FW: SIP: Patients not getting the care they need

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Patients not getting the care they need, study says

Medical treatment falls short, even in cities with teaching hospitals,

according to a new report.

By Jane E. , Times Staff Writer

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. "

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

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. "

The study was funded by the Wood 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.

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