In contrast to the oft-expressed concerns that increasing patient complexity impedes the delivery of preventive services because of competing demands, researchers find the presence of chronic illness is positively associated with receipt of recommended preventive services.
In a study of 667,379 adult patients from 148 primary care practices across the United States, researchers found strong positive associations between the receipt of clinical preventive services and the presence of chronic illnesses. For each preventive service examined, they found a curvilinear relationship with the number of chronic conditions, with an increased likelihood of being up-to-date with preventive services as the number of chronic conditions increases from zero to four or five. At this point, they note, the association largely plateaus with no further increases in the proportion of patients up-to-date with the preventive service as the number of chronic conditions increases above five. The associations between the odds of being up-to-date and the presences of chronic illness persisted even after adjustment for age and encounter frequency.
The authors conclude these findings suggest that it is something about the nature of the care provided to these patients that accounts for the finding of increased attention to prevention. They assert primary care practices, facilitated by tools like electronic health records, can overcome competing demands and effectively deliver preventive services to the growing number of patients with multiple chronic illnesses.
Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations
By Steven M. Ornstein, MD, et al
Medical University of South Carolina, Charleston
News From The Annals Of Family Medicine: July/August 2013