The Impact of Primary Care in Reducing Cardiometabolic Risk

Friday, October 18 at 5:00 pm

LAS VEGAS—The 2013 Primary Care Cardiometabolic Risk Summit kicked off yesterday with a keynote address from John E. Anderson, MD, a Nashville-based internist and the president of the American Diabetes Association. He stressed that primary care has made a significant impact on the spread of cardiovascular disease—to the tune of 1.1 million deaths averted between 1970 and 2010¹—but that diabetes is on the rise globally and we need to stay vigilant in early detection and managed care.

Anderson outlined several challenges that primary care practitioners face including lack of time, competing interests at the time of visit, an episodic/acute care model, absent reimbursement for care coordination, limited resources, and evolving treatment options. In addition, there is an overall decline in the number of residents, physician assistants, and nurse practitioners choosing to go into general internal medicine versus subspecialties that pay more. In 1998, 54% of internal medicine residents went to internal medicine general practice versus 21% in 2009.² Conversely, in 1998 there was no such thing as a hospitalist and today, there are 20,000 hospitalists and the number is projected to reach 40,000 in the near future.

Despite all that, we are seeing a 19% to 35% decline in cardiovascular deaths across the country.¹ Emergency room visits have also declined. Anderson acknowledged better medications and better treatment options played a role, however, “I would argue that this is you and me.”

Reductions in complications from diabetes over the last 15 years include a 50% decrease in amputations, 34% reduction in end-stage kidney disease, and a 24% drop in 10-year coronary disease risk.

In 2007, $174 billion was spent on diabetes treatment. In 2012, that number jumped by 41% to $249 billion.³ “I don’t know of any other disease that is growing at a rate of 8.1% per year,” said Anderson. And what’s the driving force? The prevalence of diabetes, particularly in an older, ethnically diverse society, is today’s reality and a major concern for primary care.

References:

1. National Institutes of Health. 2012 Chart Book. Available at: https://www.nih.gov. Accessed August 22, 2013.

2. Weissman A. Internal medicine in-training examination survey. Office of Research, Planning and Evaluation. American College of Physicians. Personal communications between John Anderson, May 2010. ITE Exam Survey.

3. American Diabetes Association. Diabetes Care. 2013;36(4):917-932,1033-1046.