Hallowell AL, Outland BE, Algase LF
… +2 more, Watkins C, Medical Practice and Quality Committee of the American College of Physicians
Ann Intern Med
· 2026 May · PMID 42150171
·
Publisher ↗
Medicare Advantage (MA), the private plan option within Medicare, now enrolls more than half of all beneficiaries and is projected to keep expanding. The American College of Physicians (ACP) assesses the ethical and poli...Medicare Advantage (MA), the private plan option within Medicare, now enrolls more than half of all beneficiaries and is projected to keep expanding. The American College of Physicians (ACP) assesses the ethical and policy dimensions of this growth and its implications for the delivery of fair, high-quality, and fiscally responsible care to older adults and persons with disabilities. Payment and risk adjustment policies have created vulnerabilities to overpayment and favorable risk selection, whereas quality measurement remains fragmented and overly complex. Beneficiaries often face challenges in navigating plan choice, marketing practices, prior authorization, and access to clinicians and postacute services, with these barriers disproportionately affecting persons with low income, persons with several chronic conditions, or persons who live in rural communities. Limited transparency about ownership structures and relationships between insurers, "provider" networks, and investors complicates accountability and public oversight. ACP calls for reforms to ensure accurate payment, streamline and strengthen quality metrics, and protect enrollees from inappropriate utilization controls while supporting innovations that promote coordinated, patient-centered care. Collaborative engagement among policymakers, clinicians, health systems, insurers, and beneficiaries is essential to align MA with its original purpose and ensure that it complements traditional Medicare while providing accessible, affordable, and high-quality coverage for all who depend on it.
Piggott T, Saadat P, Herrmann A
… +46 more, Tetelbom Stein A, Darzi AJ, Haines A, Bognanni A, Sousa-Pinto B, Michels C, Akl EA, Poluzzi E, Senerth E, Madrid E, Barbic F, de'Donato F, Nonino F, Vist GE, Neumann I, Bracchiglione J, Bousquet J, Meerpohl JJ, Antó JM, Scahill KA, Qiu K, Miersch K, Saif-Ur-Rahman KM, Vasanthan Thinagaran L, Benton L, Schwingshackl L, Siedler MR, Bala MM, Metzendorf MI, Aloosh M, Cinquini M, Cumpston M, Skoetz N, Oloyede O, Alonso-Coello P, Dahm P, Wang Q, Vieira RJ, Morgan RL, Murthy S, Hofstede S, Laot-Cabon S, Thomander T, Siebert U, Leontiadis GI, Schünemann H
Ann Intern Med
· 2026 Jun · PMID 42114098
·
Publisher ↗
Human health and natural systems are intrinsically linked-stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while havin...Human health and natural systems are intrinsically linked-stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap. Guided by the concepts of planetary health and planetary boundaries and following established methods for GRADE guidance development, the project group conducted iterative case study analyses, expert workshops, and a 2-round global Delphi consensus process. Four case studies were selected for application of this guidance before recommendations were finalized. The GRADE Working Group approved the official guidance. The Planetary Health Project Group presents 7 domains of guidance for incorporating planetary health aspects into the guideline development process, including highly desirable items and optional items. Highly desirable items include formally addressing planetary health in public health and health system guidelines and explicitly justifying its exclusion where it is not addressed. Judgments within the evidence-to-decision (EtD) framework should systematically integrate included evidence across the prioritized planetary boundaries and equity. This guidance aims to support guideline developers and policymakers in making evidence-based, trustworthy recommendations to protect individual and planetary health, while maintaining thoroughness and feasibility for guideline developers within the GRADE approach.
Botteri E, Holme Ø, Løberg M
… +4 more, Bretthauer M, Kalager M, Randel KR, Hoff G
Ann Intern Med
· 2026 Jun · PMID 42114097
·
Publisher ↗
BACKGROUND: Meta-analyses of randomized trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and death for 15 years. OBJECTIVE: To report the benefits of sigmoidoscopy after 23 years....BACKGROUND: Meta-analyses of randomized trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and death for 15 years. OBJECTIVE: To report the benefits of sigmoidoscopy after 23 years. DESIGN: Randomized controlled trial. (NORCCAP [Norwegian Colorectal Cancer Prevention], ClinicalTrials.gov: NCT00119912). SETTING: Population of Oslo and Telemark County, Norway. PARTICIPANTS: Persons aged 50 to 64 years without CRC at randomization. INTERVENTION: Screening with once-only sigmoidoscopy, with or without 1 fecal immunochemical test, or no screening. MEASUREMENTS: Colorectal cancer incidence and death. RESULTS: A total of 100 210 persons were randomly assigned, and 98 654 were included in intention-to-screen analyses: 20 552 in the screening group and 78 102 in the no-screening group. Participation with screening was 61.4% in men and 64.7% in women. In men, the 23-year cumulative risk for CRC was 4.3% in the screening group and 6.0% in the no-screening group, corresponding to a risk difference of -1.7 percentage points (95% CI, -2.2 to -1.2 percentage points). In women, the corresponding risks were 4.2% and 4.7%, yielding a risk difference of -0.5 percentage points (CI, -1.0 to -0.01 percentage points). In men, the 23-year cumulative risk for CRC death was 1.4% in the screening group and 2.2% in the no-screening group, corresponding to a risk difference of -0.8 percentage points (CI, -1.1 to -0.5 percentage points). In women, the corresponding risks were 1.3% and 1.4%, yielding a risk difference of -0.1 percentage points (CI, -0.3 to 0.1 percentage points). The effect was strongest for rectosigmoid cancer. The addition of fecal blood testing to sigmoidoscopy did not change screening benefits. LIMITATION: Follow-up through national registries. CONCLUSION: Offering sigmoidoscopy screening in Norway reduced CRC incidence more in men than in women and reduced CRC death only in men. PRIMARY FUNDING SOURCE: Norwegian government and Norwegian Cancer Society.
Ann Intern Med
· 2026 May · PMID 42114096
·
Publisher ↗
Giant cell arteritis is a relapsing large-vessel vasculitis affecting the aorta and its branches. It is the most common vasculitis in persons 50 years of age and older. Vision loss occurs in 18% of patients and is preven...Giant cell arteritis is a relapsing large-vessel vasculitis affecting the aorta and its branches. It is the most common vasculitis in persons 50 years of age and older. Vision loss occurs in 18% of patients and is preventable with prompt recognition, evaluation, and treatment. Large-artery complications include stenosis, aortic aneurysms, or dissections. Glucocorticoid therapy is effective, but nearly 50% of patients experience relapse. Tocilizumab and upadacitinib are efficacious glucocorticoid-sparing therapies. Patients require long-term monitoring for aortic aneurysms, a late disease complication, even after therapy is discontinued.
Johnson D, Quinn S, Algase LF
… +2 more, Watkins C, Medical Practice and Quality Committee of the American College of Physicians
Ann Intern Med
· 2026 May · PMID 42114091
·
Publisher ↗
In response to the COVID-19 pandemic, federal policymakers temporarily lifted long-standing restrictions on telemedicine, resulting in an unprecedented and rapid expansion of virtual care across video, audio, and asynchr...In response to the COVID-19 pandemic, federal policymakers temporarily lifted long-standing restrictions on telemedicine, resulting in an unprecedented and rapid expansion of virtual care across video, audio, and asynchronous modalities. When integrated into longitudinal care relationships, telemedicine can increase access, reduce patient burden, and support continuity for people facing geographic, mobility, or socioeconomic barriers. However, telemedicine also introduces new clinical, regulatory, equity, and safety challenges that require deliberate policy design. Beyond its clinical considerations, telehealth offers environmental and logistical benefits, including reduced travel time and cost, decreased fuel consumption, lower transportation expenses, and lower greenhouse gas emissions. In this position paper, the American College of Physicians updates its previous policy paper on telemedicine to reflect changes in payment policy, licensure, prescribing authority, and utilization patterns that have occurred over the past decade and accelerated during the COVID-19 public health emergency. This paper focuses on access, payment policy, licensure, prescribing practices, equity, and patient safety across federal and state programs and private payers and emphasizes the conditions under which telemedicine should be integrated into clinical practice. Key developments addressed include the expansion and partial lapse of Medicare telemedicine waivers, evolving U.S. Drug Enforcement Administration rules governing prescribing, increased reliance on interstate practice, and normalization of telemedicine by private payers.
Khalili M, Haghdoost F, Liaghatdar A
… +19 more, Torabiardakani K, Mahdian F, Levit T, Moradi S, Hedayati E, Ahmadi F, Khademioore S, Atkin-Jones T, Sofi-Mahmudi A, Patil V, Fashami FM, Mehmandoost S, Kahlon HS, Couban RJ, Prasad K, Fereshtehnejad SM, Buckley N, Busse JW, Sadeghirad B
Ann Intern Med
· 2026 Jun · PMID 42081823
·
Publisher ↗
BACKGROUND: Migraine headaches are considered chronic when they occur on 15 or more days per month. Newer medications are available for prevention. PURPOSE: To explore the effectiveness and tolerability of pharmacologic...BACKGROUND: Migraine headaches are considered chronic when they occur on 15 or more days per month. Newer medications are available for prevention. PURPOSE: To explore the effectiveness and tolerability of pharmacologic prophylaxis for chronic migraine. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Web of Science, and Scopus to October 2025. STUDY SELECTION: Independent paired reviewers identified randomized controlled trials (RCTs) of prophylactic pharmacologic interventions for adults with chronic migraine. DATA EXTRACTION: Paired reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Random-effects meta-analysis and assessment of certainty of evidence were performed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. DATA SYNTHESIS: The review included 43 RCTs (14 725 participants). High- and moderate-certainty evidence suggests that eptinezumab (mean difference [MD], -2.34 [95% CI, -2.76 to -1.92]), erenumab (MD, -2.08 [CI, -2.82 to -1.33]), fremanezumab (MD, -1.77 [CI, -2.45 to -1.09]), galcanezumab (MD, -2.00 [CI, -2.96 to -1.04]), and atogepant (MD, -2.10 [CI, -3.06 to -1.14]) reduce monthly migraine headache days by 2 versus placebo. Botulinum toxin may slightly reduce monthly migraine days (MD, -1.34 [CI, -2.27 to -0.41]; low certainty), whereas rimegepant probably has no effect (MD, -1.20 [CI, -2.59 to 0.19]; moderate certainty). Galcanezumab probably reduces dropout due to any cause versus placebo (relative risk [RR], 0.52 [CI, 0.33 to 0.83]; moderate certainty). Botulinum toxin probably increases discontinuation due to adverse events (RR, 3.36 [CI, 1.75 to 6.45]; moderate certainty). Studies on topiramate, valproate, and propranolol were sparse and had high risk of bias. LIMITATION: Most trials had high risk of bias, with few available comparisons. CONCLUSION: Most calcitonin gene-related peptide-targeted therapies are probably effective for chronic migraine prophylaxis. Evidence for botulinum toxin, propranolol, topiramate, and valproate mostly had high risk of bias. PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42023456915).
Frazzoni L, Cesaro P, Radaelli F
… +13 more, Fabbri C, Guglielmo S, Mussetto A, Manno M, Pugliano CL, Segatta F, Pezzuto E, Raschi E, Facciorusso A, Hassan C, Spada C, Fuccio L, INTERPRET Study Group
Ann Intern Med
· 2026 Jun · PMID 42081822
·
Publisher ↗
BACKGROUND: Adequate bowel preparation is essential for high-quality colonoscopy but remains challenging in hospitalized patients, and comparative data on preparation volume are limited. OBJECTIVE: To compare the efficac...BACKGROUND: Adequate bowel preparation is essential for high-quality colonoscopy but remains challenging in hospitalized patients, and comparative data on preparation volume are limited. OBJECTIVE: To compare the efficacy, tolerability, and safety of very low-volume (1-liter [1L]), low-volume (2-liter [2L]), and high-volume (4-liter [4L]) polyethylene glycol (PEG) regimens for inpatient colonoscopy preparation. DESIGN: Multicenter, randomized controlled, endoscopist-blinded trial. (EudraCT: 2019-002799-15; ClinicalTrials.gov: NCT04708366). SETTING: Community and academic hospitals in Italy. PATIENTS: Hospitalized adults undergoing elective colonoscopy. INTERVENTION: Patients were randomly assigned (1:1:1) to split-dose 1L PEG-ascorbate, 2L PEG-ascorbate, or 4L PEG. MEASUREMENTS: Primary end point was adequate bowel cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with all segments ≥2). Secondary end points included high-quality cleansing (BBPS score, 8 to 9), high-quality right-colon cleansing (BBPS score, 3), and willingness to repeat. RESULTS: Among 665 randomly assigned patients (1L, = 228; 2L, = 218; 4L, = 219), adequate overall cleansing occurred in 82.0%, 78.0%, and 78.5% (absolute difference between the 1L and 2L groups [Δ1L-2L], 4.0 percentage points [95% CI, -3.4 to 11.4 percentage points]; absolute difference between the 1L and 4L groups [Δ1L-4L], 3.5 percentage points [CI, -3.9 to 10.9 percentage points]). High-quality overall cleansing occurred in 46.9%, 35.3%, and 37.4% (Δ1L-2L, 11.6 percentage points [CI, 2.5 to 20.5 percentage points]; Δ1L-4L, 9.5 percentage points [CI, 0.3 to 18.5 percentage points]). High-quality right-colon cleansing occurred in 40.6%, 29.5%, and 31.6% (Δ1L-2L, 11.2 percentage points [CI, 2.1 to 20.0 percentage points]; Δ1L-4L, 9.0 percentage points [CI, 0.0 to 17.9 percentage points]). Tolerability was good across regimens, with the highest willingness to repeat in the 1L group (84.2%), despite more frequent vomiting and thirst. LIMITATION: Patients requiring urgent colonoscopy for active gastrointestinal bleeding and those with severe/unstable comorbid conditions were excluded. CONCLUSION: In hospitalized adults undergoing elective colonoscopy, 1L PEG-ascorbate yielded higher rates of high-quality cleansing, including right colon, than 2L PEG-ascorbate and 4L PEG, with similar rates of adequate cleansing and high willingness to repeat. PRIMARY FUNDING SOURCE: Norgine Srl.
Anderson TS, Purkayastha S, Bernstein EY
… +7 more, Parr A, Mor MK, Bachrach RL, Gellad WF, Hausmann LRM, Fine MJ, Essien UR
Ann Intern Med
· 2026 Jun · PMID 42081820
·
Publisher ↗
BACKGROUND: Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs). OBJECTIVE: To describe patterns and factors associated with hospit...BACKGROUND: Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs). OBJECTIVE: To describe patterns and factors associated with hospital initiation of MAUD. DESIGN: Retrospective cohort study. SETTING: Veterans Health Administration (VHA). PARTICIPANTS: Veterans hospitalized with a primary diagnosis of AUD in 2022 or 2023. MEASUREMENTS: Patients had MAUD initiated as an inpatient or within 7 days of discharge. Logistic regression models estimated the predicted probabilities of MAUD initiation based on hospital fixed effects and demographic and clinical characteristics. RESULTS: Among 29 041 hospitalizations for AUD of veterans without MAUD at baseline in 142 hospitals (median age, 55 years; 94% male), in 8932 hospitalizations (30.8%), MAUD was initiated as an inpatient or within 7 days; MAUDs were naltrexone (57.9%), acamprosate (16.5%), and injectable naltrexone (13.9%). Of MAUD initiations, 6221 (69.6%) were during an inpatient stay and the rest were within 7 days. Of the 6221 inpatient initiations, 97.7% had a prescription for MAUD within 30 days after discharge. In adjusted analyses, MAUD initiation was more likely for hospitalizations with a specialty addiction consultation and those receiving psychiatry versus medicine service. Initiation of MAUD was less likely for persons aged 65 years or older, men, American Indian or Alaska Native versus White veterans, frail veterans, veterans diagnosed with opioid use disorder, and those in the intensive care unit. The median hospital-level rate of MAUD initiation was 29.9% (IQR, 22.6% to 36.3%). LIMITATION: Generalizability to other health care systems. CONCLUSION: Within the VHA, 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within 7 days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and National Institute on Aging.
Ghabril M, Barros N, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 May · PMID 42081819
·
Publisher ↗
GIM/FP/GP:[Formula: see text] Gastroenterology:[Formula: see text] Critical Care:[Formula: see text].GIM/FP/GP:[Formula: see text] Gastroenterology:[Formula: see text] Critical Care:[Formula: see text].