Research articlePrioritization of Evidence-Based Preventive Health Services During Periodic Health Examinations
Introduction
More than 20% of the U.S. population, or 44.4 million adults, receive a periodic health examination (PHE) each year.1 The majority of both physicians and patients agree that PHEs are needed.2, 3 Physicians report that PHEs contribute to the physician–patient relationship and provide more time for counseling, meeting patient expectations, and improving disease detection.2 Patients believe that discussion of health habits and risk factors should occur during a PHE along with a physical examination and various health screening tests.3
Although many professional organizations historically have recommended that adult preventive health services be offered in the context of routine medical care rather than during PHEs,4, 5 recent findings suggest that patients who use PHEs may be more likely to receive recommended preventive services.6, 7, 8, 9, 10, 11, 12 Yet, the use of such visits is not sufficient to ensure a physician recommendation for, or receipt of, evidence-based cancer screening and other preventive services.9, 11
Even during PHEs, time limitations and other constraints likely force primary care physicians and patients to make choices about what topics are addressed.13, 14, 15, 16, 17, 18, 19 Few observational studies have been conducted which evaluate the delivery of a broad range of recommended preventive services and the patient, physician, patient–physician relationship, and visit factors that may be associated with such service delivery. The present study links audio-recording data from a large sample of PHEs with that from pre-visit administrative claims and patient survey data in order to evaluate the occurrence of preventive service delivery and the patient, physician, patient–physician relationship, and visit characteristics associated with service delivery. The association of service delivery with visit length also is described.
Section snippets
Study Setting
Physician and patient samples were identified from an integrated delivery system located in southeast Michigan. The system includes a 1000-member, salaried medical group that staffs 26 ambulatory clinics in Detroit and surrounding suburbs. At the time of the study, the medical group did not have a set policy for the scheduling of PHEs. Thus, scheduling varied by physician preference. Since 2005, the medical group's electronic medical record (EMR) has included a gender- and age-targeted prompt
Sample Characteristics
Five hundred patients consented to participate. Among these, there were 484 audible office visit recordings to 64 primary care physicians. Physician and patient participants/nonparticipants are described in detail elsewhere.20 Sample physicians were on average aged 48 years, 56% were female and 48% were white, 17% African-American, and 34% other race. Seventy percent were general internists and 30% were family physicians. On average, 7.6 office visit recordings were recorded for each physician
Discussion
Although an average of three preventive health services that patients were eligible and due for at the time of a PHE were delivered, almost as many services went undelivered. While the opportunity to deliver breast cancer, colorectal cancer, and hypertension screening was rarely missed, delivery of aspirin and diet counseling, influenza immunization, and vision and hearing screening was achieved less than one third of the time. These results are generally consistent with previous findings of
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