Impact of an RN-led Medicare Annual Wellness Visit on Preventive Services in a Family Medicine Practice

Abstract

Objective: To evaluate the impact of a registered nurse (RN)-led Medicare annual wellness visit (AWV) on preventive services in a family medicine clinic. Patients and Methods: A retrospective chart review was performed on patients who underwent an RN-led AWV and patients who underwent a standard assessment (SA) between October 2017 and October 2018. A total of 630 patients (330 AWV and 300 SA) were included in this study. Results: There were seven preventive services examined for in women and five preventive services examined for in men. Each service was used more often by patients in the AWV group than the SA group (all odds ratios ≥1.64; all P values ≤.004). Conclusion: The RN-led AWV is an effective way to assist Medicare beneficiaries in meeting their preventive needs while allowing physicians more time to focus on chronic and acute needs.

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

“…Level of diabetes education and years since graduation varied No specific nurse intervention; study examined PN activities and assessments routinely performed during a diabetes consultation on a randomly selected day. Nurses who had consulted at least one person with diabetes on this day were asked about assessments and care provided for these patients, specifically in regards to foot care General practices that employed a PN across three district health boards in Auckland, NZ 21 Farford et al, 2021 [ 55 ] USA To evaluate the impact of a RN-led Medicare annual wellness visit on preventive services in a family medicine clinic Quasi-experimental; retrospective chart review A total of 630 patients (330 undergoing annual wellness visits and 300 undergoing standard assessments) aged 68–72 years who were Medicare beneficiaries RN-led annual wellness visits of Medicare beneficiaries compared to standard assessment (defined as a 30-min office visit with the primary care physician) The annual wellness visits were conducted by 3 care team RNs (one at each location). Each RN received a 1-h lecture on annual wellness visits and was required to observe a previously trained RN perform annual wellness visits on live patients before offering the service RNs provided intervention independently; during the annual wellness visits, the RNs ordered needed preventive imaging, labs, and vaccinations.…”

“…Most focused on some aspect of chronic disease prevention and management ( n = 7) related to diabetes, coronary heart disease, and obesity [ 50 , 52 , 54 , 60 , 61 , 64 , 65 ]. Other RN interventions included smoking cessation support [ 56 , 62 ], chlamydia screening, partner notification and treatment [ 51 , 63 ], back pain education and management [ 53 ], telephone consultation/triage service [ 57 ], assessment of psychological distress [ 66 ], consultations aimed at increasing patient physical activity levels [ 58 , 59 ], annual wellness visits [ 55 ], and laboratory monitoring [ 65 ]. Despite commonalities in study design and type of intervention delivered, strengths and limitations in scope and methodology varied across studies.…”

“…Of the studies included, five examined a RN-led intervention compared to the same intervention delivered by other healthcare providers [ 56 , 60 , 62 – 64 ], six studies compared RN-led interventions to ‘usual care’, defined as either care that existed prior to the intervention that did not involve a RN ( n = 3) [ 50 , 53 , 59 ], or care associated with reduced or alternate levels of RN involvement ( n = 3) [ 51 , 52 , 58 ], and one study compared a collaborative intervention involving primary care RNs supported by two different types of healthcare providers (clinical pharmacy specialists [CPS] and physicians) [ 65 ], where RNs assessed patients independently and presented the patient to either a CPS or a physician if hypertension continued to be poorly controlled). Lastly, five studies examined the effectiveness of a primary care RN intervention using a quasi-experimental design as a means of evaluation (i.e., no comparison group) [ 54 , 55 , 57 , 61 , 66 ].…”

“…PNs have significantly expanded their role in managing people with diabetes over the last decade by increasing the number of foot examinations and providing recommended foot-care education. Farford et al, 2021 [ 55 ] USA Number of preventative services utilized by patients (mammography, colon cancer screening, bone mineral analysis, pneumococcal vaccination, influenza vaccination, screening for hepatitis C, and screening for depression) Each preventive service was utilized more often by patients in the annual wellness visit group than the standard assessment group (all ORs ≥1.64; all p -values ≤0.004). The preventive services with the greatest improvement in the annual wellness visit group compared to standard assessment were depression screening (OR = 4.15; 95% CI: 2.57 to 6.70; p < 0.001) and mammogram (OR = 3.87; 95% CI: 2.00 to 7.50; p < 0.001).…”

“…Six studies examined the effectiveness of primary care RN-led assessment and screening. Three studies used a quasi-experimental design (no comparison group); one used patient questionnaires to assess the ability of primary care RNs to detect psychological distress [ 66 ], another implemented a cross-sectional survey of primary care RNs to evaluate trends in diabetes-related foot examinations [ 54 ], and another carried out a retrospective chart review to assess the impact of primary care RNs on preventative services performed during annual wellness visits [ 55 ]. Another study compared laboratory testing data before and after an intervention [ 51 ], and two conducted a randomized controlled trial in which RN-led care was examined against two comparator groups (i.e., ongoing physician support and usual care for follow-up of cardiovascular disease risk factors) [ 64 ] or usual care alone (standard protocol for partner notification after chlamydia diagnosis) [ 63 ].…”