Without primary care, less awareness of chronic ills
NEW YORK |
NEW YORK (Reuters Health) - In a new U.S. study, people who said emergency rooms were their usual site of medical care were less likely to know they had chronic conditions, including high blood pressure and high cholesterol, than those who got primary care at doctors' offices or clinics.
People who don't see a primary care doctor, whether because they lack insurance, time or transportation, wait longer to seek treatment for their symptoms and don't get checked out as often, researchers said.
They also miss out on the coordinated care provided by doctors' offices and clinics, which can track patients' health over time, follow up on drug prescriptions and provide diet and lifestyle counseling, said Dr. George Rust, head of the National Center for Primary Care at the Morehouse School of Medicine in Atlanta.
All that could lead to certain conditions going undiagnosed and unmanaged.
"Emergency rooms are great for treating emergencies," said Rust, who didn't participate in the study.
"They are set up to deal with urgencies. What they are not able to do is provide long-term continuity of care. (They're) not a great place to get your high blood pressure treated or your other chronic medical needs taken care of," he told Reuters Health.
Rust said that health care reform should go a long way toward addressing these disparities and increasing primary care access, but added that more work is needed on a public health level to deal with cultural and other barriers to preventive care.
Researchers led by Chima Ndumele of Brown University in Providence, Rhode Island, analyzed data from a nationwide survey of close to 22,000 adults, conducted between 1999 and 2008. Participants were asked where they went for their usual healthcare, what diagnosed chronic conditions they had and if they'd ever had a heart attack or stroke. Finally, the subjects underwent tests including blood pressure and cholesterol measurements.
More than half of the study participants said they got their regular care at a private doctor's office or through a health maintenance organization. Others went to a community health clinic or a hospital outpatient clinic. More than 3,000 people said they had no usual site for care, and another 435 went to ERs for their general ailments.
Between 17 and 46 percent of all the participants had high blood pressure (above 140/90 mm Hg) or high cholesterol (over 200 mg/dl).
ER visitors did not have higher rates of either condition, but compared to office and clinic-goers, they were less likely to know it if they had them.
When it came to high blood pressure, 46 percent of the ER group that qualified as hypertensive didn't know about their condition, compared to 33 to 39 percent of people treated elsewhere.
Lack of awareness was highest -- 61 percent -- in those who said they didn't have a usual place they went for care.
Seventy-two percent of the ER users with high cholesterol didn't know about it, compared to 61 or 62 percent of people who got their care at private offices and clinics.
Study participants who used ERs for general care were also two to four times more likely to have had a previous heart attack or stroke than those who saw private doctors, according to the findings published in the American Journal of Cardiology.
"There is a considerable amount of research suggesting that management of chronic or cardiovascular conditions in the ER is suboptimal," Ndumele told Reuters Health in an email. And, he added, "it's very difficult to adequately manage a condition when the patient is not aware of it."
"This study supports the intuitive notion that expanded primary care makes a big difference," said Peter Jacobson, a health law and policy professor at the University of Michigan School of Public Health in Ann Arbor, who wasn't involved in the research.
One barrier to getting good, timely primary care is health insurance, Jacobson told Reuters Health -- but it's not the only one. Poorer people especially might not have access to transportation to get to a doctor's office, or they might not be able to afford taking time off from work for a preventive care appointment, he said.
The experts agreed that health care reform should mean more people have access to the kind of care that's necessary to prevent high blood pressure and high cholesterol from turning into potentially life-threatening conditions.
"We know that being insured dramatically improves your chances of having these conditions diagnosed and treated and ultimately controlled," Rust concluded. "Fixing this, working on this, getting the right care in the right setting at the right time, especially in these chronic conditions can really make a dramatic difference in preventable suffering."
SOURCE: bit.ly/uxVYo8 American Journal of Cardiology, online November 24, 2011.
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