Preventive Health Services Missed in Half of Patients

During periodic health examinations (PHEs), a variety of patient, physician, and visit factors together affect the recommendation and delivery of evidence-based preventive health services, with patients receiving only about half of those services for which they are due, according to research published in the February issue of the American Journal of Preventive Medicine.

Deirdre A. Shires, M.P.H., M.S.W., of the Center for Health Policy and Health Services Research in Detroit, and colleagues conducted audio recordings of 484 PHE office visits to evaluate recommendations made by 64 general internal medicine and family physicians, and compare them to 19 guideline-recommended preventive services.

The researchers found that, overall, patients were due to receive 2,662 services, but only 54 percent of these were recommended or delivered. Services were less likely to be delivered for older patients and for patients expressing more concerns. Services were more likely to be recommended with increasing body mass index and with each additional minute of appointment time. Preventive services were more likely to be recommended when the physician and patient were the same gender, and less likely to occur if the physician utilized an electronic medical record during the visit or had seen the patient during the past year.

"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," the authors write.

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