The delivery of clinical preventive services - Acute care intervention

BACKGROUND. Evidence-based clinical preventhe services are underutilized. W e explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care f or both fee-for-service (FFS) and health maintenance organization (HMO) pat ient populations. METHODS. We performed a cross-sectional audit of the computerized billing d ata of all adult outpatients seen at least once by any primary cave provide r in 1995 (N = 75,621). Delivery of preventive services was stratified by a ge, sex, visit frequency, insurance status (FFS or HMO), and visit type (ac ute care only or scheduled preventive visit). RESULTS. Insurance status and visit type were the strongest predictors of c linical preventive service delivery. Patients with FFS coverage received 6% to 13% (absolute difference) fewer of these services than HMO patients. Ac ute-care-only patients received 9% to 45% fewer services than patients who scheduled preventive visits. The combination of these factors was associate d with profound differences. CONCLUSIONS, Having insurance to pay for preventive services is an importan t factor in the delivery of such care. Encouraging all patients to schedule preventive visits has been suggested as a strategy for increasing delivery , but that is not practical in this setting. Assessing the need for prevent ive services and offering them during acute care visits has equal potential for increasing delivery.