Quality of ambulatory care of the elderly: an analysis of five conditions.

Twelve hundred twenty-six (1,226) persons representative of the noninstitutionalized United States population aged 65-74 years were interviewed and examined as part of the 1971-1975 Health and Nutrition Examination Survey (HANES). Using information available in the HANES data base, standards for what could be considered minimally acceptable care were developed for five tracer conditions. Rates of "deficient" care were: angina, 46 percent; dyspnea on exertion, 78 per cent; hypertension, 26 per cent; hearing impairment, 61 per cent; depression, 80 per cent. Deficient care was analyzed by gender, race, income, locale, and self-rated health status. Only low income emerged as a consistent risk factor for deficient care, with the relative odds for deficient care for poor patients as compared with non-poor patients ranging from 2.7 to 5.6 (P less than 0.05) for four of five conditions. A subgroup analysis attempted to determine whether deficiencies were caused by limited access to physicians, underreporting of symptoms, or barriers that occurred after presenting complaints to a physician. The analysis revealed that for three of four symptomatic conditions, the poor and non-poor patients were equally likely to report their symptoms, whereas the poor were more likely to receive "deficient" care after presenting complaints to physicians. The ramifications of these findings as they pertain to the present situation are discussed.