A series of reports released today by the Wisconsin Collaborative for Healthcare Quality and Healthy Metric provide an initial look at the impact the pandemic has had on health care disparities. The reports cover three chronic conditions, diabetes, colorectal cancer screening and high blood pressure from the onset of the pandemic through 2020.
The pandemic created several barriers to patients accessing care, perhaps none more hindering than the closure of some clinics across Wisconsin in early 2020. While health systems rapidly pivoted to telehealth, not all patients could access this service. That, along with other factors including personal concerns for safety outside of the home, reduced the number of patients that were seen in primary care clinics. Health disparities existed before the pandemic; however, they were made worse by challenges to access care during the pandemic.
The total number of diabetic patients who saw a primary care physician fell, with the largest declines of 7 percent for American Indians and 3 percent for Black Wisconsinites. While the percentages seem small, the number of people not seen for important screening services was significant. Typically, the number of patients seen in primary care remains stable from year to year.
“WCHQ’s member health systems are committed to addressing health disparities, as demonstrated by their continued public reporting of this essential information during a global pandemic. WCHQ’s role is to use this data to shine a spotlight on populations in need and to facilitate solution generation across the region,” according to WCHQ President and CEO Gabrielle Rude, PhD. “Our multi-disciplinary team of health system leaders representing the Midwest are using WCHQ’s data to identify and eliminate disparities.”
All racial and ethnic groups had lower rates of diabetes control during the pandemic, but white Wisconsinites had the most significant change at 6 percent more patients who were uncontrolled in 2020 when compared with 2019, or more than 6,000 individuals. People with uncontrolled diabetes are at greater risk of serious complications, such as heart disease, stroke, amputation, kidney disease, blindness and death.
High blood pressure, a sentinel chronic disease that is often linked to other serious health conditions, was significantly impacted by lower rates of primary care visits in the pandemic. More than 30,000 people in Wisconsin with high blood pressure did not receive care in 2020 compared to 2019. Primary care visits related to high blood pressure in rural underserved areas dropped the most at 10 percent while urban underserved and rural service areas fell nearly as much.
Disparities in colorectal cancer screening persisted and, at the end of 2020, had not changed, with Asian/Pacific Islanders having the lowest screening rates. Screening intervals for different colorectal cancer tests vary, so only a subset of patients is eligible for screening each year. This may be why the change in this measure from 2019 to 2020 is not as large as expected, even though primary care visits and preventive care decreased during the COVID-19 pandemic.
“The pandemic led to substantial decreases in primary care visits, which has concerning implications for the health of Wisconsin residents such as cancer being diagnosed at later stages and chronic diseases, like diabetes, not being well-managed,” according to Maureen Smith, MD, MPH, PhD, UW Madison School of medicine and Public Health, Professor of Population Health Sciences and Family Medicine. “With these findings, we want to encourage people to return to their health care provider to care for their health and stay up to date on screenings and care for chronic conditions. Focusing on health maintenance and addressing health issues as soon as possible helps prevent more serious health complications in the future.”
Joan Neuner, MD, MPH, an internal medicine specialist and Georgia Carroll Professor of Women’s Health, Department of Medicine at the Medical College of Wisconsin, believes investments must be made to ensure health care is accessible to everyone.
“Treatment of chronic conditions like diabetes and high blood pressure, can prevent strokes, heart attacks, amputations, and kidney failure and everyone 45 and over should get colon cancer screening. People should see their doctors, and make sure their loved ones do, too” according to Dr. Neuner. “For some people, this can be easier than before as most doctors now do televisits using computers or smartphones, or even telephone calls. For others, our state needs to reinvest and innovate in public health solutions like better transportation. Working together, we can make those investments that advance the health of our state.”
WCHQ is facilitating a statewide team comprised of representatives from Wisconsin health systems that is tasked with gathering and implementing evidence-based interventions to eliminate health care disparities. This work is funded by the Medical College of Wisconsin’s Advancing a Healthier Wisconsin and the University of Wisconsin School of Public Health’s Wisconsin Partnership Program.
For nearly two decades, WCHQ has focused on using data and scientific evidence to help its member health systems and medical clinics improve the quality and value of health care. De-identified, aggregated data for the brief reports was provided by WCHQ member health systems and clinics for these reports.
Healthy Metric is a partnership between UW-Madison, the Medical College of Wisconsin, the Medical College ofWisconsin, Marshfield Clinic Research Institute, the Wisconsin Collaborative for Healthcare Quality and the Wisconsin Health Information Organization. The goal is to eliminate disparities by identifying where they exist and developing interventions to eliminate them.
Funding and on-going support in the measurement of outcomes and development of interventions to address disparities in Wisconsin is provided by Advancing a Healthier Wisconsin, the Medical College of Wisconsin and the Wisconsin Partnership Program, University of Wisconsin School of Medicine and Public Health.