Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations

Abstract

PURPOSE Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database derived from electronic health records. METHODSWe conducted a cross-sectional study as of October 1, 2011, of the association between being up to date with 10 preventive services and the prevalence of 24 chronic illnesses among 667,379 active patients aged 18 years or older in 148 member practices in a national PBRN. We used generalized linear mixed models to assess for the association of being up to date with each preventive service as a function of the patient's number of chronic conditions, adjusted for patient age and encounter frequency. RESULTSOf the patients 65.4% had at least 1 of the 24 chronic illnesses. For 9 of the 10 preventive services there were strong associations between the odds of being up to date and the presence of chronic illness, even after adjustment for visit frequency and patient age. Odds ratios increased with the number of chronic conditions for 5 of the preventive services.CONCLUSIONS Rather than a barrier, the presence of chronic illness was positively associated with receipt of recommended preventive services in this large national PBRN. This finding supports the notion that modern primary care practice can effectively deliver preventive services to the growing number of patients with multiple chronic illnesses. Ann Fam Med 2013;344-349. doi:10.1370/afm.1502. INTRODUCTION It has long been argued that competing demands in the primary care encounter are barriers to the effective delivery of clinical preventive services.1 One estimate is that 7.4 hours of a primary care clinician's workday would be needed to provide services recommended by the US Preventive Services Task Force (USPSTF), 2 clearly impossible given competing demands for acute care, chronic care, and other responsibilities.An alternative perspective is that encounters primarily for other reasons, particularly for chronic illnesses that entail frequent clinician contacts, would facilitate delivery of clinical preventive services. Research to date on this issue has yielded inconsistent findings. A 1997 study showed that patients with chronic illness were less likely to receive recommended preventive services, 3 as did a more recent report focused only on patients with diabetes mellitus. 4 In contrast, other reports have shown positive associations between chronic disease comorbidity and osteoporosis screening, 5 and between rheumatoid arthritis and dyslipidemia and osteoporosis screening. CHRONIC IL L NES S A ND PR E V EN T IV E SERV IC ES DEL IV ERYAll existing reports are limited by the number of practices, patients, preventive services, and chronic illnesses analyzed. In this report, we analyze the cross-sectional association between receipt of 10 preventive services recommended by the USPSTF and ...

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