Internal Medicine — Weekly Evidence Brief

Potentially inappropriate prescribing (PIP), including both inappropriate medications (PIMs) and prescribing omissions (PPOs), is highly prevalent among older adults and is associated with adverse health outcomes. Research indicates that exposure to two or more PIMs significantly increases the risk of all-cause and non-cancer mortality. Similarly, exposure to two or more PPOs is linked to an 84% increased risk in all-cause mortality, with stronger associations observed in men. Addressing PIMs in healthier older individuals and reducing PPOs in clinical practice are critical steps to improve long-term outcomes 1.

Beyond medication management, adverse social determinants of health (SDoH) significantly contribute to poor patient outcomes, particularly after hospitalization. Integrating SDoH identification and mitigation into transitional care interventions, such as the Transitional Care Model, can help prevent adverse events like avoidable emergency room visits and rehospitalizations, especially for older individuals with chronic illnesses 2. Furthermore, area-based measures of social risk are increasingly used in policy and can predict health outcomes, with the Area Deprivation Index being a strong and equitably predictive measure across various subpopulations 3. Racial disparities in acute care utilization are also observed, with non-White patients in highly segregated areas experiencing a 26% higher risk compared to White patients in similar settings 4.

Digital health technologies offer immense potential but face significant challenges regarding equitable access and widespread adoption. While artificial intelligence (AI) shows promise in health promotion through improved early detection and lifestyle modification support, particularly via AI-powered mobile apps 5, inequalities in mobile health utilization persist, with older age, lower education, and income negatively associated with mHealth adoption 6. For instance, only a minority of heart failure patients utilize virtual visits, though digital access markers like an email or cell phone on file, and an active patient portal, significantly increase their likelihood of use 7. Moreover, technical, ethical, and regulatory barriers, alongside clinician skepticism, hinder the large-scale integration of telemonitoring systems 8. Generative AI also holds promise to transform primary care by alleviating data overload and documentation burdens, enhancing efficiency, quality, and engagement 9.

Addressing specific population vulnerabilities and foundational skills is also crucial. For women living with HIV, healthcare stigma acts as a significant barrier, with high stigma profiles directly linked to suboptimal antiretroviral therapy adherence and subsequent viral nonsuppression, especially among Black women who use drugs or those with depression/PTSD 10. These findings highlight the need for targeted, integrated interventions. Additionally, a robust understanding of statistics is essential for all medical professionals, enabling them to critically appraise research, avoid cognitive biases, and engage in evidence-based practice, which is fundamental to improving clinical outcomes across specialties 11.