Todd Shryock

(PCC) and the AAFP Robert Graham Center found that more Americans lack a consistent source of health care – most often primary care – despite the pandemic, which does not bode well for Americans’ future overall health.

Differences between racial/ethnic groups in usual source of care (USC) are likely contributors to health disparities, which were made worse by the pandemic.

“Americans with an ongoing primary care relationship dropped 10% between 2000-2019, from 84% to 74%, and ticked up only slightly in 2020,” said Ann Greiner, president and CEO of the PCC, in a statement. “Many innovators are moving into the primary care space because they understand patients are finding it difficult to find affordable primary care. These innovators differ in whether they are supporting longer-term relationships or providing a more transactional set of primary care services.”

Hispanic individuals had a 66% higher rate of no USC (34.3%) as compared to their White counterparts (20.7%) in 2019

Non-Hispanic Black individuals had a 38% higher rate of no USC (28.4%) as compared to their White counterparts (20.7%) in 2019

There was a 10% decline in USC for those with dual coverage (Medicare & Medicaid) between 2015 – 2020

46% of 18–34-year-olds had no USC in 2019, up from 34% in 2014

In 2020, there was a spread of 27% points in USC across 50 state

“There are structural barriers preventing our children, families, and neighbors from accessing ongoing preventive and comprehensive care when they need it,” said Mark Del Monte, JD, chair of the PCC board of directors and CEO/executive vice president of the American Academy of Pediatrics (AAP), in a statement. “There are opportunities for leaders across government and the private sector to partner with primary care and make investments that will improve physical and mental health and well-being.”

According to the report, financial barriers are an ongoing issue for patients and can interfere with getting regular primary care that helps avoid emergency department visits and addresses health problems early before they worsen.

Asaf Bitton, MD Executive Director, Ariadne Labs - Harvard T.H. Chan School of Public Health noted, “Employers have a very important role to play to ensure that all their employees and their families have ready, convenient access to a usual source of affordable primary care. We applaud those employers who are providing highly accessible virtual and in-person primary care options, and working with preferred provider organizations and health systems to support patients in establishing and maintaining these crucial primary care relationships.”

The PCC Report also highlights the need to attract more diverse students to the primary care workforce so that it better reflects the populations they serve.

“We need to train primary care clinicians in teams in community settings where people work and live as recommended by the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care,” said Yalda Jabbarpour, MD, director of the AAFP Robert Graham Center for Policy Studies, in a statement. “The evidence suggests that residents who train in rural and underserved settings, such as Community Health Centers, are much more likely to end up practicing in such settings. This strategy can help address primary care maldistribution and close USC gaps.”

This article originally appeared on Medical Economics.

Articles

Health disparities in care were made worse by the pandemic.

More Americans Lack a Consistent Source of Health Care

 found that as a result of inflation, many American consumers are making difficult choices about household expenses, including whether they can pay for medical care. These decisions of choosing to pay for either housing, transportation, prescription drugs, or needed medical care can impact their health and quality of life.

According to the report, consumers are dealing with economic pressures they weren't facing just one year ago. Prices for food at home rose 12.2% between 2021 and 2022, the largest increase since April 1979. Energy prices rose 41.6 % over the same time, the largest 12-month increase since April 1980. With prices rising in other areas of consumers' lives, one likely outcome is they'll have less money available for health care needs.

Twenty-six percent of consumers who don't have a health plan that covers virtual visits intend to change their health plans to accommodate. Nearly two-thirds of consumers who had virtual health care visits last year cited either convenience (38%) or cost (27%) as the top reasons why they sought virtual health. In response to rising expenses, some consumers are delaying routine care, cancer screenings, preventive care, and other essential medical needs.

"Inflation can also impact spending on health equity initiatives which can further exacerbate inequities and outcomes of historically vulnerable and underserved populations that already are struggling to pay for critical needs like food, housing, transportation and clothing,” said Jay Bhatt, DO, MPH, MPA, executive director, 

, in a statement. “We know that when basic needs go unmet, this can lead to poorer health outcomes, and have a cascading effect. We're poised to reverse the gains we've made in health equity if we aren't intentional and thoughtful about how we care for the most vulnerable among us."

Virtual health may be one way health systems fight inflation. According to the "Deloitte Survey of Health Care Consumers" in 2022, virtual health visits continued to increase from 22% in 2018 to 44% in early 2022. Some consumers are considering changing health plans if they don't offer virtual visits, as well as other more affordable and convenient options. Financial pressures for both consumers and providers and retailers may accelerate virtual health transformation providing cost effective options for consumers and diversified services for providers and retailers to grow, build trust and potentially lessen the effects of inflation, according to Deloitte.

Hospitals, health systems and clinicians are not immune from the financial pressures imposed by a tight labor market and ongoing supply chain issues, so retaining patients is critical, the report states. Deloitte's research shows that consumers are demanding a trusted health care experience and are willing to move on when they don't receive it. Thus, health care organizations should weave trust elements into their offerings, including:

Helping consumers navigate their health care journeys 

by using established and credible entities to help consumers find information and providers.

Collaborating with trusted community partners

 like pharmacies and other community-based organizations.

Providing (better) cost transparency tools

 that help consumers predict costs and resources, so they're more prepared.

Including social drivers of health in patient discussions 

so consumers can factor these into their planning and make more informed decisions.

Inflation is the top reason that nearly one-third of Americans are concerned about covering unexpected health care needs

Almost 1 in 3 Americans Feel Unprepared for 2023 Health Care Costs

Vaccine confidence has declined significantly since the start of the pandemic, according to a 

 from the University of Portsmouth. Researchers used anonymous surveys in the winters of 2019 and 2022 to examine attitudes toward vaccinations and that factors that might lead to hesitancy and refusal.

The results from more than 1,000 adults show the post-pandemic group was considerably less confident in vaccines than the pre-pandemic group. The results were published in the medical journal 

Researchers found that nearly one in four participants reported a fall in confidence since 2020, and this occurred regardless of age, gender, religion, education, and ethnicity.

 hesitancy is not a new phenomenon, COVID-19 vaccines have been met with particular hostility despite the overwhelming scientific evidence of their safety and effectiveness,” says 

, associate head of the School of Biological Sciences at the University of Portsmouth, in a statement. “This isn’t just among conspiracy theorists though, but also those who don’t consider themselves ‘anti-vaxxers’ and had supported other vaccination campaigns in the past.”

Participants were asked how much they agreed with statements including:

I think vaccines should be a compulsory practice

I believe if I get vaccinated it would benefit the wellbeing of others

Vaccines are a necessity for our health and wellbeing

In both surveys participants who held religious beliefs were significantly more vaccine-hesitant than atheist and agnostic ones, and individuals from Black and Asian backgrounds were more hesitant than those belonging to White ethnicities. However, gender showed no association with vaccine confidence.

While these overall trends remained largely similar between the two surveys, some noteworthy changes were observed in the post-pandemic survey, according to researchers. For example, the analysis revealed that while in 2019 middle-aged participants were considerably 

 about getting vaccinated than younger groups , this was not the case in the 2022 survey.

“This could be because COVID-19 infections notoriously lead to more severe outcomes in older patients,” said Siani. “Young people who are infected rarely experience severe symptoms that lead to hospitalization and death, so it’s possible that many have become complacent and don’t feel the need to get vaccinated. On the other hand, older people may have been more wary of the consequences of the infection, and more appreciative of the protection offered by the vaccine.”

While providing precious insight into how the pandemic affected the public perspectives on vaccinations, the study is not without limitations. The original survey was designed as a standalone piece of research, so a different group of people had to be sampled in 2022. This resulted in a cross-sectional study as opposed to a longitudinal one.

“However, the study is consistent with other observations suggesting that vaccine confidence may be yet another victim of the COVID-19 pandemic,” said Siani.

Confidence in vaccines is lower post-pandemic across all demographic groups

 Vaccine Confidence Decreased Significantly During Pandemic

Johns Hopkins Bloomberg School of Public Health

 found that the overall number of undiagnosed diabetes cases in the U.S. is significantly lower than current government estimates suggest.

Researchers attribute public health efforts to improve diabetes awareness and screening over the last 30 years to better detection of type 2 diabetes in the United States. However, there are some population subgroups that show major disparities in undiagnosed diabetes.

 is more prevalent in older and obese adults, racial/ethnic minorities, notably Mexican Americans and Asian Americans, and those without health care access. Individuals who reported an interval of more than one year since their last health care visit also had a high estimated prevalence of confirmed undiagnosed diabetes.

 The analysis used government health survey data from 1988-2020, but used the two-test criterion that doctors use when screening for diabetes. The researchers found that about 9.5% of the total diabetes burden in the U.S. is undiagnosed, versus estimates that are in the 20-30% range.

 and Prevention, in its 2020 National Diabetes Statistics Report, estimated that about 2.8% of the 18-and-over population, or roughly seven million Americans, have undiagnosed diabetes. That figure would represent about 22% of the total diabetes burden. The estimates were based on national survey data and using any single blood test result indicating elevated glucose.

The researchers considered individuals in the survey as having “confirmed undiagnosed diabetes” if they had no diabetes diagnosis, yet their test results included elevated results on both a fasting glucose and an HbA1c test. They found that the number of individuals in this category suggested a national prevalence of only 1.23%—less than half the CDC’s most recent estimate based on single test results—and only about 9.5% of the total diabetes prevalence.

Overall numbers may be lower, but the obese, racial/ethnic minorities, and those without health care access have higher numbers of undiagnosed diabetes

Undiagnosed Diabetes May Not Be as Common as Thought

/Gallup poll found that nearly four in 10 Americans in the last six months have delayed or skipped health care treatments, trim regular household expenses, or borrow money, because of rising health care costs. Extrapolated across the entire population, that means 98 million adults are having to figure out how to afford health care.

While half of adults in households earning less than $48,000 per year report cutting spending, the effects also extend to more influential households. For those earning at least $180,000, 19% said they have pared back spending to pay for health care.

According to the report, women under 50 are disproportionately being compelled to cut back on health care with 36% reporting they have done so, compared to 22% of men. having done so, compared with 22% of men.

Overall, 26% of adults report delaying or avoiding medical care or purchasing prescription drugs in the prior six months due to higher health care prices. This rises to 43% among adults in lower-income households (those making less than $24,000 annually).

For those cutting costs, health care is usually on the chopping block with other expensed. The report found:

Of those who cut back on utilities, 59% also cut back on medical care and medicine.

Of those who skipped a meal, 71% also cut back on medical care and medicine.

Of those who borrowed money, 60% also cut back on medical care and medicine.

Of those who drove less, 55% also cut back on medical care and medicine.

The effect of inflation exacerbates an already significant issue for millions of Americans struggling to pay for health care and medicine. Prior findings from the 2021 West Health-Gallup Healthcare Study showed that an estimated 18% of adults, or about 46 million people, 

could not afford needed care if they required it today

unable to pay for prescribed drugs in the prior three months

Health care inflation, which stood at 4.5% in June, is lagging overall inflation, which spiked to 9.1% in June, a new 40-year high primarily because of rising prices for gas, food and rent. According to the report, inflation has not yet fully hit health care prices due to prenegotiated contracts with insurers and providers for 2022, but inflation is likely to impact prices later in the year -- something that consumers may not fully appreciate given the mere 3% that cite health care as the service expected to rise in price the most in the next six months.

Patients are either skipping care completely, cutting costs elsewhere, or borrowing money to pay for health care

Nearly 40% of Americans Say Inflation Has Impacted Health Care

There’s always been a commonsense link between opioid use disorder and chronic pain, but a new study found how patients with central sensitization struggle more than others.

Central sensitization is abnormal pain processing in the brain and spinal cord, and those that have it experience higher pain levels than those who do not, and their brains struggle to turn off the pain signals once they arrive.

The Ohio State University Wexner Medical Center

 examined how individuals with OUD are affected by central sensitization.

The study provides the first evidence of central sensitization underlying the chronic pain and opioid use disorder relationship. Study findings are published in the journal 

Researchers say that chronic pain may lead to OUD, and people with chronic pain and OUD have a harder time quitting opioids than people with OUD only. The more central sensitization patients had, the worse their quality of life among patients with OUD, and the more likely they were to report that chronic pain was the reason they became addicted.

This study suggests central sensitization may be an important underlying factor complicating the treatment of chronic pain and OUD. This provides an example for other clinicians and researchers to measure central sensitization in OUD, which could help them produce better treatments for people suffering with chronic pain and OUD.

Patients with central sensitization struggle more with pain and quitting opioids