Literature Collection

INTRODUCTION: Allergic rhinitis (AR), anxiety, and depression are prevalent comorbidities that negatively impact patients' quality of life. This study explored how help-seeking behaviors act as intermediaries between medication use, AR symptoms as measured by the Sino-Nasal Outcome Test (SNOT-22), and mental health outcomes, specifically anxiety and depressive symptoms, assessed through the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7). METHODS: This longitudinal study analyzed data from 1035 adults 18 years and older. Participants were recruited from 105 non-allergist primary care clinics across the United States using the QHSLab Digital Medicine platform between February 20, 2024, and January 18, 2025. Of the original sample, 891 participants completed the follow-up, yielding an attrition rate of approximately 14 %. Health-seeking behavior was defined as seeking professional assistance for emotional well-being, allergies, or neither. Baseline medication use for intranasal steroids, antihistamines, decongestants, and oral leukotriene blockers was recorded. Pearson correlations, Analysis of Variance (ANOVA), chi-squared test (χ(2) test), and regression analyses explored relationships between these factors and health score changes (α = 0.05). RESULTS: Patients who actively sought help for emotional well-being and allergic rhinitis exhibited the most significant improvements in symptom severity and mental health outcomes. Pearson correlation analyses revealed a significant negative association between dual-condition help-seeking and reductions in both SNOT-22 (r = -0.22, p < 0.01) and PHQ-GAD scores (r = -0.34, p < 0.01). Regression analysis confirmed that help-seeking behaviors (HSB) were significant predictors of symptom improvement, with individuals seeking assistance for both conditions showing notable reductions in SNOT-22 (β = -0.19, p < 0.05) and PHQ-GAD scores (β = -0.28, p < 0.01). Longitudinal analyses further demonstrated that consistent HSB engagement over six months led to a 23 % greater reduction in SNOT-22 scores (β = -0.21, p = 0.03) and a 31 % greater reduction in PHQ-GAD scores (β = -0.27, p < 0.01) compared to pharmacologic interventions alone. Sensitivity analyses reaffirmed these findings, and mindfulness meditation (β = 3.54, p < 0.001) and allergen immunotherapy (β = 5.60, p = 0.0185) were identified as additional predictors of mental health improvement. These results highlight integrated care's critical role in addressing physical and mental health conditions to optimize patient outcomes. CONCLUSION: This study underscores the importance of help-seeking behaviors in improving allergic rhinitis and mental health outcomes, highlighting the benefits of integrated care approaches. Patients who sought help for both conditions experienced the most significant symptom relief, reinforcing the need for multidisciplinary, patient-centered treatment. Expanding mental health screening within AR management, enhancing access to behavioral interventions, and leveraging digital health tools can optimize patient engagement and long-term outcomes. These findings advocate for a holistic shift in AR care, emphasizing integrating physical and mental health support to improve overall well-being.

OBJECTIVES: Hospital employment of physicians, often called hospital-physician vertical integration, has become widespread in health care delivery, but whether hospital employment tilts the case mix of physicians toward higher-complexity patients remains unknown. STUDY DESIGN: Cross-sectional and difference-in-differences analysis of 2014-2019 Medicare Standard Analytic Files. METHODS: We compared pre- and postemployment patient panels of primary care physicians who did and did not become hospital employees, analyzing changes in the prevalence of chronic conditions. We measured arthritis, depression, diabetes, hypertension, and ischemic heart disease. We also evaluated whether patients who were dropped from physician panels found alternative sources of primary care. RESULTS: Hospital-employed physicians treated patients of similar or better health; for instance, 54% of integrated physicians' patients had 2 or more chronic conditions compared with 56% among independent physicians (P < .001). After becoming hospital employees, physicians treated approximately 10% fewer Medicare patients (-9.5%; 95% CI, -11.3% to -7.7%). Within physician panels, the prevalence of patients with 2 or more chronic conditions did not significantly change after employment relative to independent physicians (-1.1%; 95% CI, -2.3% to 0.2%). Approximately 37% of patients were dropped from physician panels after employment; these patients were less likely to find alternative primary care compared with those dropped from independent physician panels (P < .001). CONCLUSIONS: Hospital employment of physicians resulted in neither a higher number nor a higher proportion of complex patients treated by integrated physicians, at least among traditional Medicare patients.

OBJECTIVE: The aim is to assess the impact of long-acting buprenorphine (LAI-BNP) on frequency of methamphetamine (MA) use. METHODS: We undertook an observational, descriptive, retrospective cohort study of patients of a public, tertiary, community-based Alcohol and Other Drug Service (AODS) with opioid use disorder (OUD) treated with LAI-BNP who are current or past users of MA. We assessed the changes of frequency of use in their MA use at start (baseline), 3 and 6 months of LAI-BNP. RESULTS: Study included 59 participants. Based on their MA use at the commencement of LAI-BNP, the sample was further sub-grouped as active users (n = 30) and past users (n = 29). At 6 months of LAI-BNP, all the past users remained abstinent from MA use. 70% (n = 21) of participants with active MA use had reduced or ceased their MA use while 17% (n = 5) increased their MA use at 6 months. CONCLUSIONS: The results favour the use of LAI-BNP as a potential treatment for MA use.