National Trends and Outcomes Associated With Presence and Type of Usual Clinician Among Older Adults With Multimorbidity

Abstract

IMPORTANCE Declining primary care visit rates and increasing specialist visit rates among older adults with multimorbidity raise questions about the presence, specialty, and outcomes associated with usual clinicians of care for these adults.OBJECTIVE To examine trends in the presence and specialty of usual clinicians and the association with preventive care receipt and spending.

Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study

“…At a structural level, these results might reflect decades of structural racism resulting in racially segregated neighborhoods and lower density of primary care clinics and high quality urgent care centers60 in predominantly Black neighborhoods compared with White neighborhoods. Despite our finding that Black patients had a larger share of visits with primary care or advanced practice clinicians, they are less likely to have a regular primary care clinician2861 (who might appropriately triage them away from the emergency department) and might be more likely to receive acute care from urgent care or emergency medicine clinicians who do not know them well,2762 potentially contributing to more acute diagnostic testing 63. This low value acute diagnostic testing affects recipients through direct harms (eg, radiation exposure, treatment burden, and out-of-pocket spending)64 and through downstream care cascades that can often arise from imaging tests in particular 6566…”

“…As a result of such influences, researchers have noted differences in overall care quality both within and across health systems; that is, Black and White patients have been shown to receive differential care due to bias within systems and because Black patients disproportionately receive care at lower quality systems 12392122232425. Secondly, racial differences in low value care receipt might be influenced by broader differences in healthcare use; for example, differential access to primary and specialty care resulting, at least in part, from structural racism 262728. Understanding racial differences in low value care receipt overall and within systems is critical for developing interventions to reduce low value care use and promote equity.…”

Increasing Access to Preventive Services Is Needed—No Medicare Beneficiary Left Behind

“…Although Ganguli and colleagues found an association between having a UCP and uptake in preventive services, we are left without an answer as to why this association exists, or why a minority of Medicare beneficiaries do not have a UCP. Events of recent years provide at least some insight into both uptake of vaccination and barriers to primary care.…”

“…Ganguli and colleagues explore national trends in receipt of preventive services among older adults with multiple comorbidities enrolled in Medicare based upon having a usual care clinician (UCP). Previous research has linked having a UCP with improved health outcomes and high-value care, as well as improved mortality with greater primary care physician supply .…”

“…Using the Medicare Current Beneficiary Survey (MCBS), an administrative claims–linked survey database, Ganguli and colleagues found that the proportion of older adults enrolled in Medicare with a UCP declined a small amount between 2010 and 2016 and remained quite high at 94.2% and 91.0%, respectively. Additionally, the authors found essentially no shift in the proportion of Medicare enrollees having their UCP as PCP as opposed to a specialist clinician.…”