Looking at LARCs in primary care

This issue includes stories on long-acting reversible contraceptives, medications for type 2 diabetes, and issues affecting the elderly.

More than one in 10 U.S. women of reproductive age use a long-acting reversible contraceptive (LARCs). They aren't often prescribed in primary care, but there are several reasons why experts think they should be. For example, patients may feel more at ease discussing contraceptive options with a clinician who knows them well, and offering LARCs at a primary care visit can improve both access and continuity of care. In our story in this issue, Senior Writer Mollie Frost provides an overview of available LARCs, the training needed to get comfortable with them, and the best ways to talk about these and other methods of contraception with patients.

Medications to treat type 2 diabetes vary widely in type and cost, as well as in what a patient's insurance will pay. While newer drugs offer some health benefits compared with old ones, they're often much more expensive, and as for insulin, its cost has nearly tripled in the past 15 years. It's difficult to add drug costs to the equation when deciding on a diabetes treatment, but doing so can increase the chances of its success. Our story offers internists advice about finding data on costs, discussing them with patients, and prescribing the treatment that fits each individual patient best.

Speaking of diabetes, this issue's Pearls from I.M. Peers column features Irl B. Hirsch, MD, MACP, a specialist in diabetes care at the University of Washington in Seattle. Read his tips on starting and titrating basal insulin in patients with type 2 diabetes, then go online to watch a related video on the limitations of HbA1c.

Three articles in this issue focus on the elderly. In a Q&A, a geriatrician explains why physicians may want to ask about money management in their standard review of symptoms. Another feature story offers a look at advance care planning, and a Success Story introduces a free app that can streamline screening for delirium in the hospital.

Our Conference Coverage this issue is from the American Medical Women's Association's 107th Annual Meeting, held virtually at the end of March. Learn from Carrie A. Horwitch, MD, MACP, an ACP Well-being Champion and a certified Laughter Leader, about the value of therapeutic laughter, and why laughter and humor are not the same.

Also in this issue, a feature story outlines the ever-changing field that is perioperative medicine during a pandemic, and Ryan D. Mire, MD, FACP, ACP's new President for 2022-2023, shares his thoughts on the importance of staying connected through touch rather than tech.

Do you ask your patients about their finances? Do you have an idea for the Pearls from I.M. Peers column? Let us know at


Jennifer Kearney-Strouse
Executive Editor