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“Overall, the quality of outpatient care has remained largely flat;
there are some areas of improvement, but we also see areas of
decline,” said lead study author Dr. David Levine of Brigham and
Women’s Hospital and Harvard University in Boston.
“The take-home for patients: there is likely recommended care that
you are not receiving but should, and there is likely extra care
that you are receiving and could be harmful to you,” Levine added by
email.
Levine and colleagues analyzed survey data from a nationally
representative sample of patients, clinicians, hospitals,
pharmacists and employers collected from 2002 to 2013.
Each year, the survey included roughly 21,000 to 27,000 individuals.
There was some good news.
During the study period, the percentage of patients receiving
recommended medical treatment rose from 36 percent to 42 percent,
the researchers report in JAMA Internal Medicine. For example, more
patients got medications needed for conditions like high blood
pressure, elevated cholesterol, asthma and heart failure.
At the same time, the proportion getting recommended counseling for
weight loss, exercise and smoking cessation jumped from 43 percent
to 50 percent; receipt of recommended cancer screenings climbed from
73 percent to 75 percent and avoidance of inappropriate cancer
screenings rose from 47 percent to 51 percent.
Patient satisfaction also appeared to improve, with 77 percent of
patients giving high ratings for their care by the end of the study,
compared with 72 percent at the start.
The proportion of participants giving high marks for physician
communication rose from 55 percent to 63 percent, while high ratings
for access to care increased from 48 percent to 58 percent.
Still, some other measures got worse.
The percentage of cases when patients avoided inappropriate medical
care such as opioids for headaches or MRIs for back pain declined
from 92 percent to 89 percent. Skipping unnecessary antibiotic use
for things like the flu or acute bronchitis dropped from 50 percent
to 44 percent.
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Over the decade-long study, Americans as a whole got older, sicker,
less white and better educated on average. U.S. adults also became
less likely to smoke and more likely to live with multiple chronic
diseases.
One limitation of the study is that the quality measures included
don’t address all outpatient care, the authors note.
The quality assessment in the study also doesn’t account for how
easy or difficult it may be to achieve certain measures, making it
impossible to say how care for heart disease may have changed
relative to treatment for diabetes, the authors also note.
Even so, the findings add to a growing body of evidence suggesting
there’s room for outpatient care in the U.S. to improve, said
Elizabeth McGlynn, author of an accompanying editorial and vice
president at Kaiser Permanente Research in Pasadena, California.
“I don't think the study tells us anything particularly new although
it does confirm that quality deficits remain,” McGlynn said by
email.
“The take home message for patients is that they should take an
active role in identifying the important components of their care
and advocating for themselves - being actively engaged is
important,” McGlynn added.
SOURCE: http://bit.ly/2emuxDT JAMA Internal Medicine, online October
17, 2016.
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