Increased Risk of Uncontrolled Hypertension Among Vets Experiencing Temporary Gaps in Access to Care

A recent study found that decreased access to care services for a temporary period increased the rate of uncontrolled hypertension among a cohort of veterans. The findings of this study were published online in JAMA Network Open. 

“Temporary disruptions in health care access are common, but their associations with chronic disease control remain unknown,” said lead study authors Aaron Baum, PhD, Veteran Affairs (VA) New York Harbor Healthcare System, and colleagues. 

In order to evaluate the association of long-term changes in chronic disease control with a temporary 6-month decrease in access to health care services, Dr Baum and colleagues conducted a cohort study. The study observed the long-term changes in chronic disease control associated with the 6-month closure of the Manhattan facility of the VA New York Harbor Healthcare System after superstorm Sandy. The research team used electronic health records between October 20, 2010 and October 29, 2014 to identify veterans who were and were not exposed to the 6-month closure. Based on the criteria, the researchers identified 81,544 veterans of which 62.7% were white, 31.8% were black, and the mean age was 62.1 years. Of the participants identified, 19,207 veterans were included in the exposed cohort and 62,337 were included in the nonexposed control cohort, which included veterans who were equally exposed to the storm but maintained access to care services.

“The outcomes measured were uncontrolled blood pressure (defined as mean blood pressure per patient per quarter >140/90 mm Hg), uncontrolled diabetes (defined as mean hemoglobin A1c per-patient per-quarter >8%), uncontrolled cholesterol (defined as mean low-density lipoprotein per-patient per-quarter >140 mg/dL), and patient weight,” explained Dr Baum and colleagues. 

According to the study findings, a decrease of 24.8% was observed in the percentage of veterans who had any VA primary care visits per quarter at the 3-month midpoint of the facility closure compared with a baseline of 47.8% before the closure. The researchers also found that a year after the facility reopened, there was no differential change in the percentage of patients with a primary care visit between the exposed vs nonexposed cohorts. Although, patients in the exposed cohort were 25.9% more likely to have uncontrolled blood pressure than patients in the nonexposed cohort after a year of the facility reopening.

Further study findings observed 2 years after superstorm Sandy show that patients in the exposed cohort were 10.9% more likely to experience uncontrolled blood pressure than those in the nonexposed cohort. Additionally, the exposed cohort experienced a decrease in filled medication prescriptions per-patient per-quarter of 6.9% during the facility closure and 2.2% a year after the facility reopened. The researchers noted that there were no differential changes in uncontrolled diabetes, uncontrolled cholesterol, or patient weight during the study. 

“In this study, a temporary period of decreased access to health care services was associated with increased rates of uncontrolled hypertension, but not with increased rates of uncontrolled diabetes or hyperlipidemia, more than 1 year after the Manhattan VA facility reopened,” Dr Baum and colleagues concluded. “Temporary gaps in access to health care may be associated with long-term increases in uncontrolled blood pressure among patients with hypertension.” —Julie Gould