UNC, Shaw research shows continuity of care, not race, key to better blood pressure control


(Embargoed) CHAPEL HILL Sustained access to the same doctor is more important than a doctor being of the same race in helping older black patients control their high blood pressure, a new study indicates. The same holds true for older whites.

The study, conducted by researchers at the University of North Carolina at Chapel Hill and Shaw University in Raleigh, showed that continuity of care was associated with patients' increased awareness of their hypertension and receiving medications for it, as well as a lower incidence of undetected high blood pressure. Racial conformity between patients and caregivers was not a significant factor.

"We believe these findings are important because, despite progress in hypertension management, African-Americans still are less likely than whites to know that they have the illness, be treated for it and have their blood pressure controlled," said Dr. Thomas R. Konrad of UNC. "Regular access to a usual care source and sustained affiliation with a physician can improve hypertension management in both older African-American and white patients."

A report on the findings appears in the December issue of the American Journal of Public Health. Besides Konrad, authors are Dr. Timothy S. Carey of UNC's Cecil G. Sheps Center for Health Services Research, Dr. Daniel L. Howard, professor of health policy at Shaw, and Drs. Lloyd J. Edwards and Anastasia Ivanova at the UNC School of Public Health.

Carey, professor of medicine at the UNC School of Medicine, directs the Sheps center, and Konrad is co-director of its program on health professions and primary care. Respectively, Edwards and Ivanova are associate professor and assistant professor, both of biostatistics. At Shaw, Howard directs the Institute for Health, Social and Community Research.

Investigators conducted the study to learn how important continuity of care and doctors being of the same race as their patients were in diagnosing high blood pressure and medication use. Earlier work elsewhere had suggested that racial concordance in health-care settings was important.

They analyzed data from in-home interviews with -- and blood pressure readings on -- 4,162 North Carolinians aged 65 or older in 1986 and 1987 and during a follow-up of 3,536 survivors in 1990. That project was known as the Piedmont Health Survey of the Elderly.

Researchers also matched the names of doctors that patients mentioned to information physicians completed for licensure to the N.C. Medical Board. Among details extracted was each doctor's race. How patients fared in terms of blood pressure control and their race were then compared with the race of their doctors.

"Those who lacked or had switched physicians received fewer hypertension diagnoses and, if diagnosed, took fewer medications compared with those keeping the same physician," Konrad said. "Rates of detection of high blood pressure in people changing doctors tended to be midway between those without doctors and those keeping the same one."

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