Article Figures & Data
Figures
- Figure 1
Unadjusted associations between being up to date with each preventive service and the number of chronic conditions.
BP = blood pressure; HDL = high-density lipoprotein; Pap = Papanicolaou; UTD = up to date.
Tables
- Table 1
Chronic Conditions Prevalence Among 667,379 Active Patients in 148 Practices as of October 1, 2011, in Order of Frequency
Chronic Condition No. With Condition % With Condition Hypertension 223,653 33.51 Hyperlipidemia 220,053 32.97 Depression 124,596 18.67 Gastroesophageal reflux 99,658 14.93 Diabetes mellitus 79,641 11.93 Obesity 79,407 11.90 Osteoarthritis 66,255 9.93 Asthma 58,900 8.73 Osteoporosis and osteopenia 43,700 6.55 Migraine 37,756 5.66 Coronary disease 32,867 4.92 Atherosclerosis 31,638 4.74 Chronic obstructive pulmonary disease 29,005 4.35 Chronic kidney disease 22,496 3.37 Cerebrovascular disease 19,227 2.88 Atrial fibrillation 14,487 2.17 Heart failure 11,241 1.68 Alcohol use disorders 8,594 1.29 Dementia 7,361 1.10 Peptic ulcer 7,242 1.09 Chronic liver disease 6,951 1.04 Epilepsy 6,893 1.03 Rheumatoid arthritis 6,357 0.95 Parkinson’s disease or syndrome 1,886 0.28 - Table 2
Grade A and B Recommendations of US Public Service Task Force Studied, Eligible Patients for Each Service, and Percentage Up to Date as of October 1, 2011
Preventive Service Interval y Age y Sex No. of Eligible Patients Up to Date % Blood pressure measurement 2 ≥18 Both 667,379 96.80 At-risk drinking assessment 2 ≥18 Both 667,379 22.57 Depression screen 2 ≥18 Both 667,379 18.75 Total and high-density lipoprotein cholesterol 5 ≥35 Male 446,502 73.16 ≥45 Female Blood glucose measurement if last blood pressure >135/80 mm Hg 3 ≥18 Both 348,084 76.10 Colorectal cancer a 50–74 Both 274,716 43.71 Papanicolaou smear 3 21–64 Females 268,850 42.63 Mammogram 2 50–74 Females 150,452 52.95 Bone density Any ≥65 Females 86,200 47.71 Urogenital chlamydia 1 18–24 Females 43,762 13.39 -
↵a Colonoscopy within 10 years, sigmoidoscopy within 5 years, or fecal occult blood test within 1 year.
-
- Table 3
Odds of Being Up to Date With Preventive Service Based on Number of Chronic Conditions Compared With Patients With No Chronic Conditions, Adjusted for Patient Age and Encounter Frequency
Chronic Conditions Preventive Service 1
OR (95% CI)2
OR (95% CI)3
OR (95% CI)4
OR (95% CI)≥5
OR (95% CI)Blood pressure measurement 2.9 (2.8–3.0) 4.4 (4.1–4.7) 5.0 (4.6–5.4) 5.7 (5.2–6.3) 4.3 (3.9–4.6) At-risk drinking assessment 1.7 (1.7–1.8) 2.3 (2.3–2.4) 2.7 (2.7–2.8) 2.9 (2.8–3.0) 3.1 (3.0–3.2) Depression screen 6.3 (6.1–6.4) 9.2 (8.9–9.4) 11.7 (11.3–12.0) 14.8 (14.4–15.4) 21.8 (21.1–22.5) Total and high-density lipoprotein cholesterol 3.1 (3.1–3.2) 6.1 (6.0–6.3) 9.4 (9.2–9.7) 13.0 (12.5–13.5) 16.2 (15.6–16.8) Blood glucose measurement if last blood pressure >135/80 mm Hg 2.6 (2.5–2.7) 4.7 (4.6–4.9) 6.7 (6.5–6.9) 8.8 (8.4–9.2) 11.1 (10.6–11.6) Colorectal cancer 1.9 (1.8–1.9) 2.3 (2.2–2.3) 2.5 (2.4–2.6) 2.7 (2.6–2.7) 2.9 (2.8–3.0) Papanicolaou smear 1.4 (1.3–1.4) 1.5 (1.4–1.5) 1.4 (1.4–1.4) 1.3 (1.2–1.3) 1.0 (1.0–1.1) Mammogram 1.8 (1.7–1.9) 2.2 (2.1–2.3) 2.4 (2.3–2.5) 2.5 (2.4–2.6) 2.1 (2.1–2.2) Bone density 2.9 (2.7–3.1) 4.0 (3.8–4.3) 5.0 (4.6–5.3) 5.8 (5.4–6.2) 6.9 (6.4–7.3) Urogenital chlamydia 0.8 (0.8–0.9) 0.7 (0.6–0.8) 0.6 (0.5–0.8) 0.6 (0.4–0.9) 0.5 (0.3–1.0)
The Article in Brief
Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations
Steven M. Ornstein , and colleagues
Background Delivery of recommended preventive health services is an important for public health, but it is unclear whether patients with chronic illnesses are more or less likely to receive such services. This study explores the issue in a large national practice-based research network.
What This Study Found Among 667,379 adult patients from 148 primary care practices across the United States, there are strong positive associations between receiving clinical preventive services and the presence of chronic illnesses. The associations persist regardless of the number of chronic illnesses.
Implications
- These findings are in contrast to commonly expressed concerns that increasing patient complexity impedes the delivery of preventive services because of competing demands.
- The authors suggest that primary care practices, using tools like electronic health records, can overcome competing demands and effectively deliver preventive services to the growing number of patients with multiple chronic illnesses.
