HEALTH PROMOTION AND SCREENING SERVICES REPORTED BY OLDER ADULT PATIENTS OF URBAN PRIMARY-CARE PHYSICIANS

BACKGROUND, Adult preventive services provided at intervals recommende d by expert panel guidelines may reduce morbidity and mortality, As pa rt of an intervention trial to increase primary preventive services in urban primary care practices, baseline data were collected on primary prevention and screening test rates in older adults and on patient ch aracteristics associated with provision of these services. METHODS, A questionnaire on preventive services offered or provided over the past 2 years was completed by patients aged 52 to 77 years and another by their 42 participating physicians. Logistic regression was used to ide ntify patient characteristics associated with increased provision of t hese services. RESULTS. Usable questionnaires were completed by 1457 ( 80.9%) patients. Patient age and sex were not associated with the prov ision of primary preventive and counseling services. The presence of t wo or more chronic diseases was predictive of primary preventive servi ces (P<.02), but was not associated with an increase in screening test s or procedures. Age was positively associated with delivery of prosta te-specific antigen blood tests (P<.001) and rectal examinations (P<.0 01) in men, but was negatively associated with mammography (P<.001] an d Papanicolaou (Pap) tests (P=.02) in women. The negative trend in scr eening mammography was evident even for women aged 50 to 65 years desp ite the national consensus regarding the benefits of screening for thi s age group. Patients with health management organization insurance re ported significantly more mammography (P=.002), cervical Pap tests (P= .050), sigmoidoscopies (P=.002), and fecal occult blood tests (P=.035) . CONCLUSIONS, In our study patients, the provision of primary prevent ive and screening services was closer to consensus guidelines than is typically reported in the literature, The data suggest that future inv estigations and interventions to improve primary prevention and screen ing services in older adults who have access to primary care do not ne ed to be directed at fundamental changes in the way preventive service s are delivered, but rather should target procedures of proven benefit , such as mammography, where rates remain below recommended guidelines .