Locating a health advocate in a private obstetrics/gynecology office increases patient's receipt of preventive recommendations

This study was performed to determine if adding a health advocate (HA) to t he care team for postmenopausal women increased the number of women for who m the physician recommended screening tests or prevention strategies: chole sterol level, mammography, depression counseling, smoking cessation, or wei ght reduction. The study took place in two locations of a private obstetric ian-gynecologist practice. In one location, an HA reviewed screening forms and counseled women about preventive services recommended by the physician. In the second location, women completed the screening form, but treatment occurred as usual. Women were eligible if they were postmenopausal or age 5 0 or over and were being seen for preventive care. A total of 210 postmenop ausal women were screened. Women who were screened when the HA was present (n = 85) did not differ from women screened at the intervention location wh en the HA was not present (n = 68) or screened at a second practice locatio n (n 57) in the prevalence of risk factors. Women were significantly more l ikely to receive indicated preventive recommendations when the HA was prese nt (24% versus 73%, p < 0.001). For breast cancer screening, nearly all wom en screened when the HA was present received a referral compared to about o ne third of women screened when the HA was not present (OR = 3.0, 95% CI 1. 8-5.2). Women are more likely to receive recommendations based on screening data when ancillary staff are available to assist in patient education and referral and to encourage physician recommendations. Further work is neede d to identify cost-effective methods for supporting physicians' preventive care efforts.