The rate of preventive care use is lower when the number of guideline-recommended services is higher, and prioritizing recommendations may improve use of high-value services, according to a study published in the American Journal of Preventive Medicine.

Glen B. Taksler, PhD, from the Medicine Institute at the Cleveland Clinic, and colleagues reviewed electronic medical records from 2008 to 2015 from the Cleveland Clinic Health System to assess whether eligibility for more guideline-recommended preventive services is associated with lower preventive care use. Patients were aged 50 to 75 years and received 5 or more years of care in the health system with visits to an internal medicine or family medicine provider at least every other year.

The researchers considered eligibility for 11 preventive services most closely associated with guidelines: tobacco cessation; control of obesity, hypertension, lipids, or blood glucose; influenza vaccination; and screening for breast, cervical, or colorectal cancers, abdominal aortic aneurysm, or osteoporosis. Additionally, all patients were eligible for influenza vaccination each year. Eligibility was assessed at the end of each year on December 31. In the year after which a patient was identified as eligible, researchers examined successful use of the service most closely associated with each guideline.

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The primary outcome was the rate of preventive care use in the following year. Results were adjusted for demographics and stratified by the number of disease risk factors (smoking, obesity, hypertension, hyperlipidemia, diabetes). Data were collected in 2016 and analyzed in 2017.

The sample included 80,773 patients across 390,778 person-years. Nearly 50% of patients (44%) had no disease risk factors, 35% had 1 risk factor, 16% had 2 risk factors, and 5% had 3 or more risk factors. Patients who were eligible for more guideline-recommended preventive services used more services; however, eligibility for more guideline-recommended preventive services was strongly associated with lower use of each individual service in the following year. The adjusted rate of preventive care use decreased from 38.67 preventive services used per 100 eligible services in patients eligible for one guideline-recommended service to 31.59 per 100 in patients eligible for 2 services, and 25.43 per 100 in patients eligible for 6 or more services.

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Results were robust to disease risk factors and observed for all but 2 services (tobacco cessation and obesity reduction). However, for any given number of guideline-recommended services, patients with more disease risk factors had higher usage rates.

“In this 8-year cohort study, eligibility for more guideline-recommended preventive services was strongly associated with lower patient utilization of each recommended service,” the authors concluded. “This relationship held for nearly all major preventive services and stratification by disease risk factors. Because the value of preventive care interventions is not uniform, these findings suggest a need for prioritization of preventive care guidelines to maximize value for patients.”


Taksler GB, Pfoh ER, Stange KC, Rothberg MB. Association between number of preventive care guidelines and preventive care utilization by patients. Am J Prev Med. 2018 May 8. doi: 10.1016/j.amepre.2018.03.011