Study: Half of recommended preventive services missed during annual check-ups

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Although 44.4 million adults make it a point to receive periodic health examinations (PHEs) each year, many of them may not be receiving the recommended screening tests and counseling services that could benefit their health, according to a study published January in the American Journal of Preventive Medicine.

The study, led by Jennifer Elston Lafata, PhD, co-leader of the Cancer Prevention and Control program at Virginia Commonwealth University's (VCU) Massey Cancer Center in Richmond, found that 46 percent of eligible and due services were missed during PHEs.

“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,” wrote the authors.

The researchers pulled their results from audio recordings of 484 PHE visits to 64 general internal medicine and family physicians in southeast Michigan from 2007 to 2009.

A total of 2,662 services were due for the patients involved, and an average of three services were delivered to patients during the PHE. However, this only represented about half (54.4 percent) of the total services for which patients were eligible or due to receive.

“While the percentage of services delivered may appear low, when you account for the lack of incentives to physicians for screenings and preventive counseling and the limited amount of time during visits to address all recommended services, the numbers are not surprising,” said Elston Lafata.

When looking individually at the 19 guideline-recommended preventive services studied, the authors noted that some services were more likely to be delivered than others. Screenings for colorectal cancer, hypertension and breast cancer were rarely missed with delivery rates of 92.9, 92 and 89.9 percent, respectively. Conversely, 18.3 percent of patients were counseled about aspirin use and 18.9 percent were counseled on vision screening. One-in-five patients due for an influenza immunization received the service.

The researchers also evaluated the factors contributing to service delivery. Service delivery decreased with patient age and increased with the patient’s body mass index. While approximately half of the 19 preventive services studied were prompted in the patient’s EMR, the researchers were surprised to find that services were less likely to be delivered during visits where the physician accessed the EMR in the exam room.

Another interesting finding: the patients whose doctors ran behind in their appointments seemed to receive more preventive services.

“It appears that while some preventive services are likely to be received by some patients, several services which are known to reduce disease go undelivered during routine PHEs,” said Elston Lafata. “Relying on face-to-face interactions between physicians and patients will likely continue to result in less-than-optimal service delivery. However, technological advances that provide patients with easy access to their personal health records coupled with automated reminders may be one way patients can work with physicians to increase delivery of preventive services and subsequently lower overall healthcare costs.”