title: Beyond insurance coverage: usual source of care in the treatment of hypertension and hypercholesterolemia. Data from the 2003-2006 National Health and Nutrition Examination Survey.
abstract: BACKGROUND
  Expanding insurance coverage, while necessary, may not be sufficient to ensure high-quality care for adults with cardiovascular disease. We sought to examine the association between having a usual source of care (USOC) and receiving medication treatment of hypertension and hypercholesterolemia.
  
  
  METHODS
  Using the 2003-2006 National Health and Nutrition Examination Survey, we categorized USOC (a place to go when sick or need medical advice) and insurance status in adults >or=35 years old with an indication for medication treatment of hypertension (n = 3,142) and hypercholesterolemia (n = 1,134), determined using the Joint National Committee 7 and Adult Treatment Panel III recommendations, respectively. Multivariable logistic regression modeling was used to determine the independent effect of USOC on receiving treatment of hypertension and hypercholesterolemia, controlling for age, sex, race/ethnicity, insurance status, and comorbidities. Separate multivariable models were examined stratified by insurance status.
  
  
  RESULTS
  Among subjects with an indication for treatment of hypertension and hypercholesterolemia, 32.4% and 42.0% were untreated, respectively. When compared with adults with a USOC, adults without a USOC were more likely to be untreated for hypertension (adjusted prevalence ratio [aPR] 2.43, 95% CI 1.88-2.85) and hypercholesterolemia (aPR 1.79, 95% CI 1.31-2.13). In stratified analyses among subjects with insurance, no USOC remained associated with being untreated (hypertension, aPR 2.58, 95% CI 1.88-3.08; hypercholesterolemia, aPR 1.65, 95% CI 0.97-2.18).
  
  
  CONCLUSIONS
  Absence of a USOC was associated with being untreated for hypertension and hypercholesterolemia, even among individuals with insurance, suggesting that efforts to improve chronic disease management should also facilitate access to a regular source of care.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT 06520-8088, USA. erica.spatz@yale.edu
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000191:economics; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents