Newswise – If more people have access to health insurance, we need to make sure that death rates for people with certain chronic conditions go down.
This is one of the statements Gregory Peck, an acute care surgeon and associate professor at Rutgers Robert Wood Johnson Medical School, will research for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). from the National Institutes of Health.
Funded by NIH grants totaling more than $1 million through a recent two-year award from the New Jersey Alliance for Clinical and Translational Science (NJ ACTS), a Rutgers center at the National Center for Advancing Translation Science, and now a four-year NIDDK awardee, Peck is on average one of two critical care surgeons nationally funded each year to create new health models for NIH.
Peck recently published two studies of death rates from gallstone disease, a disease of the abdomen that causes right-sided belly pain after eating, which shares risk factors with other life-threatening diseases. . His study, published in Gastro Hep Advancesfound that between 2009 and 2018, the number of deaths of people in New Jersey with diagnosed gallstones (1,580) remained stable and did not improve, and that deaths among Latinos aged 65 and more have potentially increased.
His study in the Surgical Research Journal found that after the 2014 Medicaid expansion compared to before, the number of emergency surgeries to remove the gallbladder for gallstone disease decreased statewide, but increased in people with Medicaid. While deaths from gallbladder removal surgery have declined in people aged 65 or older, there has been an increase in deaths from surgery in the younger population and a trend towards more deaths in the population with Medicaid. Also, the relatively small number of gallbladder removal surgeries in outpatient care centers has not necessarily contributed to this.
Peck discusses the implications of the findings on a further shift in health care toward the prevention model.
Why did you focus on gallstone disease?
As a metabolic disease, gallstone disease is also linked to heart disease, cancer, diabetes, obesity, and a sedentary lifestyle. In fact, heart disease, which is the number one cause of death in America, and gallstones, which is the number one digestive disease requiring surgery in America, share the risk factors for high levels of bad cholesterol and obesity. .
How do these studies inform public policies?
The number of people dying from cholelithiasis – most of which require surgery – over the past decade has not improved. That’s 160 people a year still dying from a preventable death such as gallstone disease. Making progress is what this type of epidemiological study focuses on, and worryingly, we might not have made good progress.
If the expansion of Medicaid has not had a positive effect on the death rate of people with cholelithiasis and we are seeing it increase specifically in older Latin American populations, we have to ask ourselves if we are helping the people of color and those living in communities of lower socioeconomic status to improve. health or treat them earlier to avoid emergency surgery and most importantly reduce the number of deaths from emergency surgery. Insurance expansion is certainly needed, but we need to ensure that action-specific policy elements impact the population requiring surgery in a patient-centric way.
The real goal is to prevent disease from occurring. When we adopt public health policy, we must advocate for preventive care that reaches people through their community. Right now, the results show that we could simply provide insurance cards to people who still need to use the emergency department. Instead, this insurance should help them see their primary care physician, who can help them make changes such as lowering their bad cholesterol levels, which contribute to gallstone disease, and help them faster access to care in ambulatory surgery centers.
We need to cultivate preventive health care rather than inflate investments in emergency health care, which does not solve current inequalities.
What other measures should be taken to improve access to care?
We propose a new approach to population health that shifts from reactive treatment of emergency disease to proactive prevention. One starting point is to increase access to appropriate elective outpatient health care for underrepresented groups facing barriers to preventive care, for example by increasing health insurance that incentivizes health-enhancing behaviors. A first step for my research group is to focus on illnesses that currently require as much urgency as elective care, such as gallstone disease, and understand that by understanding who comes to the hospital, in order to remember this at the community level, reduce hospital care.
In addition, in primary care, laboratory, radiology or ambulatory care settings, we need to improve communication with people with low English proficiency, especially the quality of explanation of prevention in the patient’s primary language. Language barriers might also prevent them from understanding the importance of cholesterol or blood pressure control over the one, two and three decades of life, or how they find access to needed diagnostic tests or treatment more early.
How is Rutgers working to increase knowledge about primary care in underserved communities?
Shawna Hudson, co-director of community engagement for NJ ACTS, and my research mentor, explores how community-grounded reps can help healthcare providers and researchers better understand how we can use community engagement to involving people in the preventive care of a community. to reduce chronic disease risk factors before they need hospital care and, more importantly, emergency surgery.
One initiative is the Virtual Community Engagement Fairs, which help NJ ACTS researchers and healthcare providers engage with patients and community members about how biomedical and clinical research leads to action. by understanding the disease and then adopting policies. At these sessions, the public serves as an expert to provide input from a community perspective. This allows the medical profession to build relationships with community partners and increase the culturally sensitive participation of hard-to-reach populations.