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Policy recommendations for use of telemedicine in primary care

( 1. ACP recommends policies for practicing telemedicine in primary care Free:
URLs go live when embargo lifts

In a new position paper, the American College of Physicians (ACP) says that telemedicine can improve access to care, but policies are needed to balance the benefits and risks for both patients and physicians. The authors note that conscious scrutiny is especially important as policymakers and stakeholders shape the landscape for telemedicine going forward. The position paper, A Guide to the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper, is published in Annals of Internal Medicine.

Telemedicine is the use of technology to deliver care at a distance. While the use of technology, including electronic health records, patient portals, and telemedicine can augment the practice of medicine in an efficient and secure way, there are risks and challenges associated with their use. In its policy paper, ACP supports the expanded role of telemedicine as a method of health care delivery and offers more than a dozen policy statements and recommendations for utilization and reimbursement.

An accompanying editorial suggests that telemedicine offers an opportunity for significant cost savings compared to traditional office visits. The author writes that the innovation telemedicine promises is not just doing the same thing remotely that used to be done face-to-face, but instead recognizing that many things thought to require an office visit actually don't.

Notes: For an embargoed PDF and author contact information, please contact Cara Graeff. To speak with the lead author, please contact David Kinsman at

2. Task Force finds insufficient evidence to make recommendations on iron screening or supplementation in pregnant women and young children
Free abstract:
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The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against screening for iron deficiency anemia in pregnant women and young children and iron supplementation in pregnant women. The Task Force recommendation statement for asymptomatic pregnant women is published in Annals of Internal Medicine. A recommendation for screening for iron deficiency anemia in young children will be published simultaneously in Pediatrics.

The aim of iron supplementation or screening for and treatment of iron deficiency anemia in pregnant women is to improve maternal and infant health outcomes. Researchers for the Task Force reviewed published evidence to assess the association between change in iron status as a result of supplementation or treatment in pregnant women and adolescents and improvement in maternal and infant health outcomes. The researchers found insufficient evidence to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women to prevent adverse maternal health and birth outcomes. They also found insufficient evidence to assess the balance of benefits and harms of routine iron supplementation.

Note: The URLs, including video link, will be live when the embargo lifts. For an embargoed PDF, please contact Cara Graeff. To interview a member of the Task Force, please contact Ana Fullmer at or 202-350-6668.

3. Shingles vaccine a poor value for younger patients
Free abstract:
URLs go live when embargo lifts

A cost-effectiveness study supports the decision of the Advisory Committee on Immunization Practices (ACIP) not to recommend the herpes zoster (shingles) vaccine to patients aged 50 years. According to the study being published in Annals of Internal Medicine, the vaccine does not seem to be a good value for patients in this age group.

Shingles affects approximately one million Americans every year, many of whom develop postherpetic neuralgia (PHN). Currently, the shingles vaccine is licensed for persons aged 50 years or older but is recommended only for patients 60 years or older. Researchers used a computer model to assess the cost-effectiveness of the shingles vaccine for adults aged 50 years with healthy immune systems. They found that while the vaccine is highly efficacious at that age, the incidence of both herpes zoster and PHN is low. The vaccine would be ineffective in 10 years, which is the age at which vaccination is currently recommended and at which shingles incidence increases rapidly. At current costs, the shingles vaccine is too expensive to be considered a good value for younger patients.

Note: The URLs, including video link, will be live when the embargo lifts. For an embargoed PDF, please contact Cara Graeff. To interview the lead author, please contact Katrina Healy at or (216) 444-4255.

Also in this issue:

The Financial Effect of Value-Based Purchasing and the Hospital Readmissions Reduction Program on Safety-Net Hospitals in 2014: A Cohort Study
Matlin Gilman, BA; Jason M. Hockenberry, PhD; E. Kathleen Adams, PhD; Arnold S. Milstein, MD; Ira B. Wilson, MD, MSc; and Edmund R. Becker, PhD
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Collateral Damage: Pay-for-Performance Initiatives and Safety-Net Hospitals
Steffie Woolhandler, MD, MPH, David U. Himmelstein, MD

Calls for Caution in Genome Engineering Should Be a Model for Similar Dialogue on Pandemic Pathogen Research
Marc Lipsitch, DPhil; Kevin Esvelt, PhD; and Thomas Inglesby, MD
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Time to Get Off the Diagnosis Dime Onto the 10th Revision of the International Classification of Diseases
Scott Manaker, MD, PhD
Ideas and Opinions

Why Physicians Hate "Patient Satisfaction" but Shouldn't
Ira S. Nash, MD
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