Rural prevention efforts face specific hurdles

This issue covers topics such as programs that improve rural health, effective advance care planning, and new tools such as precision medicine in clinical medicine.

Prevention efforts can be difficult to incorporate into primary care under the best of circumstances, but physicians trying to tackle population health in rural or underserved areas can face even greater challenges. Our story takes a look at a decades-long program in rural Maine that had substantial success (including in hypertension management, cholesterol control, and smoking cessation) and questions what it would take for physicians to implement this kind of multipronged intervention in their rural communities now. Difficulties include physician recruitment and limitations of technology and infrastructure, among others.

ACP has issued guidance in several areas of women's health over the past year, including pelvic exams, cervical cancer screening, and breast cancer screening. Some of the guidance, such as that recommending Pap tests beginning at age 21 and then every 3 years until age 65, has been met with nearly universal agreement, while other recommendations, such as that against annual pelvic screening exams in asymptomatic, average-risk women, engendered more controversy. In our story, our new staff writer, Mollie Durkin, talks to the authors of the guidance to learn more about the science behind the recommendations, as well as to internists and obstetricians/gynecologists to get their take.

Advance care planning has been in the news again lately, ever since the Centers for Medicare and Medicaid Services again proposed in July that physicians be paid for discussing the topic with their patients. As Bob Doherty, ACP's senior vice president for governmental affairs and public policy, discusses in the Washington Perspective, ACP has worked hard for this and other recent advocacy victories. Assuming the proposal is finalized and payments begin in 2016, physicians may have some questions about how to approach this sensitive topic. Our story details the differences between advance care and current care directives and offers advice on discussing patients' wishes with them and with their families.

This issue also looks further into the future at the idea of precision medicine and how the White House's initiative in this area, announced in January, might translate into additional genetic advances that can be used in clinical practice. In addition, this issue includes a report from BIO 2015, an article on managing seizures in primary care, and an examination of how post-discharge visits can best be used to prevent hospital readmissions.

As always, we'd love to hear your thoughts on any of the topics we're covering, or on what you think we should cover. Please contact us any time.


Jennifer Kearney-Strouse