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Article Title

Do Preventive Visits Among Seniors Lead to Better Completion of Recommended Preventive Services?

Publication Date

8-10-2017

Keywords

end-of-life care/decisions, cardiovascular disease, aging, elderly, geriatrics, observational studies, diabetes, health policy/politics/law/regulation, chronic disease, health care costs/resource use, health promotion, prevention, screening

Abstract

Background: Under the Affordable Care Act, the annual preventive visit became fully covered by Medicare. We assessed whether the use of preventive visit, as compared to frequent use of routine nonpreventive primary care visit, is associated with higher completion rates of recommended preventive care services.

Methods: Primary care patients (aged 65–85 years) in a large, mixed-payer ambulatory care organization between 2011 and 2014 were identified (N = 184,576). We examined preventive care services recommended by U.S. Preventive Services Task Force guidelines or the National Committee for Quality Assurance. Services were categorized as: 1) Preventive Screening –– colorectal cancer screening, breast cancer screening; 2) Management of Chronic Conditions –– annual monitoring for patients on persistent medications (ACE inhibitors/ARBs or diuretics), coordinated diabetes care; and 3) Preventive Counseling –– smoking cessation counseling, discussion of end-of-life care planning. We estimated the likelihood of completing each service by preventive visit status (yes/no) and the frequency of nonpreventive primary care visits. We used a mixed-effect multivariate logistic regression, controlling for patient demographic and clinical characteristics and provider characteristics, with patient random effects to take into account clustering across multiple observations per patient. Odds ratios (OR) were generated. A statistical significance level of 0.01 was used.

Results: Seniors who had a preventive visit, versus those who did not, were more likely to have completed recommended services for Preventive Screening (OR: 1.77–1.85), Management of Chronic Conditions (OR: 1.32–1.48) and Preventive Counseling (OR: 3.04–3.95). The likelihood of completing preventive services increased with the frequency of nonpreventive primary care visits for some services, but to a much smaller degree, for one (OR: 1.21–1.25), two (OR: 1.10–1.95), three (OR: 1.23–2.29) and four or more (OR: 1.29–2.92) versus no nonpreventive visit. Predicted probability of completing “discussion of end-of-life planning,” for example, was larger with one preventive visit (without nonpreventive visit) (31.12%) than with 4+ nonpreventive primary care visits (without preventive visit) (21.95%).

Conclusion: Seniors with preventive visits were more likely to complete recommended preventive services than those who make frequent nonpreventive visits. This was particularly prominent for Preventive Counseling services, which are time-consuming and thus difficult to be handled during routine nonpreventive visits. Annual preventive visit may be necessary for improved preventive care for seniors

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