CHRONIC ILLNESS: Secondary Conditions Often Go Untreated
Patients with chronic diseases like diabetes or emphysema may not be getting adequate treatment for secondary conditions such as high cholesterol or osteoporosis, according to a study in today's New England Journal of Medicine (click here to view the study abstract). The Boston Globe reports that the study found women with diabetes are 60% less likely to get estrogen treatment to prevent thinning bones and heart disease than women without the chronic illness. Emphysema patients are 30% less likely to be treated for high cholesterol, and patients with psychosis are 40% less likely to be treated for arthritis. "Our findings suggest a shortfall in health care specifically, that unrelated disorders are relatively neglected in patients with chronic medical diseases," said the Toronto researchers who conducted the study.
The researchers said inadequate insurance coverage can't be blamed for the undertreatment, largely because their findings were "based on prescription records of more than 1 million Ontario residents" over 65 who receive free prescription drugs through a government program, the Globe reports (Kong, 5/21). Dr. Frank Vinicor, who directs diabetes research at the Centers for Disease Control and Prevention, said the findings could be attributed to the boom in new treatments for diabetes and other chronic illnesses as well as shorter patient visits under managed care, the AP/Philadelphia Inquirer reports. Vinicor said physicians focus most of their efforts "on diabetes-related issues, and have even less time to spend now on unrelated chronic problems that could be effectively treated." The study authors blamed the undertreatment on doctors' failure to diagnose secondary conditions or their decisions not to treat them "because of concerns about side effects, drug interactions or resistance from the patient." "Patients with chronic diseases may be exhausted and reluctant to accept multiple interventions," said the researchers, headed by Dr. Donald Redelmeier of Toronto's Sunnybrook Health Science Centre (Webster, 5/21).
Further Research Needed
An accompanying editorial in today's New England Journal of Medicine says the Toronto researchers' findings demand further research. For example, the editorial suggests that the "computerized databases of managed-care plans or pharmacy-benefit-management companies can be used to test" several hypotheses about why chronically ill people may not be receiving necessary care for secondary conditions. "If the findings are confirmed," the editorial continues, "patterns of undertreatment of unrelated disorders could be identified. This information would allow physicians and health plans to focus on those that are clinically significant and to consider specific corrective measures" (5/21 issue).