title: Cardiovascular disease and risk in primary care settings in the United States.
abstract: Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. In this study, a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (NHANES; 1999 to 2008) using multivariate logistic regression was conducted to assess the relation between site of usual care and disease prevalence. Patients' self-reported histories of several chronic conditions (hypertension, diabetes, and hypercholesterolemia), awareness of chronic conditions, and associated cardiovascular events (angina, coronary heart disease, cardiovascular disease, myocardial infarction, and stroke) were examined. After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients receiving usual care at private doctors' offices, hospital outpatient clinics, community-based clinics, and emergency rooms (ER). However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions than participants at other sites. The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs relative to private doctors' offices. In conclusion, participants who report using ERs as their usual sites of care are disproportionately more likely to have histories of poor cardiovascular outcomes and are more likely to be unaware of having hypertension or hypercholesterolemia. As health care reform takes place and millions more begin seeking care, it is imperative to ensure access to longitudinal care sites designed for continuous disease management.
authors: Program in Public Health, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA. chima_ndumele@brown.edu
authors: Chima D
authors: CD
authors: Ndumele
authors: Heather J
authors: HJ
authors: Baer
authors: Shimon
authors: S
authors: Shaykevich
authors: Stuart R
authors: SR
authors: Lipsitz
authors: Leroi S
authors: LS
authors: Hicks
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult