Wednesday, January 31, 2024

Gene editing and health care

Imagine a world where genetic diseases are a thing of the past, harmful mutations can be corrected, and crops are enhanced for better nutrition. This isn't science fiction—it's the promise of gene editing, a powerful tool that holds the key to a revolutionary transformation in healthcare. As primary care physicians, you play a pivotal role in understanding and harnessing the potential of gene editing to improve patient outcomes. This article delves into the exciting possibilities gene editing presents and examines its implications across diverse medical domains.


The basics of gene editing


Gene editing can be likened to a "find and replace" tool for genetic information, similar to how we fix typos in computer documents. As this tool corrects text, gene editing technologies like Crispr-Cas9 allow scientists to rewrite DNA, altering physical traits and addressing hereditary diseases. This method involves precision changes to specific genes, offering a promising future for genetic diversity and trait modification.

How gene editing works
  • A popular molecular tool, Crispr-Cas9, is a guiding light in gene editing.
  • Crispr-Cas9 targets specific genetic regions, including mutated genes.
  • The enzyme Cas9 cuts the target gene, allowing the cell to repair itself.
  • Harmful genes can be disabled through this process, showcasing gene editing's potential.

A leap forward in genetic disease treatment
  • Gene editing offers a revolutionary approach to treating genetic disorders.
  • Thousands of genetic disorders affect individuals, with conditions like cystic fibrosis and sickle cell anemia being common.
  • Rewriting faulty DNA and modifying immune cells promise to cure or prevent genetic diseases.
  • Designed cells can enhance resistance to infections like HIV and aid in cancer treatment.
  • Editing human embryos is also on the horizon, but ethical considerations and risks accompany this approach.

Precision gene editing for tumor treatment
  • CRISPR/Cas9 holds the potential for improving cancer treatments.
  • Editing specific genes could alter tumor behavior and improve therapies.
  • Clinical trials show promise, but long-term research and ethical guidelines are essential.

Revolutionizing agriculture and nutrition through gene editing
  • Gene editing transforms agriculture with its speed, accuracy, and cost-effectiveness.
  • Unlike traditional genetic modification, gene editing doesn't involve introducing genes from other organisms.
  • Crops like seedless tomatoes and gluten-free wheat can be developed using gene editing techniques.


Ethics and regulations in gene editing


Progress isn't without its ethical and regulatory intricacies. For primary care physicians, comprehending these dimensions is critical as they venture into uncharted territories of medical advancement.

Ethical considerations and challenges
  • While gene editing is precise, errors can occur, and off-target effects are a concern.
  • Misuse of gene editing for non-therapeutic purposes raises ethical debates.
  • Safety and effectiveness must be established before reproductive applications.

Gene editing risks
  • Primary care physicians must inform patients of potential unintended changes.
  • Patient consent is crucial before proceeding with gene editing interventions.
  • Regulations for gene editing in reproductive contexts vary globally.


Gene editing's impact on reproductive health and beyond


Bridging beyond health, gene editing casts ripples across generations. This section delves into its influence on reproductive health and broader societal realms, triggering profound ethical dialogues.

Benefits and complexities of gene editing
  • Editing human embryos can prevent hereditary diseases but poses inheritable changes.
  • Clear legal frameworks and ethical guidelines are necessary to ensure responsible use.

Navigating the future of gene editing
  • Ongoing trials worldwide, like gene edits for improved lung cancer outcomes in China, shape the future.
  • Base editing, a non-cutting approach, offers new possibilities for rewriting genetic code.
  • Gene drives and epigenome editing also hold promising avenues for research.


Embracing challenges for a brighter tomorrow


As primary care physicians, you are at the forefront of healthcare innovation. To fully realize the benefits of gene editing, addressing challenges is essential. Regulatory bodies, policymakers, and the medical community must collaborate to ensure the safe and responsible use of gene editing. This transformational tool demands support from research groups and visionary scientists. Equally important is raising public awareness and promoting education to prevent misuse. By embracing these changes, you can lead the way in ushering in a new era of healthcare driven by the revolutionary potential of gene editing.


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Fulfilling the growing need for primary care

In the United States, we are facing an increasingly severe shortage of primary care physicians: More than 100 million Americans do not have access to primary care due to a lack of providers in their local community. Even before the COVID-19 pandemic, the Association of American Medical Colleges was already predicting a primary care shortage of as many as 48,000 doctors by 2034. As increased burnout rates push many physicians into early retirement from primary care, the true scale of the future shortage may be expanding.

The American Association of Nurse Practitioners (AANP) reports that nearly 90% of nurse practitioners (NPs) have been trained in primary care, and the American Academy of Physician Assistants (AAPA) reports that almost a quarter of physician assistants (PAs) specialize in primary care. The U.S. Bureau of Labor Statistics estimates that NPs are the fastest-growing profession in the nation, and PAs are not far behind. Through 2030, the CAGR for NPs is forecasted to be 6.8%, with 4.3% for PAs.

NPs and PAs, alongside nurse anesthetists and midwives, are pivotal to addressing the primary care gap, now and in the near future. Our primary care landscape is not only facing a physician shortage, but also a massive shift in our systems for health care delivery. Corporate giants continue to extend their reach into primary care. For instance, Amazon recently completed its acquisition of One Medical for $3.9 billion. These new options in the health care space are shifting patients’ expectations. In response, many traditional primary care practices and health care systems are modifying their care delivery models.

Meanwhile, many patients find themselves exhausted from and exasperated by the many barriers to swift access to care – and yet craving an ongoing relationship with a trusted medical professional. APCs may be the United States health care system’s linchpin to restoring that all-important continuity of care.


Role definition and authorization protocols enable top-of-license practice


Many medical practices, health care systems, and hospitals – not to mention retail clinics – are recognizing the value of incorporating APCs into their teams. With thoughtful consideration of role definition and authorization protocols, traditional practices that add APCs to their clinician roster can give patients swifter access to care, while allowing physicians to focus on complex cases. In this way, patients benefit from greater access to care, while clinicians enjoy the professional satisfactions and business efficiencies of practicing at the tops of their licenses.


Integration of advanced practice clinicians improves continuity of care, care access


The specifics of scope of practice and supervisory requirements for APCs vary from state to state, but APCs know when to consult a physician, just as primary care physicians consult and collaborate with specialists when necessary. Collaboration among physicians and APCs can prepare the ground for longitudinal practice, with all the benefits that continuity of care delivers to both patients and practitioners.

Moreover, the benefits stretch far beyond individual patients and clinicians. Patient access to primary care is indispensable for halting the escalation of medical conditions before they reach an urgent or emergent level. This helps preserve access to the emergency department, which benefits our entire health care system and society at large


Scope of practice will continue to evolve


The regulatory environment is also a factor in the increasing prevalence of APCs, as the vast majority of states explicitly identify NPs as primary care providers. The same cannot be said for PAs and other APCs, but given the trend toward increasing physician shortages, and with NPs as a precedent, more APCs could be licensed for independent practice in the next decade.

All these trends have combined into a new landscape for primary care. This new landscape underlies everything from patient-facing interactions to practices’ business structures to clinicians’ liability – APCs who opt for independent practice face a parallel elevation of their liability exposure, and they need superior malpractice coverage, risk management resources, educational support, and practice management solutions to deliver the best possible care to their patients. It is our collective responsibility to evolve and innovate to advance the practice of good medicine.


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Tuesday, January 30, 2024

The latest healthcare KPI influencing the experience: Patient alone time

Patient wait time is an ongoing focal point in discussions surrounding healthcare efficiency. Ambulatory to acute, patients have grown accustomed to their dreaded wait time, but that doesn’t mean it’s any easier to endure. Whether it’s needing to schedule appointments weeks or months ahead of time or sitting in the waiting room, it’s no secret that the longer a patient waits to be seen, the more likely their dissatisfaction for the experience climbs.

However, there is an often-overlooked counterpart: patient alone time. As demands for instant access become more mainstream throughout the patient experience, alone time is taking over as the new KPI to track, and its emergence is influencing how healthcare providers approach the delivery of care.


What is the difference in the clinic between patient wait and alone time?


Wait time is time patients spend in a waiting room.

Alone time is time patients spend in care areas without a caregiver present.


Why is patient alone time an important metric to measure?


Patients consider every aspect of their experience in their satisfaction, and even a fraction of time where patients wait alone could be a make-or-break factor. What message do you think it sends to patients? Consider how alone time impacts the following:

Patient Experience and Satisfaction: Patients, especially in vulnerable situations, may feel anxious, isolated or uncertain when left alone for extended periods. Their emotional state can be jeopardized, and it’s important for caregivers to be mindful of the healthcare experience. Tracking alone time allows caregivers to identify instances where patients may be experiencing discomfort, contributing to a more patient-centered approach.

Patient Engagement and Communication: Monitoring alone time offers a window into the effectiveness of interactions between caregivers and patients. This allows health leaders to identify areas for improvement in their cross-communication, ensuring that patients feel informed and supported throughout their healthcare journey.

Quality of Care: Patient alone time can affect the perceived quality of care. When patients feel attended to and supported, their perception of the care they receive is likely to be more positive. On the other side, with too much alone time, patients may feel their care is lacking. Tracking alone time helps caregivers identify and address any gaps in the experience, enhancing the overall quality of care.

Operational Efficiency and Resource Allocation: Understanding patterns of alone time helps optimize resource allocation and workflow management. This enables healthcare facilities to identify peak times and areas where additional staff or process improvements may be needed. The insights derived from tracking alone time improve operational efficiency and contribute to a more streamlined and patient-focused healthcare environment.


How can you measure patient alone time?


The tricky part about alone time is that it’s impossible to track without the right technology. To reduce the amount of patient alone time, consider modernizing the experience with insightful and accurate information fueled by real-time locating system (RTLS) technology.

An RTLS uses location information to automatically identify movements in your facility in real time. Staff and patients wear RTLS badges that emit signals, read by sensors placed throughout the facility. A server processes the signals and turns them into location data, displayed on a digital white board for care teams. This location data is a real-time, clear-picture view of your entire operations.

Visual cues with timestamps indicate to staff which patient may be waiting for the next step in their visit (e.g., the provider, labs, imaging or treatment) and for how long. This may seem simple, but the increased visibility that comes from the accurate, timely RTLS data empowers staff to stay on top of patient alone time and cues staff to keep a visit progressing when possible.


How can insights derived from RTLS data address alone time?


Clinics: Outpatient care is the backbone of a healthy patient population. With a shift to valued-based medicine, outpatient visits are growing exponentially, doubling the rest of the healthcare continuum combined.1 However, clinics are having a hard time juggling the increased care needs with the staff and resources they have. With a look inside your clinical workflow through automated RTLS data, this is where you identify non-value-add time, specifically patient alone time, that is keeping a visit from progressing and affecting the experience. When you identify those bottlenecks through the RTLS data, you’ll be able to make more informed decisions that can positively impact scheduling and how patients move through the clinic. Providers have the potential to see more patients per day, without sacrificing quality face-to-face time.

Oncology: Cancer care is very delicate, and it’s especially important in these settings to optimize a patient’s experience by making them feel comfortable while in a sensitive state. Although alone time is expected during treatment—oncology patients are often sitting in an infusion chair for hours—that doesn’t mean caregiver engagement should stop. Most oncology centers require checking on the patient every 30-45 minutes, but this can be difficult to stay on top of during busy routines. RTLS technology can help by providing visual cues of alone time on automated, digital whiteboards, so the attending nurse can proactively engage with patients, making a big impact on the patient experience.

Acute: In acute care, especially for patients with certain conditions or who are at risk of falling, extended alone time may pose safety concerns. In critical care or post-surgery recovery settings, timely responses to changes in a patient's condition are crucial. Monitoring alone time allows for more informed rounding routines and timely patient care that contribute to overall patient well-being and experience.


What should health systems do next?


Patient flow solutions, powered by RTLS technology, offer a dynamic approach to measure and mitigate patient alone time. Fueling care teams with real-time information about a patient’s visit, RTLS helps ensure timely and proactive patient engagement, contributing to a more patient-centered and efficient healthcare environment. Embracing RTLS is more than a technological upgrade; it's a strategic investment in elevating patient care, staff productivity and operational excellence across the entire healthcare continuum.


1. NCHS, National Ambulatory Medical Care Survey, 2019. US Census.



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