A review of electronic medical records of adult patients at both hospital-based and community-based care centers between 2000 and 2005 indicated that patients using community-based clinics were less likely to receive cardiology consultations for coronary artery disease (CAD) and congestive heart failure (CHF) than those who had used a hospital clinic. In both settings, women were not as likely as men to be referred to a cardiologist for further consultation.

CAD patients from community centers were 21 percent less likely to receive an initial cardiology consultation, and CHF patients were 23 percent less likely to receive an initial consultation for cardiology than those seen at hospital clinics. For ongoing consultations, community-based health center patients had 20 percent fewer follow-ups overall, with women receiving 15 percent fewer follow-up consultations than hospital-based clinical patients.

“This is very true nationwide,” said Dr Z. Michael Taweh of Kevin’s Community Center in Newtown, “but luckily for us, we have had the opposite experience here at Kevin’s Community Center. We send patients out for specialty care, and all testing we do is covered at no cost to the patients or Kevin’s.”

Because Kevin’s Community Center has more than 100 doctors in the network who work pro bono, said Dr Taweh, and because the community care center is affiliated with Danbury Hospital, they are able to routinely refer heart patients for further assessment.

“Most free clinic cannot utilize lab services or referrals, and the free visits are limited. Here, we have unlimited visits so long as financial qualifications are met. We are very fortunate compared to community clinics across the nation,” said Dr Taweh.

It is also true, said Dr Taweh, that women are less likely to be referred for heart problems. But that can often be because women tend to present unusually with heart symptoms. “Women have ‘silent’ heart attacks that may appear as malaise, or fatigue, or dizziness, not the normal heart attack symptoms. So overall, heart disease in women tends to go underdiagnosed,” he said.

“Access to a cardiology specialist is often a prerequisite for obtaining cardiovascular procedures,” said Nakela Cook, MD, MPH, an author of the study and clinical medical officer at the National Heart, Lung, and Blood Institute. “In this group, consultation with cardiology specialists improved the quality of medical care and reduced disparities in treatment of women,” she noted in the AHA press release.

The study showed that African Americans and Hispanic patients are just as likely as white patients to receive an initial cardiology consultation. Community-based health clinics often serve a large proportion of minorities who are uninsured or on Medicaid.

Medicaid and Medicare recipients, however, were more likely to receive a consultation than patients who were privately insured. “Leveling the consultation access playing field will take a multilevel approach,” said Dr Cook in the press release. That would include increased patient awareness, removal of access barriers, and provider/system changes to refer appropriate patients. “We need to figure out who needs specialty care and when, and provide it to them,” she said.