Getting the Preventive Care You Need?

Posted by William on August 5, 2011

Less than half the population in the United States gets medical tests or advice that could prevent serious disease later in life, new research reveals.

A first-ever cost-to-benefit analysis of preventive care found that:
Doctors and health care professionals help fewer than a third of their patients quit smoking.

Only 21 percent of older adults get a regular test for colorectal cancer, the second-most common cancer killer in the country.

Fewer than one in five sexually active women get screened for chlamydia.

Fewer than half those over the age of 65 get the pneumonia vaccine.

Prioritizing preventive care could, in the long run, save millions of lives and millions of dollars, the researchers conclude.

“We know that a lot of preventive services work,” says lead author Ashley Coffield, a senior fellow with the Partnership for Prevention in Washington, D.C. “They are effective at helping people avoid getting sick. But there are lots of options. We know that choices have to be made with regards to time and money.”

“So the question we addressed is, which preventative services should we emphasize first,” Coffield says. “Which of those preventative services provide the greatest health benefits for the most people at the best cost?”

With sponsorship from the Centers for Disease Control and Prevention (CDC), the Partnership for Prevention assembled a team of primary-care and preventive-care experts to examine 30 clinical preventive services.

The services had been recommended for the general population in 1996 by the U.S. Preventive Services Task Force and are considered “the gold standard for recommendations for preventive care,” Coffield says. Using data from the government and the health care industry, the team prioritized the services.

Tobacco counseling for adults, colorectal cancer screening for patients over the age of 50, chlamydia screening for young women, problem-alcohol counseling, and pneumonia vaccinations for senior citizens were ranked the top five, Coffield says.

To figure out how many Americans were advised by their doctors to get preventive care, the team plumbed government and industry data on health maintenance organizations’ delivery of services and procedures.

So why aren’t Americans taking advantage of preventive care, and why aren’t doctors prescribing tests or giving counsel?

“I don’t think there’s one bogeyman here causing the problem,” Coffield responds. “I think there’s multiple factors. Insurance coverage — either lacking or incomplete — with co-pays or deductibles that would discourage people from seeking the service is one issue.”

Another factor is that “doctors don’t always suggest preventive care,” she continues. “Oftentimes people present [illness] at a doctor’s office and there are competing demands for the doctor’s time, and prevention sometimes gets crowded out. And you also have to remember — patients don’t always want these tests.”

And don’t forget employers, she adds. “Employers don’t demand or insure those services. They don’t make sure they are covered or that their employees get preventive care.”

Two studies documenting the findings appear in the July issue of the American Journal of Preventive Medicine.

The study could provide health care professionals with a guide to preventive care, says the CDC.

“People understand that preventive care is important and effective, but they often do not know where to start,” says Lisa Koonin, the CDC’s director of the Office of Healthcare Partnership in Atlanta. “This should prove to be a blueprint.”

Government officials should also pay attention, Koonin adds. “The study’s benefit is going to help decision-makers prioritize preventive services, so that they can look at which services can save the most lives and also be cost-effective. There’s a great underutilization of preventive services.”

“What [decision makers and health care professionals] don’t know is when you rank a service against other preventive services, which are going to be most effective. These top five obviously rise right to the top.”

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