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Editorial
September 2018

Introducing JAMA Internal Medicine Patient Pages

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Editorial Fellow, JAMA Internal Medicine
  • 3Deputy Editor, JAMA Internal Medicine
  • 4Editor, JAMA Internal Medicine
JAMA Intern Med. 2018;178(9):1161-1162. doi:10.1001/jamainternmed.2018.3738

In this issue of JAMA Internal Medicine, we are proud to launch our Patient Page section. This feature, written for the public and made available online free of charge, is designed to distill high-quality evidence and make it more accessible for patient education and help guide patient decisions. While patient-directed educational materials have long been available—JAMA Network Journals have produced hundreds of them over the past 20 years1—we seek to add to existing resources by incorporating updated evidence to help guide patients, in alliance with their health care providers, to make more informed everyday and common decisions about their health. We hope that many of the known benefits of using decision aids to foster conversations and shared decision making will ensue from these pages, including increased patient satisfaction and a more judicious use of care.2

As a journal, we are privileged to publish research that not only illuminates aspects of medicine within the more traditional clinical and physiological contexts but also encompassing societal, political, and psychological levels. We recognize that sharing medical knowledge with patients now goes beyond traditional pathophysiology and epidemiology. Changing evidence, new technologies, and current societal trends all exert substantial influence over how patients understand and nurture their health. For example, in this issue of the journal, Palms et al3 present data suggesting that a large portion of visits to urgent care and retail clinics are for self-limited upper respiratory tract infections (URIs). People who attended in-person visits at these locations for URI symptoms often received low-value care in the form of unnecessary antibiotics.3 Why would this finding prompt us to create our inaugural Patient Page,4 when there are ample existing resources on the natural history of URIs? In this instance, while the biology of the common cold has not changed, the health care landscape has—the rapid proliferation of urgent care centers and retail clinics has lowered the bar for access for an in-person visit for common cold symptoms. Thus, our inaugural Patient Page4 aims to help patients make informed judgments about when such visits are likely to be of benefit and when they are more likely to result in unnecessary care, such as antibiotics for a viral infection, in which case antibiotics are more likely to cause harm than good.

In other areas of medicine, new evidence and technology have substantially changed the approach to certain conditions, yet uptake in clinical practice and public opinion often lags far behind. For example, in the past 2 years guidelines for managing insomnia disorder, a condition that affects up to 15% of Americans, have changed to promote cognitive behavioral therapy as first-line treatment.5 Furthermore, in a 2017 update on the management of insomnia disorder published in JAMA, Buysse et al6 endorse the use of smartphone-based self-guided cognitive behavioral therapy as an evidence-based alternative to in-person therapy, and recommend specific applications based in part on the results of a National Institutes of Health–funded randomized clinical trial.7 This approach represents a major shift in evidence-based management of insomnia, moving away from potentially hazardous long-term sedative use and incorporating an evidence-based treatment that is widely available in the community behavioral health setting or even on one’s smartphone. In an upcoming issue, we will summarize this information in a Patient Page to help people better understand current evidence and make a more informed decision about how to treat insomnia.

At JAMA Internal Medicine, we publish research that not only affects how we practice medicine but also sheds new light on decisions facing our patients in a rapidly changing health care environment. In the spirit of sharing medicine, we aim to broaden our audience through the creation of Patient Pages that seek not only to address biological aspects of health and illness but also to provide evidence-based, patient-centered education to help people make healthy choices amidst strong and often conflicting social and cultural pressures. With this goal in mind, we add a new feature to the journal, aspiring to share our knowledge, mission, and the collective wisdom of our contributing authors with the public. As always, we welcome your feedback and suggestions.

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Article Information

Corresponding Author: Michael A. Incze, MD, MSEd, Department of Medicine, University of California, San Francisco, 550 16th St, PO Box 0558, San Francisco, CA 94143 (michael.incze@ucsf.edu).

Published Online: July 16, 2018. doi:10.1001/jamainternmed.2018.3738

Conflict of Interest Disclosures: None reported.

References
1.
Patient Information. JAMA Network website. https://jamanetwork.com/collections/6258/patient-information. Accessed June 19, 2018.
2.
Spatz  ES, Krumholz  HM, Moulton  BW.  Prime time for shared decision making.  JAMA. 2017;317(13):1309-1310. doi:10.1001/jama.2017.0616PubMedGoogle ScholarCrossref
3.
Palms  DL, Hicks  LA, Bartoces  M,  et al.  Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States [published online July 16, 2018].  JAMA Intern Med. doi:10.1001/jamainternmed.2018.1632Google Scholar
4.
Incze  M, Grady  D, Gupta  A.  I have a cold—what do I need to know? [published online July 16, 2018].  JAMA Intern Med. doi:10.1001/jamainternmed.2018.2621Google Scholar
5.
Qaseem  A, Kansagara  D, Forciea  MA, Cooke  M, Denberg  TD; Clinical Guidelines Committee of the American College of Physicians.  Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians.  Ann Intern Med. 2016;165(2):125-133. doi:10.7326/M15-2175PubMedGoogle ScholarCrossref
6.
Buysse  DJ, Rush  AJ, Reynolds  CF  III.  Clinical management of insomnia disorder.  JAMA. 2017;318(20):1973-1974. doi:10.1001/jama.2017.15683PubMedGoogle ScholarCrossref
7.
Ritterband  LM, Thorndike  FP, Ingersoll  KS,  et al.  Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year follow-up: a randomized clinical trial.  JAMA Psychiatry. 2017;74(1):68-75. doi:10.1001/jamapsychiatry.2016.3249PubMedGoogle ScholarCrossref
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