Family Medicine

Digitally enabled stewardship slashes antibiotic use for ARIs in rural primary care without safety signal

This cluster RCT in 34 rural township hospitals in China tested a comprehensive, digitally enabled antibiotic stewardship program for acute respiratory infections. The intervention embedded concise ARI guidelines and prompts in the EMR, added clinician training, monthly peer-review feedback, and patient smartphone education. Across 97,239 ARI consultations, antibiotics were prescribed in 26% of intervention vs 71% of control visits, a large adjusted absolute reduction. Thirty-day hospitalizations for respiratory illness or sepsis were similar between groups, suggesting no short-term harm from reduced prescribing. Findings support implementing integrated electronic decision support plus audit-feedback to curb inappropriate outpatient ARI antibiotic use in resource-limited primary care. 1

High telehealth exposure in VHA primary care links to lower performance on several quality measures

This retrospective cohort study evaluated 744,599 veterans with at least three primary care visits over two fiscal years. Patients were categorized by proportion of visits via telehealth: none, low, intermediate, or high (≥50%). Low or intermediate telehealth exposure produced quality outcomes similar to all in-person care for cardiovascular and behavioral measures. High telehealth use was associated with lower influenza vaccination rates, reduced statin adherence, and less depression screening. These data support hybrid primary care models and caution against shifting most longitudinal care to virtual-only visits in complex populations. 2

Produce prescription program failed to improve HbA1c or utilization in food-insecure adults with diabetes

This pragmatic RCT randomized 2,155 adults with diabetes and risk of food insecurity to a produce prescription vs usual care. Intervention participants received $80 monthly for up to 12 months to buy fruits, vegetables, and legumes, plus standard diabetes education. After 12 months, adjusted HbA1c was slightly higher in the intervention arm, with a 0.20 percentage point difference favoring usual care. There were no between-group differences in ED visits, inpatient admissions, BMI, or blood pressure, including among those with baseline HbA1c ≥8%. Benefit use was moderate, suggesting limited engagement, and indicating that financial produce support alone may not improve glycemic control. 3

Telemedicine for type 2 diabetes yields modest but consistent cardiometabolic benefits vs usual care

This systematic review and meta-analysis pooled 58 RCTs including 13,942 adults with type 2 diabetes comparing telemedicine to usual care. Telemedicine interventions achieved a mean HbA1c reduction of about 0.4 percentage points compared with usual care, despite high heterogeneity. They also modestly lowered fasting glucose, weight, BMI, and both systolic and diastolic blood pressure. No significant improvements were seen in HDL or LDL cholesterol compared with controls. Results suggest telemedicine, especially when clinician- or dietitian-delivered, can incrementally improve diabetes control when layered onto standard care. 4