Douglas Shenson, MD, MPH, MS SPARC, Sickness Prevention Achieved through Regional Collaboration dshenson@sparc-health.org
Mary Adams, MPH On Target Health Data LLC
Julie Bolen, PhD, MPH Lynda Anderson, PhD Centers for Disease Control and Prevention (CDC)
The authors reported no potential conflict of interest relevant to this article.
The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC). Funding for this research was provided by the CDC.
Questions still unanswered. Although BRFSS data suggest older adults are regularly receiving “routine checkups,” it is not clear what kind of intervention this refers to beyond its nonacute nature. What characterizes routine checkups in patients’ minds, and how might such visits be limited as venues for providing preventive services? Furthermore, what are the characteristics of providers associated with different types of checkup services? How do primary care providers differ from subspecialists in the kinds of preventive services they provide? Answers to these questions have important implications for physician training and for targeted outreach to subspecialty groups. From a community standpoint, it would be helpful to know if there are specific untapped opportunities for delivering preventive services, particularly in underserved and minority communities where coverage rates are very low.
This study’s limitations. Because the BRFSS relies on self-reports, our findings are subject to various biases, including “telescoping,”28 the tendency of people to remember events as having occurred more recently than they actually did.29 Moreover, because BRFSS surveys exclude people in households without telephones (who are more likely to be poor and thus also less likely to have access to health care and preventive services), our estimates may be slightly higher than the true rates.30 People with cell phone service only were not sampled; however, this had little impact on estimates for older adults, since just an estimated 2.2% use cell phones exclusively.31 People in institutions, such as nursing homes, which account for 3% to 4% of adults 65 and older were also excluded.32
The strength of this study is that, based on a large sample of randomly selected respondents, it is the first report on the adoption of clinical preventive services in all states in relation to the use of routine checkups and a composite measure. However, as noted in the methods, although the interviewer provided a definition for the term routine checkup, the description may have been interpreted differently by survey respondents.
The provider’s office and medical home should remain at the center of a national strategy to increase the delivery of these services, but expanding these efforts to include community access is critical to improving overall rates of preventive services. We need more determined and strategic collaborations between medicine and public health that will facilitate access to, and use of, preventive services for all Americans.
CORRESPONDENCE Douglas Shenson, MD, MPH, 76 Prince Street, Newton, MA 02465; dshenson@sparc-health.org
