ACP recommends ways to better meet the health care and social needs of unhoused populations

 @Annalsofim   
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. ACP Recommends Ways to Better Meet the Health Care and Social Needs of Unhoused Populations 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2795  

URL goes live when the embargo lifts    

Policy action is needed to better meet the unique health challenges of persons experiencing homelessness and housing instability, says the American College of Physicians (ACP) in a new policy paper published in Annals of Internal Medicine. The paper underscores the need to address the underlying drivers of homelessness and makes recommendations about better meeting the health care needs of unhoused populations. 

ACP says that stable housing is essential to an individual’s well-being and goes on to say that policy efforts must prioritize safe and affordable housing for all, and policymakers must adequately fund programs that seek to meet the health care and shelter needs of unhoused individuals. ACP recommends that efforts to address homelessness should be part of a sufficiently funded national strategy and accompanied by additional research into the causes of homelessness and the needs of unhoused populations.  

The paper also makes recommendations about providing health care services to unhoused populations and urges Medicare and Medicaid to implement demonstration projects that provide housing supports and targeted medical services to those who are unhoused or are at risk of becoming unhoused. ACP also says that physicians and other health professionals should be knowledgeable about screening patients for homelessness and treating unhoused patients, and that this should be incorporated into all levels of medical education. The paper asserts that laws and regulations should decriminalize an individual undertaking life-sustaining activities, like camping, scavenging, or sleeping, in public. Finally, the report recommends research into approaches to provide accessible and appropriate health care services to unhoused populations, and that public and private payers should pay for providing services to those individuals. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Joshua Serchen, MD, please contact Jacquelyn Blaser at jblaser@acponline.org.  

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2. VA, DoD clinical guideline synopsis details 34 new recommendations for PTSD and acute stress disorder

New guideline recommends psychotherapies over pharmacotherapy and recommends against benzodiazepines, cannabis, or cannabis-derived products

Abstract:https://www.acpjournals.org/doi/10.7326/M23-2757  

URL goes live when the embargo lifts    

A synopsis of new clinical guidelines from the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD) details 34 recommendations for treating posttraumatic stress disorder (PTSD) and co-occurring conditions. The VA/DoD guidelines notably recommend the use of specific manualized psychotherapies over pharmacotherapy and recommend against the use of benzodiazepines, cannabis, or cannabis-derived products. The synopsis is published in Annals of Internal Medicine.

Seven in 10 U.S. adults will experience a traumatic event in their lifetime. Exposure can lead to substantial problems, especially PTSD, a condition that persists for more than 1 month after exposure and cause clinically significant distress or functional impairment. Acute stress disorder (ASD) can occur during the first 30 days after traumatic exposure. Individuals with occupationally related exposure face increased risk for PTSD and ASD, but its prevalence in the U.S. general population is 4 percent in men and 8 percent in women.

Researchers from the VA and DoD collaborated to revise the 2017 VA/DoD Clinical Practice Guideline for the management of PTSD and acute stress disorder. The authors made 34 recommendations in all, covering 5 treatment areas, including assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of PTSD with co-occurring conditions. The authors recommend individual psychotherapies rather than pharmacotherapies. Specifically, they recommend the use of cognitive processing therapy (CPT), eye movement desensitization and reprocessing psychotherapy (EMDR), or prolonged exposure (PE). Medications such as paroxetine, sertraline, or venlafaxine are recommended. Secure video teleconferencing may be used to deliver treatments when that therapy has been validated for use with video teleconferencing or when other options are unavailable for the treatment of PTSD. The authors encourage providers to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals’ health outcomes and quality of life.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Paula P. Schnurr, PhD, please contact Margaret Willoughby at Margaret.Willoughby@va.gov.

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3. Risk profile tool provides clearer insight on hospitalized COVID-19 patients who benefit most from baricitinib treatment

Abstract:https://www.acpjournals.org/doi/10.7326/M23-2593  

URL goes live when the embargo lifts    

A post-hoc analysis of ACTT-2 (Adaptive COVID-19 Treatment Trial-2) found that the use of a risk profile may more precisely characterize high-risk patients who may benefit from the use of baricitinib. The analysis is published in Annals of Internal Medicine.

ACTT was a series of large, double-blind, randomized, placebo-controlled trials, that were sponsored by the NIH. These trials evaluated treatments for adults hospitalized with COVID-19 and helped define the standard of care. Based on the findings of ACTT-1 and ACTT-2, society and government guidelines on COVID-19 management make the strongest recommendations for remdesivir use in patients requiring low-flow supplemental oxygen and for baricitinib use in patients requiring high-flow oxygen or noninvasive ventilation. However, there may be patient-specific characteristics that, when added to oxygen requirement, more precisely define who may benefit from a particular COVID-19 therapeutic, such as baricitinib.

Researchers analyzed data from the ACTT-2 trial consisting of 999 adult participants who were hospitalized with COVID-19 and received either baricitinib+remdesivir or placebo+remdesivir. The authors analyzed outcomes related to mortality, progression to invasive mechanical ventilation (IMV) or death, and recovery within 28 days. They found that patients with higher (absolute neutrophil count)ANC, lower (absolute lymphocyte count) ALC, and lower platelet count were at greatest risk for severe outcomes from COVID-19 and had a significantly improved time to recovery, lower mortality/IMV risk, and lower mortality when treated with baricitinib+remdesivir compared to those receiving placebo+remdesivir.  Additionally baricitinib+ remdesivir treatment reversed trends in ALC and ANC associated with risk of severe outcomes.  According to the authors, their findings suggest that a biomarker-based approach utilizing simple parameters found in a bedside complete blood count provides complementary information on who might benefit from baricitinib treatment. Additionally, they note that 60 percent of patients within the high-risk quartile in ACTT-2 required no oxygen or low-flow oxygen at baseline, suggesting that baseline oxygen requirement is an incomplete proxy for COVID-19 severity and prediction of whom benefits from baricitinib.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Rekha R. Rapaka, MD, PhD, please contact rrapaka@som.umaryland.edu.