Abstract
Background/Aims Limited time and competing demands force primary care physicians and patients to prioritize among evidence-based preventive health services during periodic health examinations (PHE). We examined the rate of discussion of and recommendation for 19 USPSTF-endorsed preventive services during PHEs.
Methods Claims data, a pre-visit survey, and transcripts of audio-recorded office visits were used to identify which services patients were eligible and due for at the time of visit. Study physicians (N=60) are internal or family medicine physicians. Study patients (N=484) are insured, ages 50–80, and due for colorectal cancer screening at time of PHE. Audio-recordings of PHEs were evaluated for the frequency of preventive service discussions and physician recommendations - overall and by gender.
Results Patient participants are on average aged 59 years, 65% female and 66% white. Among patients eligible and due for service, smoking (100%, 54/54), breast cancer (94%, 67/71), and colorectal cancer screening (94%, 432/462) were most likely to be discussed, while aspirin use was the least likely to be discussed (28%, 31/109). Physicians were most likely to recommend colorectal cancer screening (93%, 429/462), blood pressure screening (90%, 92/102), and breast cancer screening (90%, 64/71) and least likely to counsel for aspirin use (18%, 20/109) and alcohol misuse (4%, 1/24). In our sample, males were more likely to receive recommendations for colorectal cancer (96%, 156/162 vs. 91%, 273/300), cholesterol (100%, 6/6 vs. 67%, 10/15), and hearing screening (36%, 18/50 vs. 25%, 13/52); pneumococcal vaccination (44%, 4/9 vs. 13%, 2/15); aspirin use (23%, 18/80 vs. 7%, 2/29); and alcohol misuse counseling (8%, 1/12 vs. 0%, 0/11) compared to females. Females in our sample were more likely to receive diet (38%, 65/170 vs. 23%, 29/125), weight (62%, 95/154 vs. 54%, 37/68), and tobacco cessation counseling (81%, 30/37 vs. 76%, 13/17).
Conclusions Although screening services are likely to be recommended to patients due for service, missed opportunities exist to counsel eligible patients for services aspirin use and alcohol misuse. These missed opportunities may vary by gender. We are currently exploring the patient, physician, visit and service characteristics associated with missed opportunities to deliver recommended preventive services during PHEs.
