Friday, June 15, 2018

Fewer Than 1 in 10 Adults Get All High-Priority Preventive Care

Only 8% of US adults aged 35 years or older received all of the high-priority preventive care recommended for them, according to results of a survey published in the June issue of Health Affairs. Conversely, 5% of adults received none of those services.

Amanda Borsky, DrPH, MPP, a dissemination and implementation adviser in the Center for Evidence and Practice Improvement at the Agency for Healthcare Research and Quality in Rockville, Maryland, and colleagues found that the most commonly received preventive service in 2015 was blood pressure screening (87.3%), and the least commonly received was zoster vaccination for shingles (37.9%).

Common reasons for not getting preventive services include lack of insurance, lack of a usual source of care, and delayed access to care.

The researchers used data from the Preventive Services Self-Administered Questionnaire of the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey from January to May 2015 to examine receipt of 15 preventive measures: screenings for blood pressure, cholesterol, breast cancer, colon cancer, cervical cancer, osteoporosis, and prostate-specific antigen; screening and counseling for tobacco, obesity, alcohol use, and depression; influenza, zoster, and pneumococcal vaccines; and counseling for aspirin use.

Among the 2759 adults aged 35 years and older eligible to complete the Preventive Services Self-Administered Questionnaire, 2186 (79.2%) did.

With respect to the proportion of respondents who received all appropriate preventive care, there was no significant difference between men and women or by age. However, men were almost twice as likely as women to receive 25% fewer of the services. Men were also 3 times as likely as women to have received no recommended services. “The only service received more often by men than women was counseling on aspirin use,” the authors write.

The 15 measures were identified with guidance from an expert national steering committee. Each measure had to be evidence-based, relevant, and actionable.

One of the limitations of the survey was that it relied on self-report, and people may not have accurately remembered whether they had received a service or how long it had been since they had it.

My Take:
This report was sent to physicians and other health care providers through Medscape. The system allows comment by subscribers. The number one comment was that these 15 measures have little to do with preventive care. Many physicians claimed that most physicians have little or no knowledge of preventive care and that the health care systems does not support physician efforts in preventive health. Others spoke of the ever-increasing barriers to receiving health care – lack of insurance, limitations on coverage, etc.

The aspirin counseling data is worth mention. Men are much more likely to suffer a heart attack than women, especially prior to the average age of menopause. However, aspirin is not considered a medical standard for primary prevention (even in men) but rather is only recommended as a preventive measures after someone has had a CVA (cardiovascular accident). Unfortunately, many physicians, especially primary care physicians, still counsel their patients to take a low-dose aspirin as primary prevention. In fact, such advice creates more health issues than it prevents.

The Bottom Line:
You cannot depend on the health care system for preventive medicine. They talk about diet, lifestyle, exercise and weight loss as lead therapies but in practice just prescribe a statin drug when your cholesterol exceeds 200. You must be your own heath care advocate.

Here are a few suggestions that are truly preventive: Make sure your yearly lab work includes an A1c, it will detect pre-diabetes years before the fasting glucose is elevated. In addition to the serum lipids, ask for a CRP (vascular inflammation marker) homocysteine (cardiac risk factor), and L(p)a if there is a family history of high cholesterol. Have your percent body fat checked to calibrate your body mass index in addition to checking your weight regularity. Have a nutritionist review a diet diary.

Source: June 8, 2018 National Institutes of Health

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