Access to care of adults with chronic illness

This study investigated the relationship of chronic illness and access to health care in adults responding to the 1986 National Access to Health Care Survey. Access to care was defined as actually entering the health system as evidenced by having an ambulatory visit, a hospitalization, or an emergency visit within the previous year. The sample (N = 6,147) was taken from the 48 contiguous states and included hospitalized persons. The sample was limited to persons 17 yeas and older who agreed to answer the random-digit dialed telephone interview and reported themselves to be well or have one of 11 life-threatening chronic illnesses (asthma or emphysema, cancer, heart disease or a cardiac condition, stroke, high blood pressure, kidney disease, liver disease, diabetes, epilepsy, multiple sclerosis, cerebral palsy or other neurological or neuromuscular disease that affected walking, arm movement, or memory). The data were analyzed using univariate descriptive statistics, stratified analyses and multivariable logistic regression. Adults with a chronic illness were 40% more likely to have an ambulatory visit than well adults. Similarly the likelihood that an adult with a chronic illness would be hospitalized during a year was 18 times greater than the likelihood of a well person being hospitalized. Finally, the probability that an adult would have an emergency visit was 60% greater in those with a chronic illness as compared to those with no illness. In fact, persons with chronic illnesses were more likely to have an ambulatory visit, a hospitalization or an emergency visit. Prior to this research access to care had been studied in combined samples of the seriously and chronically ill. This study suggests that persons with chronic illness form a distinct population and that chronic illness is differentially predictive of ambulatory visits, hospitalizations, and emergency visits in contrast to those who are well. Further, poor health status, which was known to be predictive of entry into the health system, is, in fact, a distinct variable from chronic illness