Continuity of care means better health outcome

Washington -- Having a medical home makes a big difference when it comes to managing hypertension among older patients -- especially seeing the same physician over the years.

At least that was the message from a recent study done by researchers at the University of North Carolina, Chapel Hill, and Shaw University in Raleigh, N.C. They concluded that continuity of care was even more important than was a racial match between physicians and their patients.

This finding held true for older black and white patients and runs counter to other studies that found race makes a difference. The results are published in the December American Journal of Public Health.

Data on effective care to people of all races has become important since the prevalence of health disparities was highlighted in the Institute of Medicine's 2002 report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."

The medical field is taking steps to address the differences. For example, the AMA is leading efforts to educate the profession on the topic.

Honing effective hypertension treatment for black patients is of particular value because the disorder develops earlier in blacks than in whites and is usually more severe.

Evaluating the roles played by individual physicians and the health care system to manage chronic diseases effectively was the impetus for the study, said Thomas R. Konrad, PhD, a lead investigator and director of the program on health professions and primary care at UNC's Sheps Center for Health Services Research.

The researchers analyzed data from the Piedmont Health Survey of the Elderly, which was compiled in 1986 and 1987 on 4,162 people, and again as a follow-up in 1990 on 3,536 survivors. It includes interviews and recorded blood pressure readings of people older than 65 who live in five counties in Eastern North Carolina. Participating in the survey were 1,834 black subjects and 1,533 whites. Their physicians were named, matched to licensure files and linked to the participants they treated.

Effective care

The researchers found that a physician's race had little effect on hypertension treatment. But stable care was associated with increased awareness of hypertension and the administration of medications to control it, as well as a lower incidence of undetected high blood pressure.

"We believe these findings are important because, despite progress in hypertension management, African-Americans are still less likely than whites to know that they have the illness, be treated for it and have their blood pressure controlled," Dr. Konrad said.

Regular access to a usual care source and sustained affiliation with a doctor can improve hypertension management, he said. "You need someone to measure your blood pressure, and when it gets out of control you need someone to work with you and try different things. I think the individual relationship with a physician is critical for that kind of situation."

The same could prove true in other types of chronic care, he said, including, for example, the management of diabetes, another condition that is having a large impact on the health of black people.

Black patients are less likely to be followed by one doctor but are more likely to receive care in public clinics where physician turnover is frequent, researchers found. While one in three black patients received health care in a public clinic, only one in 10 white patients did.

Most of the white patients received care from physicians in private practices, who tend to maintain those practices for many years, said the researchers.

But the study also found that clinics can give consistent care.

"Having the same physician is best, but if you can't, it's better to receive treatment in the same place," Dr. Konrad said.

"It's not a surprise that people with continuity of care have better blood pressure control and stay on therapy," said Daniel W. Jones, MD, spokesman for the American Heart Assn. and dean of the University of Mississippi's School of Medicine. "Certainly continuity of care is more of an issue in poorer populations, and sadly, in our country, being black is associated with being poor as well."