DELIVERY OF PREVENTIVE HEALTH-CARE TO OLDER AFRICAN-AMERICAN PATIENTS- A PERFORMANCE COMPARISON FROM 2 PRACTICE MODELS

While there is an increasing recognition by primary care providers of the importance of preventive health services (PHS), the delivery of su ch services has in general been substandard in many ambulatory care se ttings. Patient sociodemographic status and the structural and operati onal procedures of different clinic models are all believed to affect delivery of PHS. We conducted a 2-year, retrospective, sequentially ra ndomized chart analysis of African-American patients above age 50, com paring primary, secondary, and tertiary PHS performance rates in two p ractice models: a medicine resident/faculty physician clinic (MR) and a nurse practitioner/faculty physician clinic (NP). Sociodemographics, disease profile, and PHS completion rates from 132 NP and 111 MR pati ent charts were abstracted. Apart from age, sociodemographic features were similar in both patient groups. While there were differences betw een clinics with regards to disease profiles (P < 0.05), and the highe r number of diseases per patient (P < 0.0001) in the MR population, th e NP collaborative practice had significantly better PHS performance. Rates of immunization (influenza/pneumococcal), pelvic/pap and prostat e examinations, stool-guaiac testing, mammography, and functional asse ssment (activities of daily living, instrumental activities of daily l iving, and mental status testing) were >90% in the NP and <60% in MR p atients. Although tower completion rates were found for dietary counse ling (60%), auditory screening (36%), dental examination (41%), and ob taining advanced directives (24%) in the NP clinic, the rates were hig her than those for the MR clinic. In this NP collaborative model, a hi gh level of preventive health services was delivered while providing p rimary care to an older, inner city, African-American population of lo w socioeconomic means.