Specialty Care:

Heart Attack Survivors Treated by Cardiologists More Likely to Take Recommended Drugs

HEHS-99-6: Published: Dec 4, 1998. Publicly Released: Jan 4, 1999.

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Pursuant to a congressional request, GAO reviewed the potential differences in treatment patterns for health maintenance organizations (HMO) patients treated by specialists and those treated by generalist physicians, focusing on: (1) the proportion of Medicare heart attack survivors enrolled in HMOs who take cholesterol-lowering drugs, beta-blockers, and aspirin; and (2) whether Medicare heart attack survivors in HMOs regularly treated by a cardiologist are more likely to take cholesterol-lowering drugs, beta-blockers, and aspirin than those who do not have regular cardiology appointments.

GAO noted that: (1) the ongoing use of cholesterol-lowering drugs and beta-blockers reported by Medicare heart attack survivors enrolled in HMOs generally parallels the patterns for heart attack survivors in the U.S. health care system overall; (2) as others have found for the general patient population, GAO found a much smaller proportion of respondents reported taking cholesterol-lowering drugs (36 percent) or beta-blockers (40 percent) than would be expected if everyone who would benefit from using these drugs were taking them; (3) Medicare HMO heart attack survivors with regular cardiology care--40 percent of GAO's survey respondents--were more likely to take the recommended drugs than those without regular appointments with a cardiologist; (4) enrollees who saw cardiologists regularly for their cardiac care were approximately 50 percent more likely to take cholesterol-lowering drugs and beta-blockers--a finding consistent with other comparisons of care provided by cardiologists and generalists; (5) although factors such as age, education, self-reported health status, and the presence of other illnesses also influenced who took cholesterol-lowering drugs and beta-blockers, they did not account for the higher use levels observed among patients who had routine cardiology appointments; (6) still, even patients of cardiologists often did not take one or both of these drugs; (7) by contrast, the overall use of aspirin was much higher--71 percent--and while regular patients of cardiologists were still more likely to take aspirin, the difference between them and other patients was smaller and not statistically significant (75 percent versus 68 percent); (8) on the whole, GAO's results for heart attack survivors treated by cardiologists and generalist physicians in Medicare HMOs are consistent with those of other studies of physician specialty differences in the United States; and (9) GAO's finding that patients under the regular care of cardiologists are more likely to take recommended medications reinforces the findings of the small number of other studies of physician specialty differences that are specifically concerned with HMO members and extends those findings to an older population and to a different medical condition.

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