About half of eligible and due services are missed during PHEs

More than 20 percent of U.S. adults receive periodic health examinations (PHE) each year, yet new research shows that patients who have an annual routine visit to their doctor may not receive recommended preventive screening tests and counseling services that could benefit their health.

Recently published in the American Journal of Preventive Medicine, a study performed by a team of researchers led by Jennifer Elston Lafata, Ph.D., co-leader of the Cancer Prevention and Control program at Virginia Commonwealth University (VCU) Massey Cancer Center and professor of social and behavioral health at VCU, found that 46 percent of eligible and due services were missed during PHEs. The results came from audio recordings of 484 PHE visits to 64 general internal medicine and family physicians in southeast Michigan.

"While the percentage of services delivered may appear low, when you account for the lack of incentives to physicians for screenings and preventive counseling and the limited amount of time during visits to address all recommended services, the numbers are not surprising," says Elston Lafata.

By analyzing the audio recordings to determine if physicians suggested or delivered 19 guideline-recommended preventive services, the researchers discovered that the services most likely to be delivered were screenings for colorectal cancer, hypertension and breast cancer. Patients were least likely to receive counseling about aspirin use and vision screening, and were also unlikely to have an influenza immunization recommended or delivered.

The team also evaluated the factors contributing to service delivery. Service delivery decreased with patient age and increased with the patient's body mass index (BMI), an indicator of body fatness based on height and weight. While approximately half of the 19 preventive services studied were prompted in the patient's electronic medical record (EMR), the researchers were surprised to find that services were less likely to be delivered during visits where the physician accessed the EMR in the exam room. Interestingly, the patients whose doctors ran behind in their appointments seemed to receive more preventive services.

"It appears that while some preventive services are likely to be received by some patients, several services which are known to reduce disease go undelivered during routine PHEs," says Elston Lafata. "Relying on face-to-face interactions between physicians and patients will likely continue to result in less-than-optimal service delivery. However, technological advances that provide patients with easy access to their personal health records coupled with automated reminders may be one way patients can work with physicians to increase delivery of preventive services and subsequently lower overall health care costs."