Abstract P466: Health and Healthcare Disparities in the Management of Systemic Hypertension and Cardiovascular Disease: The Critical Role of Insurance Status

Abstract

Background: Minority populations are two to three times as likely to die of preventable cardiovascular events. Two main forces behind the challenge in managing hypertension among minority populations are disparities in health and healthcare. Aims: To identify the common health and healthcare disparities (HHD) among hypertensive patients who presented to a community medical center and propose a collaborative alliance for improvement. Methods: Internal medicine residents at the Newark Beth Israel Medical Center utilized a (P: Provider, I: Insurance, F: Food, E: Economic stability, N: Neighborhood, C: Culture and Language, E: Education, S: Social (PI-FENCES) model to identify health and health care disparities in hypertensive patients who presented to the ambulatory and inpatient settings over a 12-week-period. Demographic and baseline clinical characteristics were recorded. The distribution of each of the elements of PI-FENCES was documented and their association with respective demographics was determined. A protocol for usability study was designed based on preliminary data collected. Results: Between May 2019 and July 2019, a total of 86 hypertensive patients (mean ± SD age: 54 ± 12 years, BMI: 31± 8 kg/m 2 ) were identified. Seventy-one (83%) of them were African Americans. Of the patients identified, 51 (59%), presented to the ambulatory setting, 24 (28%) were seen in the in-patient setting and 11 (13%) were admitted to the Intensive care unit. According to the PI-FENCES model, distribution of HHD were as follows: n(%); P: 6 (6.9%), I: 40 (47%), F: 8(9.3%), E: 10 (11.6%), N: 1 (1.2%), C: 10 (14%), E: 26 (30.2%), S: 17 (19.7%). While 61 (71%) patients had at least 1 element of HHD, 9 (1.1%) had more than 2 elements of HHD. Associated cardiovascular conditions noted among admitted patients (n=35) were heart failure exacerbation (n=8) (22%) and cerebrovascular accident (n=4) (11%). Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit (Insurance: 31% vs. No insurance: 69%, p<0.0001). Based on the preliminary data, a Reducing ReAdmission Secondary to Hypertension (RRaSH) proposal will be implemented. RRaSH will focus on developing follow-up and referral plans for all uninsured hypertensive patients who present to the in-patient setting. The program will also encourage free health screening of families and friends of this uninsured population. Conclusion: About one out of every two patients who presented with systemic hypertension to a community medical center had no insurance. Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit. RRaSH will be a follow-up and referral plan to help reduce readmissions secondary to hypertension.

Screening for social determinants of health among populations at risk for MASLD: a scoping review

“…One study supplemented this with the validated 2-question screener for food insecurity ( 58 ). One study described using the PI-FENCES model, which includes Provider, Insurance, Food, Economic stability, Neighborhood, Culture and Language, Education and Social support, ( 54 ) while another asked similar questions based on the National Academy of Medicine Committee Social and Behavioral Domains ( 59 , 60 ).…”

“…Among the studies that included specifics regarding survey administration, the most common approaches were collection via patient interview by the provider ( 51 , 54 ) or clinic staff; in Palacio et al, patients were sent messages via text or email asking them to access their patient portal to complete the SDoH survey. The two remaining studies described collection of SDoH in clinic but did not provide additional details.…”

“…Okoh et al described future directions for use of SDoH data that included the development of a follow up and referral plan for uninsured patients presenting to the inpatient setting, as well as free health screening for families and friends of uninsured individuals, components of their Reducing ReAdmission Secondary to Hypertension proposal ( 54 ).…”

“…Arunthamakun et al found that Black populations with higher prevalence of hypertension had concurrent increased rates of household-level economic and social disparities ( 47 ). Additionally, patients with hypertension without insurance, based on findings by Okoh et al, were more likely to be admitted inpatient or to the intensive care unit likely as a result of limited healthcare access and associated financial strain ( 54 ).…”

“…Of the 6,729 unique studies identified using our search criteria, after reviewing 460 abstracts and 25 full texts, 10 studies met our inclusion criteria -8 manuscripts and 2 conference abstracts (47)(48)(49)(50)(51)(52)(53)(54)(55)(56). Figure 2 shows the flow diagram summarizing our study identification and selection.…”