Easier Primary Care Access Improved Chronic Disease Management

Irrespective of where a patient resides, having easier primary care access might be key to improving chronic disease management and detection for patients with hypertension, according to new research published in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed journal of the American Heart Association (AHA).

Hypertension impacts nearly half of the adult population in the United States. Still, many people who have the condition don’t know they have it, leaving them at risk for worse health outcomes, according to CDC data.

“Access to primary care is the key to hypertension management, however, many Americans have limited access to primary care where they live,” senior study author Brisa Aschebrook-Kilfoy, PhD, an associate professor of public health sciences at the University of Chicago in Illinois, said in a public statement. “This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals.”

The study examined the benefits that better primary care access may have on chronic disease management among patients living in disadvantaged neighborhoods. Researchers noted that healthcare professionals at community health centers and primary care practices could potentially expand high blood pressure awareness and detection by providing affordable treatment and management options.

“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care professionals in diverse racial and ethnic neighborhoods would not reduce health disparities and improve public health,” said first study author Jiajun Luo, PhD, a post-doctoral fellow at the University of Chicago’s Institute for Population and Precision Health.

“To our knowledge, there is little research to support or rebut this argument,” Luo continued. “We conducted this study to examine whether accessibility of primary care is associated with better hypertension control and awareness across various socioeconomic and neighborhood factors.”

Using the Area Deprivation Index (ADI), the researchers examined the neighborhood socioeconomic disadvantage of Chicago, one of the most racially segregated cities in the US. The South Side of Chicago holds one of the most prominent African American urban communities whose population faces substantial challenges, including poverty, violence, and food insecurity.

The city of Chicago also has significant disparities. There’s a wealth gap between the wealthier North Side of Chicago compared to the South Side, which can be linked to higher rates of high blood pressure, heart disease, and stroke, the researchers wrote.

The findings showed that nearly 80 percent of the study participants had hypertension. Additionally, almost 38 percent of patients with hypertension did not have their blood pressure under control.

Adults living in areas with the fewest primary healthcare professionals had a 37 percent increased likelihood of hypertension compared to those living in neighborhoods with the most primary care physicians.

These findings remained true in both poor and wealthy neighborhoods, suggesting that access to care, not income, is influencing chronic disease rates.

That said, researchers believe that all Chicago neighborhoods may benefit from added primary care access as it is well known that primary healthcare is linked to improved high blood pressure awareness and control.

“Based on these findings, we need to encourage primary care physicians to expand access to people who live in underserved communities with the fewest primary care professionals,” Aschebrook-Kilfoy said.

Aschebrook-Kilfoy recommended the implementation of mobile health clinics to reach patients with barriers to care access.

“Mobile health units may be one approach to increase primary care service in underserved areas by eliminating the challenge of getting transportation to and from an office visit,” Aschebrook-Kilfoy said. “The use of anti-hypertension medications also needs to be studied and addressed, especially as it was not linked to primary care accessibility in this study.”

In the last few years, utilizing mobile health units has become more common. In a time when the healthcare industry seeks to reduce care disparities, address the social determinants of health, and promote value-based care, mobile health clinics have served to fill in the gaps.