Blog | Monday, December 5, 2011

QD: News Every Day--ERs are no place to stay abreast of chronic diseases

Those who use the emergency room as their usual site of primary care are less likely to know about their chronic conditions, researchers found.

Researchers reviewed 21,778 adult participants from the National Health and Nutrition Examination Survey from 1999 to 2008. They looked at patients' self-reported histories of hypertension, diabetes and hypercholesterolemia, their awareness of chronic conditions, and associated cardiovascular events such as angina, coronary heart disease, cardiovascular disease, myocardial infarction and stroke.

Results appeared online Nov. 24 at the American Journal of Cardiology.

Two questions asked respondents whether they had a usual source for primary care (yes or no) and if so, whether it was a community health center, hospital outpatient clinic, emergency room, or private doctor's office.

Of the survey respondents, 18,127 participants (83%) received their usual care at private doctors' offices or HMOs, hospital-based outpatient clinics, or community health clinics; 435 (2%) identified their usual sources as ERs; and 3,216 (15%) reported no usual primary care source.

After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients by setting. However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions.

The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs compared to private doctors' offices. About 11% of participants who received their usual care in ERs had self-reported histories of diagnosed myocardial infarction, compared to 3% to 4% of participants at each of the other sites of care.

Poor hypertension awareness was significantly more common for participants without usual sites of care and those reporting ERs as their primary care source. Among participants with blood pressure readings >140/90 mm Hg (n=9,440), 61% of participants without usual sites of care reported not knowing about their high blood pressure. Lack of hypertension awareness was present in nearly half (46%) of participants receiving care in ERs and 39% of those receiving usual care in doctors' offices or HMOs.

"Given the chronic disease profiles across care sites the disproportionate burden of cardiovascular events in the ER could indicate that the secondary prevention provided at ERs is less robust than sites designed to provide continuous care," the authors wrote. "Our results suggest that regular interaction with providers is responsible for much of the observed difference in awareness between participants receiving care in ERs relative to other care sites; however, ongoing care from ER providers remains an unlikely prospect for most patients."