacity to address these SDOHs. This study examines the impact of a medical-legal partnership (MLP) on the clinical capacity to assist providers with addressing SDOH needs and reducing clinician stress. METHODS: A 16-question survey was emailed to 532 providers in a local health system. The survey assessed clinicians' perception of their role in addressing SDOH needs, the MLP's impact on their clinical capacity and the MLP's ability to remedy patient SDOH needs. RESULTS: Providers who have referred to the MLP indicated higher levels of agreement that SDOH screenings were part of their clinical responsibility and had higher levels of agreement regarding comfort levels for completing SDOH screenings. Geriatric providers reported higher levels of agreement that the MLP reduced clinician stress than paediatric providers. CONCLUSION: MLPs have the potential to reduce clinician stress and burnout by standing in the gap to assist providers in addressing their patient's SDOH needs.

Gender Differences in Demographic and Pharmacological Factors in Patients Diagnosed with Late-Onset of Alzheimer's Disease.

BACKGROUND: Whether gender differences exist in late-onset of Alzheimer's disease (LOAD) treated with cholinesterase inhibitors (ChEIs) is not fully understood. This study investigated demographic and pharmacological characteristics in LOAD patients to determine gender differences in LOAD patients treated with ChEIs alone and ChEIs with other medications. METHODS: This 5-year retrospective data analysis included 9290 LOAD AD patients with 2949 men patients and 6341 women. Potential predictors of demographic and pharmacological characteristics associated gender differences in patients treated with and without ChEIs therapy were determined using univariate analysis, while multivariable models adjusted for demographic and pharmacological variables. RESULTS: In the adjusted analysis, men patients with LOAD that presented with a history of alcohol use (ETOH) (OR = 1.339, 95% CI, 1.072-1.672, p = 0.010), treated with second generation antipsychotics (SGAs) (OR = 1.271, 95% CI, 1.003-1.610, p = 0.047), citalopram (OR = 5.103, 95% CI, 3.423-7.607, p < 0.001), memantine (OR = 4.409, 95% CI, 3.704-5.249, p < 0.001), and buspirone (OR = 2.166, 95% CI, 1.437-3.264, p < 0.001) were more likely to receive ChEIs therapy, whereas older men were less likely to be treated with ChEIs therapy. Women who were African Americans (OR = 1.387, 95% CI, 1.168-1.647, p < 0.001), that received memantine (OR = 3.412, 95% CI, 3.034-3.837, p < 0.001), selective serotonin reuptake inhibitor (SSRIs) (OR = 1.143, 95% CI, 1.016-1.287, p = 0.026), and a history of ETOH (OR = 2.109, 95% CI, 1.724-2.580, p < 0.001) were more likely to receive ChEIs therapy, whereas older women were less likely to receive ChEIs therapy. CONCLUSION: In both men and women patients, those with increasing age were less likely to be treated with ChEI therapy, while patients treated with memantine were also likely to receive ChEI therapy. Our findings highlight the importance for clinicians to optimize ChEI in LOAD to improve treatment effectiveness and eliminate gender differences in ChEI therapy.