Healthcare access and disparities in chronic medical conditions in Urban populations

OBJECTIVES: The purpose of this study was to identify barriers and disparities in healthcare access and the factors associated with them in an urban population. METHODS: Eligible patients were consented and enrolled randomly from the inpatient internal medicine unit at Truman Medical Center, Kansas City, Missouri, a 250-bed hospital recognized for its broad range of acute and chronic diseases seen in its inpatient and outpatient care. They had one or more of the following chronic medical conditions (CMCs): congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, hypertension, chest pain, or cirrhosis. One hundred patients were interviewed regarding challenges they have encountered as consumers and their understanding of CMCs. RESULTS: Interview results indicate patients' understanding of their CMC, the associated needs for self-management, and the potential health consequences are contributing factors leading to repeated visits to the emergency department. CONCLUSIONS: Our study suggests that access to the following health-focused services has the potential to reduce the rate of emergency department visits and hospitalizations, morbidity, mortality, and the burden of cost. These services include adequate access to and utilization of primary care characterized by preventive care, early detection of acute illness, ongoing chronic disease management through easy access to primary providers, and adequate health literacy about CMC.