Ways To Deliver Preventive Health Care

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled "Interventions That Increase Use of Adult Immunization and Cancer Screening Services: A Meta-Analysis." It is in the 7 May 2002 issue of Annals of Internal Medicine (volume 136, pages 641-651). The authors are EG Stone, SC Morton, ME Hulscher, MA Maglione, EA Roth, JM Grimshaw, BS Mittman, LV Rubenstein, LZ Rubenstein, and PG Shekelle.

What is the problem and what is known about it so far?

The goal of preventive health care is to prevent illness and cancer. There are several proven effective preventive health care practices for adults. For example, vaccination helps prevent influenza virus (the flu) and certain kinds of pneumonia in older adults. Screening tests, such as Papanicolaou (Pap) smears (examination of cells scraped from the cervix), mammography (breast x-ray), and colon examinations with scopes, help find early cancers or precursors of cancers before symptoms develop. Although experts recommend all of these preventive health care practices, studies show that many adults do not receive them. Doctors and health care organizations may not use effective ways to be sure that patients get preventive services.

Why did the researchers do this particular study?

The researchers wanted to identify effective ways to improve the delivery of common preventive care services (vaccination and cancer screening).

Who was studied?

The study included hundreds of patients who had participated in studies comparing different ways of improving preventive care practices.

How was the study done?

Instead of doing a new study, the researchers analyzed information from 81 studies that had compared different approaches for providing preventive services (vaccination and cancer screening). The researchers categorized approaches into seven areas: reminders, education, provider feedback about past performance, financial incentives, regulatory actions, mass media campaigns, and organizational change. Organizational change was defined as changing a health care system to improve performance of preventive services. The researchers then used special statistical analyses (meta-regression) to see which types of approaches were most effective.

What did the researchers find?

Organizational change was the most effective approach. Changes included having separate clinics just for prevention, scheduling specific clinic visits just for prevention, and using staff other than doctors for prevention activities. The next most effective approaches were patient financial incentives (such as reduction of copayment amounts), reminders to use a service, and patient education. Approaches aimed at providers were less effective. Using several approaches appeared to be better than relying on just one.

What were the limitations of the study?

The costs and resources needed to implement the different approaches were not described. The effectiveness of some approaches was difficult to assess because the research was poorly done.

What are the implications of the study?

Organizational changes, such as separate clinics, planned visits, and special staff, are the most effective way to improve adult immunization (vaccination) and cancer screening. Lowering the consumer cost for preventive services by decreasing or eliminating consumer cost-sharing will also be effective.