RICHMOND, Va. - (Jan. 19, 2012) - 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."
The full research manuscript is available online at: http://www.
Elston Lafata collaborated with Scott Ratliff, M.S., from Virginia Commonwealth University's Department of Social and Behavioral Health; Deidre A. Shires, M.P.H, M.S.W, Ronak Vashi, B.A., Kurt C. Stange, M.D., and George Divine from Henry Ford Health System; and Ming Tai-Seale, Ph.D., M.P.H., from Palo Alto Medical Foundation Research Institute.
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About VCU Massey Cancer Center: VCU Massey Cancer Center is one of only 66 National Cancer Institute-designated institutions in the country that leads and shapes America's cancer research efforts. Working with all kinds of cancers, the Center conducts basic, translational and clinical cancer research, provides state-of-the-art treatments and clinical trials, and promotes cancer prevention and education. Since 1974, Massey has served as an internationally recognized center of excellence. It has one of the largest offerings of clinical trials in Virginia and serves patients in Richmond and in four satellite locations. Its 1,000 researchers, clinicians and staff members are dedicated to improving the quality of human life by developing and delivering effective means to prevent, control and ultimately cure cancer. Visit Massey online at www.massey.vcu.edu or call 877-4-MASSEY for more information.
About VCU and the VCU Medical Center: Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located on two downtown campuses in Richmond, VCU enrolls more than 31,000 students in 211 certificate and degree programs in the arts, sciences and humanities. Sixty-nine of the programs are unique in Virginia, many of them crossing the disciplines of VCU's 13 schools and one college. MCV Hospitals and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the nation's leading academic medical centers. For more, see www.vcu.edu.