In the Journals

Avoid overwhelming patients with preventive guidelines

Glen Taksler
Glen B. Taksler

The more preventive care options that middle-aged and older patients received, the less likely they were to follow such options, according to findings recently published in the American Journal of Preventive Medicine.

“It is unknown whether the number of guideline-recommended preventive services is associated with utilization,” Glen B. Taksler, PhD, of the Medicine Institute, Cleveland Clinic, and colleagues wrote.

Researchers also noted that the Medicare Access and Child Health Insurance Program Reauthorization Act of 2015 stipulated that physicians and health care organizations must report preventive care quality metrics and that a physician’s quality of care rating is now contingent upon the number of services completed.

Taksler and colleagues used Poisson regression analysis of 80,773 patients aged 50 to 75 years totaling 390,778 person-years of electronic health record data. Eligibility for 11 preventive services — blood glucose, hypertension, or lipid control; influenza vaccine; obesity control; screening for abdominal aortic aneurysm; screening for breast, cervical, or colorectal cancers; osteoporosis screening; and tobacco cessation from 1 year to the next — was determined.

Researchers found the adjusted rate of preventive care utilization decreased from 38.67 per 100 (95% CI, 38.16-39.18) in patients eligible for one guideline-recommended service vs. 31.59 per 100 (95% CI, 31.29-31.89) in patients eligible for two services. In patients eligible for six or more services, the adjusted rate was 25.43 per 100 (95% CI, 24.68-26.18) (P for trend < .001).

“In general, patients were less likely to follow preventive care recommendations when they were asked to do more things, suggesting that doctors can recommend ‘too many’ preventive services, making it harder for patients to improve their health,” Taksler told Healio Family Medicine in an interview.

“There were two exceptions. Patients were just as likely — and sometimes more likely — to lose weight or quit smoking when they were asked to do more things to improve their health.”

He explained how primary care physicians can put the findings to use in their practices.

“It may be helpful [for PCPs] to discuss the advantages and disadvantages of the different preventive care options, so that patients can make a more informed decision. It may also be helpful for doctors and patients to have an open conversation about preventive care options, and then decide together on a plan. Patients should be invited to actively participate in the discussion and talk about what matters to them,” Taksler said. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.

Glen Taksler
Glen B. Taksler

The more preventive care options that middle-aged and older patients received, the less likely they were to follow such options, according to findings recently published in the American Journal of Preventive Medicine.

“It is unknown whether the number of guideline-recommended preventive services is associated with utilization,” Glen B. Taksler, PhD, of the Medicine Institute, Cleveland Clinic, and colleagues wrote.

Researchers also noted that the Medicare Access and Child Health Insurance Program Reauthorization Act of 2015 stipulated that physicians and health care organizations must report preventive care quality metrics and that a physician’s quality of care rating is now contingent upon the number of services completed.

Taksler and colleagues used Poisson regression analysis of 80,773 patients aged 50 to 75 years totaling 390,778 person-years of electronic health record data. Eligibility for 11 preventive services — blood glucose, hypertension, or lipid control; influenza vaccine; obesity control; screening for abdominal aortic aneurysm; screening for breast, cervical, or colorectal cancers; osteoporosis screening; and tobacco cessation from 1 year to the next — was determined.

Researchers found the adjusted rate of preventive care utilization decreased from 38.67 per 100 (95% CI, 38.16-39.18) in patients eligible for one guideline-recommended service vs. 31.59 per 100 (95% CI, 31.29-31.89) in patients eligible for two services. In patients eligible for six or more services, the adjusted rate was 25.43 per 100 (95% CI, 24.68-26.18) (P for trend < .001).

“In general, patients were less likely to follow preventive care recommendations when they were asked to do more things, suggesting that doctors can recommend ‘too many’ preventive services, making it harder for patients to improve their health,” Taksler told Healio Family Medicine in an interview.

“There were two exceptions. Patients were just as likely — and sometimes more likely — to lose weight or quit smoking when they were asked to do more things to improve their health.”

He explained how primary care physicians can put the findings to use in their practices.

“It may be helpful [for PCPs] to discuss the advantages and disadvantages of the different preventive care options, so that patients can make a more informed decision. It may also be helpful for doctors and patients to have an open conversation about preventive care options, and then decide together on a plan. Patients should be invited to actively participate in the discussion and talk about what matters to them,” Taksler said. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.