Primary Care Attributes Associated with Receipt of Preventive Care Services: A National Study

Emily C. White VanGompel; Anthony F. Jerant; Peter M. Franks

doi:10.3122/jabfm.2015.06.150092

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Figure 1.
Calculation of the total primary care attributes score. PCA, primary care attribute; USOC, usual source of care.

Tables

Figures

View popup

Table 1. Sample Characteristics by Primary Care Attribute Score

	No.	Proportion	PCA Score (SE)
Total	50,457	100%	0.66 (0.004)
Age (years)
18–44	24,991	46.71%	0.57 (0.006)
45–54	9,096	18.57%	0.69 (0.006)
55–64	7,297	16.18%	0.74 (0.005)
≥65	8,019	18.54%	0.80 (0.004)
Sex
Male	23,056	48.49%	0.62 (0.005)
Female	26,347	51.51%	0.71 (0.004)
Race
White	23,161	67.84%	0.70 (0.005)
Black	9,378	11.58%	0.62 (0.007)
Hispanic	12,340	13.95%	0.51 (0.009)
Other	4,524	6.64%	0.63 (0.013)
Insurance
Private, any	10,507	15.39%	0.71 (0.004)
Public only	28,636	67.42%	0.73 (0.006)
Uninsured	10,260	17.19%	0.37 (0.009)
Education level
None	273	3.00%	0.49 (0.024)
Elementary only	4,294	5.53%	0.59 (0.012)
Some HS	7,872	13.04%	0.62 (0.007)
Completed HS	14,953	2.99%	0.65 (0.006)
Some college	10,645	23.97%	0.68 (0.006)
Completed college	10,570	27.27%	0.71 (0.006)
Income
Poor/negative	8,864	12.40%	0.56 (0.007)
Near poor	2,904	4.31%	0.60 (0.012)
Low income	8,086	13.69%	0.60 (0.009)
Middle income	15,234	30.54%	0.66 (0.007)
High income	14,315	39.05%	0.73 (0.005)
Region
North	7,615	18.42%	0.75 (0.008)
Midwest	9,844	21.89%	0.71 (0.009)
South	18,473	36.53%	0.61 (0.008)
West	12,994	23.17%	0.64 (0.008)
Panel
2007	10,905	19.52%	0.68 (0.006)
2008	14,946	30.99%	0.65 (0.007)
2009	13,254	24.63%	0.66 (0.007)
2010	11,352	24.87%	0.67 (0.006)
Health-related variables
Smoking status
Nonsmoker	34,503	80.75%	0.68 (0.005)
Current smoker	8,031	19.25%	0.59 (0.007)
Seatbelt use
Always or almost always	45,237	93.63%	0.67 (0.004)
Less frequently	2,934	6.37%	0.60 (0.012)
Obesity
BMI <30 kg/m²	32,867	71.04%	0.65 (0.005)
BMI ≥30 kg/m²	13,957	28.96%	0.70 (0.005)
Chronic health conditions (n)
0	22,973	42.83%	0.56 (0.007)
1	10,270	21.44%	0.67 (0.005)
2	6,311	13.97%	0.76 (0.006)
3	4,227	9.21%	0.79 (0.005)
≥4	5,622	12.56%	0.82 (0.004)

* Total number of primary care attribute (PCA) variables endorsed by the respondent divided by total nonmissing PCA variables. Scores ranged between 0 and 1, with a population mean of 0.66.
HS, high school; SE, standard error; BMI, body mass index.

View popup
Table 2. Sample Characteristics for Continuous Health-related Variables
No. Mean (SE)
Mental health (MCS-12) 45,722 50.9 (0.1)
Physical health (PCS-12) 45,712 49.5 (0.1)
Medical skepticism 45,421 2.1 (0.01)
MCS-12, 12-item Short Form Mental Component Summary; PCS-12, 12-item Short Form Physical Component Summary; SE, standard error.

View popup

Table 3. Adjusted Associations of the Primary Care Attribute Score with Preventive Care Adherence^*

	AOR (95% CI)
Mammography	2.46 (2.13–2.84)
CRC screen	2.74 (2.35–3.19)
Papanicolaou test	2.09 (1.78–2.45)
Influenza vaccination	1.84 (1.69–2.01)
Annual exam	2.38 (2.21–2.58)
Cholesterol test^{^†}	3.55 (3.07–4.10)
PSA test	3.28 (2.71–3.98)

↵* Adjustors: demographics, medical skepticism, health behaviors, disease burden, and mental and physical health status as measured by the 12-item Short Form Mental Component Summary and Physical Component Summary scores.
↵† A diagnosis of high cholesterol was excluded from this measure's disease burden control variable.
AOR, adjusted odds ratio; CI, confidence interval; CRC, colorectal; PSA, prostate-specific antigen.

View popup

Table 4. Adjusted Odds Ratios of Individual Primary Care Attribute Components by Compliance with Preventive Care Measures^*

	Usual Source of Care	Patient-centeredness	Enhanced Access (Night and Weekends)	Comprehensiveness
	Usual Source of Care	Patient-centeredness	Enhanced Access (Night and Weekends)	Preventive Care	Referrals	New Problems	Ongoing Care	Composite
Mammography	2.30 (2.02–2.63)	1.33 (1.10–1.59)	0.94 (0.84–1.06)^{^†}	1.52 (1.22–1.90)	1.32 (1.07–1.63)	1.48 (1.17–1.88)	1.50 (1.17–1.92)	1.53 (1.21–1.95)
CRC screen	2.66 (2.30–3.08)	1.16 (1.00–1.35)^{^†}	0.97 (0.87–1.07)^{^†}	1.83 (1.48–2.26)	1.62 (1.33–1.98)	1.61 (1.30–1.99)	1.60 (1.29–1.99)	1.80 (1.43–2.26)
Pap test	1.99 (1.73–2.29)	1.30 (1.09–1.55)	0.94 (0.83–1.08)^{^†}	1.37 (1.10–1.70)	1.24 (1.01–1.52)	1.26 (1.01–1.56)	1.21 (0.97–1.51)^{^†}	1.31 (1.04–1.65)
Flu shot	1.75 (1.62–1.89)	1.25 (1.13–1.38)	0.99 (0.92–1.07)^{^†}	1.38 (1.21–1.57)	1.38 (1.22–1.56)	1.43 (1.26–1.63)	1.43 (1.26–1.63)	1.48 (1.29–1.70)
Annual exam	2.26 (2.11–2.42)	1.37 (1.23–1.53)	0.83 (0.77–0.91)^{^‡}	1.47 (1.31–1.64)	1.36 (1.21–1.52)	1.38 (1.22–1.57)	1.46 (1.31–1.64)	1.48 (1.32–1.67)
Cholesterol tests	3.08 (2.71–3.49)	1.59 (1.28–1.96)	0.98 (0.84–1.15)^{^†}	1.98 (1.59–2.47)	1.68 (1.32–2.13)	1.75 (1.37–2.24)	2.07 (1.65–2.60)	2.01 (1.58–2.55)
PSA screen	3.05 (2.56–3.64)	1.35 (1.10–1.65)	0.91 (0.78–1.05)^{^†}	2.08 (1.61–2.71)	2.11(1.62–2.73)	1.93 (1.47–2.53)	1.91 (1.47–2.46)	2.24 (1.69–2.97)

Data are adjusted odds ratios (95% confidence intervals).
↵* Adjustors: demographics, medical skepticism, health behaviors, disease burden, and mental and physical health status as measured by the 12-item Short Form Mental Component Summary and Physical Component Summary scores.
^§A diagnosis of high cholesterol was excluded from this measure's disease burden control variable.
↵† No statistically significant effect on compliance with preventive care measure.
↵‡ Statistically significant negative effect on compliance with preventive care measure.
CRC, colorectal cancer; Flu, influenza; Pap, Papanicolaou; PSA, prostate-specific antigen.

View popup

Table 5. Percentage of Respondents Adherent to Preventive Care Measures by Primary Care Attribute Score Quartile^*

	Quartile
	Lowest (0–0.49)	Second Lowest (0.5–0.79)	Second Highest (0.8–0.89)	Highest (≥0.9)
Mammography	62.5 (60–65)	75.5 (73–78)	78.9 (78–80)	76.9 (75–78)
CRC screening	40.6 (38–43)	58.7 (55–62)	60.9 (59–62)	59.1 (57–61)
Papanicolaou test	78.4 (77–80)	85.3 (83–87)	87.3 (86–88)	86.3 (85–88)
Flu vaccination	29.2 (28–31)	37.8 (36–40)	40.4 (39–41)	39.1 (38–40)
Annual exam	51.5 (50–53)	64.6 (62–67)	69.2 (68–70)	65.4 (64–67)
Cholesterol test^{^†}	82.3 (81–84)	91.2 (90–93)	92.7 (92–94)	92.0 (91–93)
PSA test	45.5 (42–49)	65.9 (62–70)	69.6 (68–71)	66.2 (64–69)

Data are percentages (95% confidence intervals).
↵* Adjustors: demographics, medical skepticism, health behaviors, disease burden, and mental and physical health status as measured by the 12-item Short Form Mental Component Summary and Physical Component Summary scores.
↵† A diagnosis of high cholesterol was excluded from this measure's disease burden control variable.
CRC, colorectal cancer; Flu, influenza; PSA, prostate-specific antigen.