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Health promotion and screening services reported by older adult patients of urban primary care physicians.

BACKGROUND
Adult preventive services provided at intervals recommended by expert panel guidelines may reduce morbidity and mortality. As part of an intervention trial to increase primary preventive services in urban primary care practices, baseline data were collected on primary prevention and screening test rates in older adults and on patient characteristics associated with provision of these services.


METHODS
A questionnaire on preventive services offered or provided over the past 2 years was completed by patients aged 52 to 77 years and another by their 42 participating physicians. Logistic regression was used to identify patient characteristics associated with increased provision of these services.


RESULTS
Usable questionnaires were completed by 1457 (80.9%) patients. Patient age and sex were not associated with the provision of primary preventive and counseling services. The presence of two or more chronic diseases was predictive of primary preventive services (P < .02), but was not associated with an increase in screening tests or procedures. Age was positively associated with delivery of prostate-specific antigen blood tests (P < .001) and rectal examinations (P < .001) in men, but was negatively associated with mammography (P < .001) and Papanicolaou (Pap) tests (P = .02) in women. The negative trend in screening mammography was evident even for women aged 50 to 65 years despite the national consensus regarding the benefits of screening for this age group. Patients with health management organization insurance reported significantly more mammography (P = .002), cervical Pap tests (P = .050), sigmoidoscopies (P = .002), and fecal occult blood tests (P = .035).


CONCLUSIONS
In our study patients, the provision of primary preventive and screening services was closer to consensus guidelines than is typically reported in the literature. The data suggest that future investigations and interventions to improve primary prevention and screening services in older adults who have access to primary care do not need to be directed at fundamental changes in the way preventive services are delivered, but rather should target procedures of proven benefit, such as mammography, where rates remain below recommended guidelines.