Patients not getting the care they need, study says
Access to healthcare, it seems, doesn’t ensure quality.
Americans get only half the recommended medical care and screenings from their doctors, a new report says, even if they live in metropolitan areas with noted teaching hospitals.
It makes no difference whether the setting is Orange County, Cleveland or Greenville, S.C., or whether patients are insured or uninsured, according to a new Rand Corp. study of 12 metropolitan areas with at least 200,000 people. Inadequate care is being delivered everywhere.
“Even in communities with excellent teaching hospitals and excellent healthcare organizations, still only about 50% of recommended care gets done,†said lead author Dr. Eve A. Kerr, a research scientist with the Veterans Affairs Center for Practice Management and Outcomes Research in Ann Arbor, Mich. “Even for these common conditions where we know what to do, half the time on average those things aren’t happening.â€
Despite all the knowledge about how to prevent death and disability, heart attack patients frequently don’t receive drugs shown to improve survival, substance abusers aren’t getting counseling during routine physicals and diabetes is often woefully under-treated.
The discrepancy between what patients should receive and what they do receive is even more striking given that the United States spends an estimated $1.4 trillion each year on healthcare, more than any other nation.
“I don’t think in any other industry we’d allow this level of performance for the price we’re paying,†said Helen Halpin, director of the Center for Health and Public Policy Studies at UC Berkeley.
The findings, published in the May/June issue of Health Affairs and released Tuesday, were based on interviews of 7,000 adults and reviews of their medical records during 1998-2000. Kerr and colleagues from Rand Health in Santa Monica and the VA Greater Los Angeles Healthcare System reviewed 439 measures of quality for 30 acute and chronic conditions, including diabetes, asthma, hypertension, heart disease and urinary tract infections, as well as preventive care.
Among the findings:
* Only about 50% of heart attack patients receive two proven life-saving medications: aspirin and beta blockers.
* Among people with chronic conditions, people with diabetes usually get the worst care, even though the disease has a high risk of serious side effects.
* For patients with depression, the number getting treatment ranges from 47% in Newark, N.J., to 63% in Seattle.
* Residents in all the communities are more likely to get preventive services such as immunizations and blood-pressure screenings than services for preventing sexually transmitted diseases and HIV or substance abuse counseling.
* The bright spot, however, was the level of care for hypertension, which hit a high of 70% among Clevelanders.
Something, experts agree, is wrong with the nation’s medical system when so many patients fail to receive care grounded in science. “Physicians are not being trained to routinely provide care we know is effective,†Halpin said. “This problem requires the immediate attention of medical schools and teaching hospitals. Something has gone wrong in the training of these professionals.â€
The study was funded by the Robert Wood Johnson Foundation and by research and development grants from the Veterans Affairs Health Services. In addition to Orange County, Greenville, Cleveland, Newark and Seattle, other communities examined were Boston, Miami, Phoenix, Indianapolis, Little Rock, Ark., Lansing, Mich., and Syracuse, N.Y.
