More Preventive Care Guidelines Linked to Less Preventive Care Utilization

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Although the quantity of preventive care guidelines has increased dramatically over the past 10 years, utilization associated with guideline-recommended services has been decreasing.
Although the quantity of preventive care guidelines has increased dramatically over the past 10 years, utilization associated with guideline-recommended services has been decreasing.

The utilization of preventive care was found to decrease when the quantity of potential preventive services increased, according to a study published in the American Journal of Preventive Medicine.

Glen B. Taksler, PhD, of Case Western Reserve University in Cleveland, Ohio, and associates conducted a retrospective group analysis to determine the correlation between the increasing number of guideline-recommended preventive services and their utilization.

The investigators used data from medical records of patients between the ages of 50 and 75 years who received ≥5 years of frequent health care from 2008 to 2015 (390,778 person-years; 80,773 participants). Participants who qualified for more guideline-recommended preventive services used more of the recommended services.

The following recommendations from the US Preventive Services Task Force, American College of Cardiology, and American Diabetes Association were used to evaluate patient eligibility for preventive services: cessation of tobacco use; obesity control; hypertension; lipids; blood glucose; influenza vaccination; screening for breast, cervical, or colorectal cancers; abdominal aortic aneurysm; or osteoporosis.

The primary outcome was the preventive care utilization rate in the year following the issuance of guideline recommendations.

About 44% of patients had no disease risk factors, while 35%, 16%, and 5% had 1, 2, or 3 or more risk factors, respectively.  A strong correlation was reported between participants who were eligible for more than 1 guideline-recommended and less adherence over the following year.

Adjusted rates dropped from 38.67 per 100 eligible services (per 100) in patients with 1 recommended service to 31.59 per 100 in patients with 2 recommended services and 25.43 per 100 for 6 or more services.

The researchers reported a higher utilization rate among patients with more disease risk factors when the number of eligible services was constant. Patients with no disease risk factors who were eligible for 4 guideline-recommended services had utilization rates of 20.84 per 100, while those with 3 or more disease risk factors had a utilization rate of 31.5 per 100.

No significant changes were observed for cessation of tobacco use or obesity reduction.

“Although further research is necessary to confirm the results and more thoroughly address each disease risk factor, healthcare organizations and physicians interested in providing value-based care might consider ways to prioritize preventive recommendations and maximize utilization,” the authors concluded. “It may be more effective to offer patients a few high priority services per year, than to offer all eligible services at once.”

Reference

Taksler GB, Pfoh ER, Stange KC, Rothberg MB. Association between number of preventive care guidelines and preventive care utilization by patients. [published online May 14, 2018]. Am J Prev Med. doi: 10.1016/j.amepre.2018.03.011
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