Regulatory Framework for Private Equity and Corporatization in Health Care: A Position Paper From the American College of Physicians

The growing involvement of private equity in the health care sector raises important questions about its effect on cost, quality, access, and the physician workforce. Private equity investment in health care is associated with increased costs and, in some settings, adverse effects on care delivery and outcomes. Rising costs, administrative burdens, workforce shortages, and declining reimbursement have made independent practice increasingly difficult, contributing to physician transitions to corporate ownership models. Physicians employed by private equity–owned health care organizations may also experience challenges due to the evolving dynamics of their work environment. State and federal regulators, as well as lawmakers, should consider implementing policy interventions to address these challenges. Although corporate investment may improve efficiency and, in limited instances, care delivery, private equity in this sector raises important questions about its role and effects. This American College of Physicians (ACP) position paper builds on the previous ACP position paper on financial profit in medicine, which explored the growing influence of corporate interests and private equity investment in the health care industry. This paper examines the effect of private equity investment on clinical autonomy, health care costs, quality, access, equity, and innovation. It emphasizes the need for more vigorous enforcement of regulatory measures and policy solutions to preserve the quality of patient care and protect the physician workforce. It also offers recommendations to strengthen oversight, transparency, and accountability related to private equity’s effects on clinical autonomy, care delivery, and organizational decision making. Finally, it discusses the potential opportunities and challenges associated with private equity investment in health care, including increased consolidation and corporatization.

Viral Load–Based Prediction of Hepatocellular Carcinoma Risk in Noncirrhotic Patients With Chronic Hepatitis B

Viral Load–Based Prediction of Hepatocellular Carcinoma Risk in Noncirrhotic Patients With Chronic Hepatitis B

In adults aged 50 to 69 y, invitation to screening with FIT was noninferior to invitation for colonoscopy for colorectal cancer mortality at 10 y

Clinical Impact Ratings GIM/FP/GP: 6 out of 7 Gastroenterology: 6 out of 7 Public Health: 7 out of 7

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, with a prevalence of 4% to 10%. It is a chronic condition characterized by abdominal pain in conjunction with altered bowel habits, abdominal distention, or bloating. IBS can present with 3 different defecation patterns: IBS with constipation, IBS with diarrhea, or mixed IBS. Recent advances in IBS include a positive diagnosis based on symptom-based criteria and a treatment plan based on IBS subtype and bothersome symptoms. In addition to diet and lifestyle modifications, this article discusses the role of new pharmacologic and nonpharmacologic treatment options for the management of IBS.

How and When to Use Microbial Restoration Therapies for Clostridioides difficile Infection

Trends in Dispensed Gabapentin Prescriptions in the United States, 2010 to 2024

The Mediterranean Diet for Irritable Bowel Syndrome: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 178, No 12

Background: Patients with irritable bowel syndrome (IBS) frequently seek dietary advice, but few evidence-based options exist. Major societal guidelines recommend traditional dietary advice (TDA) as first-line therapy, with the cumbersome and resource-intensive low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet reserved as second-line therapy. Recent pilot data suggest that the Mediterranean diet (MD), renowned for its general health benefits, improves IBS symptoms, but whether it can be considered another first-line dietary option is unknown. Objective: To determine if the MD is noninferior to TDA in managing IBS symptoms. Design: Randomized noninferiority clinical trial. (ClinicalTrials.gov: NCT05985018) Setting: Online virtual platform. Participants: 139 persons with IBS from across the United Kingdom. Intervention: 6 weeks of the MD (n = 68) or TDA (n = 71). Measurements: Primary end point was the proportion achieving clinical response, defined as 50-point or greater reduction in IBS Symptom Severity Scale (IBS-SSS). Secondary outcomes included changes in IBS-SSS scores, psychological health, somatic symptom reporting, quality of life, diet satisfaction, and Mediterranean Diet Adherence Screener (MEDAS). Results: Baseline characteristics (mean age, 40.4 years [range, 19 to 65 years]; 80% women) and IBS-SSS (mean, 309 [SD, 90]) were similar between groups. On modified intention-to-treat analysis, the primary end point was met by 62% (95% CI, 50% to 73%) following a MD versus 42% (CI, 31% to 55%) following TDA. The difference in clinical response favored the MD (difference, 20 percentage points [CI, 4 to 36 percentage points]; P = 0.017), demonstrating noninferiority and superiority. There was a greater reduction in the mean IBS-SSS after a MD than TDA (−101.2 vs. −64.5; Δ−36.7 [CI,−70.5 to −2.8]; P = 0.034). No statistically significant differences were seen between the groups with regard to changes in mood, somatic symptoms, quality of life, or diet satisfaction. The MEDAS significantly increased after a MD compared with TDA (P < 0.001). Limitation: No long-term data. Conclusion: The MD showed noninferiority and superiority to TDA in managing IBS symptoms. It represents a viable first-line dietary intervention for IBS. Primary Funding Source: None.

Guideline recommends antiviral prophylaxis for patients at high risk for HBV reactivation

Clinical Impact Ratings GIM/FP/GP: 5 out of 7 Gastroenterology: 6 out of 7 Infectious Disease: 6 out of 7 Public Health: 6 out of 7

The Risk for Bleeding in Patients With Atrial Fibrillation From Concomitant Use of Apixaban or Rivaroxaban With Diltiazem Compared With Metoprolol

Background: Diltiazem is a potent inhibitor of cytochrome P450 3A4 and P-glycoprotein substrates, which can affect the metabolic pathways of factor Xa inhibitors, predisposing patients with atrial fibrillation (AF) to serious bleeding complications. Objective: To compare the risk for bleeding among patients with AF who used apixaban or rivaroxaban in combination with diltiazem compared with metoprolol. Design: Retrospective cohort active comparator study. Setting: U.S. administrative health care database. Patients: Persons with AF. Intervention: Use of apixaban or rivaroxaban with diltiazem or metoprolol. Measurements: The primary study outcome was a composite of serious bleeding events leading to hospitalization. Secondary study outcomes included composites of stroke or systemic embolism. Diltiazem was stratified by high dose (>120 mg/d) and low dose (≤120 mg/d). Propensity score matching was used to adjust for differences between diltiazem and metoprolol users. Results: In the matched cohort of patients with AF, 23 000 were users of diltiazem and 23 000 were users of metoprolol. After propensity score matching, diltiazem (vs. metoprolol) was associated with a higher risk for bleeding events (rate difference [RD], 5.4 [95% CI, 1.2 to 9.6] per 1000 person-years). The risk for bleeding increased with high- versus low-dose diltiazem (high dose: RD, 9.2 [CI, 2.7 to 15.7]; low dose: RD, 2.6 [CI, 0.5 to 8.0]). The estimated 12- and 6-month risk differences between diltiazem and metoprolol were 0.48 percentage points (CI, 0.09 to 0.83 percentage points) and 0.31 percentage points (CI, 0.04 to 0.58 percentage points), respectively. Limitation: Residual confounding. Conclusion: In commercially insured patients with AF receiving apixaban or rivaroxaban, the use of diltiazem was associated with an increased risk for serious bleeding complications when compared with metoprolol. Primary Funding Source: National Heart, Lung, and Blood Institute.