Look to the community to bolster patient care

This issue also covers Alzheimer's disease, conference coverage from the Heart Failure Society of America, and whether heart failure is different in African-American patients


Community health workers are a growing profession in the U.S., due in part to the expense of health care and to recent changes in reimbursement rules. Physicians who have worked with CHWs report that patients are often more likely to discuss problems related to food, transportation, or medication adherence with someone from the community than with a clinician, and that rapport can help with problem-solving and patient-centered care. But adding community health workers to your practice isn't as easy as just hiring someone your patients feel comfortable talking to. Our story looks at CHW programs across the country and includes tips to make them work well for everyone.

Advances in imaging have made it possible to identify signs of Alzheimer's disease earlier, but does that do patients any good? Those on the pro side argue that treatment plans may change based on imaging results, leading to greater patient benefit, while those on the con side question whether it's worthwhile to test for a disease that can't be cured. Our story provides an up-to-date look at how amyloid positron emission tomography scans are being used to inform diagnosis, as well as an overview of best practices for physicians in recognizing early-stage memory loss and providing ongoing management.

Our conference coverage this month is from the Heart Failure Society of America, which held its annual meeting in Philadelphia in September. Read about why management of diuretic medications in patients with heart failure can often be a complicated proposition. Age, education level, and symptom severity are the three main factors in determining patients' adherence, but other variables play a role, too. Another article summarizes the meeting's opening plenary lecture, by Clyde W. Yancy, MD, MSc, MACP, which addressed the question of whether heart failure is different in African-American patients. And, an endocrinologist provides her perspective on management of diabetes and heart failure, including which medications should be used and when.

Medical history buffs may know that Sir William Osler, a towering figure in internal medicine, died 100 years ago this December. To mark the occasion, we spoke to Charles S. Bryan, MD, MACP, a member and past president of the American Osler Society, who has literally written the book (actually, several books) on the famed physician. Read Dr. Bryan's take on Osler's influence on medicine and what he would think of the field today.

Have you been influenced by Osler? Let us know how at acpinternist@acponline.org.

Sincerely,

Jennifer Kearney-Strouse
Executive Editor