Delivery of preventive services to older adults by primary care physicians

  • Pham H
  • Schrag D
  • Hargraves J
 et al. 
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ContextRates of preventive services remain below national goals.ObjectiveTo identify characteristics of physicians and their practices that are
associated with the quality of preventive care their patients receive.DesignCross-sectional analysis of data on US physician respondents to the
2000-2001 Community Tracking Study Physician Survey linked to claims data
on Medicare beneficiaries they treated in 2001. Physician variables included
training and qualifications and sex. Practice setting variables included practice
type, size, sources of revenue, and access to information technology. Analyses
were adjusted for patient demographics and comorbidity, as well as community
characteristics.Setting and ParticipantsPrimary care delivered by 3660 physicians providing usual care to 24 581
Medicare beneficiaries aged 65 years and older.Main Outcome MeasuresProportion of eligible beneficiaries receiving each of 6 preventive
services: diabetic monitoring with hemoglobin A1c measurement or
eye examinations, screening for colon or breast cancer, and vaccination for
influenza or pneumococcus in 2001.ResultsOverall, the proportion of beneficiaries receiving services was below
national goals. Physician and, more consistently, practice-level characteristics
were both associated with differences in the delivery of services. The strongest
associations were with practice type and the percentage of practice revenue
derived from Medicaid. For instance, beneficiaries receiving usual care in
practices with less than 6% of revenue from Medicaid were more likely than
those with more than 15% of revenue derived from Medicaid to receive diabetic
eye examinations (48.9% vs 43%; P = .02),
hemoglobin A1c monitoring (61.2% vs 48.4%; P<.001), mammograms (52.1% vs 38.9%; P<.001),
colon cancer screening (10.0% vs 8.5%; P = .60),
and influenza (50.2% vs 39.2%; P<.001) and pneumococcal
(8.2% vs 6.4%; P<.001) vaccinations. Other variables
associated with delivery of preventive services after adjustment for patient
and geographic factors included obtaining usual health care from a physician
who worked in group practices of 3 or more, who was a graduate of a US or
Canadian medical school, or who reported availability of information technology
to generate preventive care reminders or access treatment guidelines.ConclusionsDelivery of routine preventive services is suboptimal for Medicare beneficiaries.
However, patients treated within particular practice settings and by particular
subgroups of physicians are at particular risk of low-quality care. Profiling
these practices may help develop tailored interventions that can be directed
to sites where the opportunities for quality improvement are greatest.

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