Effect of periodic health exam on provider management of preventive services

Abstract

Rationale and objective: To evaluate the relationship between receipt of annual physicals and the receipt of provider recommendation for preventive services, during a period when Medicare did not cover annual physicals (before 2011).Methods: Electronic medical records of patients aged 65 years and older from a US health care system were extracted for the 2001 to 2007 period. A fixed-effects logistic model was used to assess the relationship between receipt of periodic health examination (PHE) and receipt of provider recommendation for mammogram screening for 6466 female Medicare beneficiaries. Logistic regression models were used to assess the relationship between receipt of PHE and receipt of provider recommendation for colonoscopy screening and pneumococcal vaccination for 10 318 Medicare beneficiaries. Nine primary care providers from the network were also interviewed, selected by random sampling stratified by care model. Results: Electronic medical record analyses suggest that patients with a PHE were more likely to obtain provider recommendations for mammogram screening (OR = 2.17, P < 0.0001), colonoscopy screening (OR = 1.54, P < 0.0001), and pneumococcal vaccination (OR = 1.10, P < 0.0001). Providers suggested that prevention care quality improves with the PHE because certain screening measures (eg, skin cancer screening, breast exam) would be neglected without it, and healthy patients could miss recommended preventive services entirely. Without the PHE, some providers reported having tried to incorporate discussions of preventive services by scheduling more frequent follow-up chronic care visits than they would have otherwise, and some routinely charged Medicare for a more complex follow-up visit than they would have charged without the preventive service discussions.Conclusion: Periodic health examination is important in connecting patients to recommended preventive services. Provider interviews suggested that, indirectly, Medicare ended up paying for the PHE via greater frequency of follow-up visits or higher visit charges from providers integrating the services with other visits.

Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study

“… 3 This situation is considered alarming, as chronic diseases are generally preventable Through periodic health examinations (PHE), abnormal signs can be detected at an early stage, and correct diagnosis and effective treatment measures can be administered early. 4 …”

“…3 This situation is considered alarming, as chronic diseases are generally preventable Through periodic health examinations (PHE), abnormal signs can be detected at an early stage, and correct diagnosis and effective treatment measures can be administered early. 4 PHE is a primary approach for general practitioners to perform clinical preventive services in China and delaying or avoiding unwanted outcomes through an organized PHE for people aged 60 years and older is a critical public health concern in China. 5 The Chinese government officially approved the health management technical protocol for elderly people based on the principles of equitable access and use of clinical preventive services.…”

Increasing pneumococcal vaccine uptake in older adults: a scoping review of interventions in high-income countries

“…Eleven studies evaluated interventions based within primary care [24,25,27,31,37,38,42,43,60,61,63]. Eight studies noted significant improvement in vaccination rates.…”