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Uninsured South Florida vascular surgery patients are less likely to receive optimal medical management than their insured counterparts.
Yeh, Dante; Jones, Monique; Schulman, Carl; Karmacharya, Jagajan; Velazquez, Omaida C.
Afiliação
  • Yeh D; University of Miami/Miller School of Medicine, Miami, FL, USA.
J Vasc Surg ; 51(4 Suppl): 4S-8S, 2010 Apr.
Article em En | MEDLINE | ID: mdl-20346337
ABSTRACT

OBJECTIVE:

Vascular disease is the most prevalent condition in patients aged >60 years, leading to increasing complications associated with their comorbid conditions. Poor medical compliance could be one reason why the rate of complications may be higher in this patient population, particularly the uninsured. This study was conducted to better assess rates of medication compliance in vascular surgical patients.

METHODS:

Consecutive patients seen in vascular clinics at a busy tertiary academic center were prospectively studied. Physicians and physician assistants used a standardized questionnaire to collect patient data and evaluated patients for coexisting medical conditions and medication use. Optimal medical therapy was defined according to the 2006 American Heart Association (AHA)/American College of Cardiology (ACC) "Guidelines for Secondary Prevention for Atherosclerotic Vascular Disease." Data were analyzed using multivariate regression.

RESULTS:

During the 4-month study period, 180 consecutive patients (47% men) were seen in vascular surgery clinics. Most patients (79%) were nonsmokers and only 21% admitted to smoking. Comorbid conditions surveyed included hypertension in 141, diabetes mellitus in 56, coronary artery disease in 24, hypercholesterolemia in 89, and chronic renal failure in 13; of these, 61% were insured and 39% had no insurance. Overall, only 31% of all patients were receiving adequate medical therapy for their comorbid conditions, and about 66% were receiving suboptimal medical treatment for their vascular disease. Uninsured patients were less likely (19%) than insured patients (39%) to receive optimal medical therapy (P = .012). Lack of insurance was a predictor of suboptimal medical therapy for hypertension (odds ratio [OR], 3.13; 95% confidence interval [CI], 1.20-8.16; P = .016), hypercholesterolemia (OR, 5.1; 95% CI, 1.87-13.88; P = .001), peripheral arterial disease (OR, 13.32; 95% CI, 2.84-62.54, P < .001), and any disease overall (OR, 2.43; 95% CI, 1.21-4.88, P = .012). Overall, men and women were equally likely (68%) to receive suboptimal medical therapy; however, women were significantly more likely to be undertreated for coronary artery disease (OR, 0.022; 95% CI, 0.0017-0.293; P < .001).

CONCLUSIONS:

Compliance with optimal medical therapy for secondary risk factor management amongst our vascular surgery patients is low. Uninsured patients are less likely to receive optimal medical therapy than their insured counterparts. This survey provides sobering statistics regarding medical compliance in our population. This issue deserves further study and may indirectly affect outcomes in minority groups that are disproportionately represented in our uninsured patients.
Assuntos

Texto completo: 1 Temas: ECOS / Aspectos_gerais / Estado_mercado_regulacao / Gestao Bases de dados: MEDLINE Assunto principal: Avaliação de Processos e Resultados em Cuidados de Saúde / Doenças Vasculares / Fármacos Cardiovasculares / Cooperação do Paciente / Pessoas sem Cobertura de Seguro de Saúde / Disparidades em Assistência à Saúde / Acessibilidade aos Serviços de Saúde / Seguro Saúde Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspecto: Determinantes_sociais_saude Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2010 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Temas: ECOS / Aspectos_gerais / Estado_mercado_regulacao / Gestao Bases de dados: MEDLINE Assunto principal: Avaliação de Processos e Resultados em Cuidados de Saúde / Doenças Vasculares / Fármacos Cardiovasculares / Cooperação do Paciente / Pessoas sem Cobertura de Seguro de Saúde / Disparidades em Assistência à Saúde / Acessibilidade aos Serviços de Saúde / Seguro Saúde Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspecto: Determinantes_sociais_saude Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2010 Tipo de documento: Article País de afiliação: Estados Unidos