Clinical Preventive Services Kathryn Kietzman, PhD Research Scientist, UCLA Center for Health Policy Research

Why Promote Use of Preventive Services?  More than 81 million Americans will have more than 1 chronic illness by 2030  Total treatment costs are projected to be $4.2 trillion dollars  Currently we spend 83% of health care spending on chronic illness and less than 3% on prevention

Clinical and Community Preventive Services  Evidence-based preventive services are effective  Preventive services can be delivered in communities  Preventive services can be reinforced by community-based prevention, policies and programs  Community programs can promote the use of clinical preventive services

Recommended CPS Services for Older Adults  Immunizations Influenza Pneumococcal  Screenings Breast and colorectal cancer Diabetes Lipid disorders Osteoporosis  Smoking cessation counseling

Additional Preventive Services Recommendations  Alcohol misuse screening and counseling  Aspirin use  Blood pressure screening  Cervical cancer screening  Depression screening and counseling  Obesity screening and counseling  Zoster vaccinations

Preventive Health Activity by Adults 65+  Flu vaccinations (68%)  Healthy weight (77%)  Regular physical activity 35% for age group 24% for 75+ age group  90% of older adults are not current smokers

Use of CPS and Prevalence of Risk Factors Among Adults Aged  2009 Study by CDC, AARP, and the AMA  Focused on 14 indicators of use of CPS and prevalence of risk factors  Highlights health challenges and under- utilization of life-saving preventive services

Indicators Screenings  Mammogram within past 2 years  Pap test within past 3 years  Colorectal cancer screening within past 10 years  Cholesterol screeninthin past 5 years Immunizations  Influenza vaccination within past year  Ever had a pneumococcal vaccination among persons at risk Up-to-date with Select Clinical Preventive Services  Women up-to-date with select clinical preventive services (influenza vaccination, mammogram, Pap test, and colorectal cancer screening)  Men up-to-date with select clinical preventive services (influenza vaccination and colorectal screening) Risk Factors  No leisure-time physical activity within past month  Currently smoke  Binge drinking within past 30 days  Currently obese  Ever had high blood pressure  Moderate depressive symptoms

Methodology  Used Behavioral Risk Factor Surveillance Survey (BRFSS) data  Controlled for racial/ethnic group, income, education, and health insurance status  Provided an interactive data website at AARP Public Policy Institute (aarp.org)

CPS Results for Year Olds  1:3 were up to date in CPS Least utilized pneumococcal vaccine Those with low income, low education and no insurance less likely to have CPS Whites used CPS more than any other group Largest disparity was between insured (32%) and non-insured women (10%)

Health Risk Factor Results for Year Olds  Most prevalent risk factor was high blood pressure (44%) followed by obesity (33%)  Low income, low education and non- insured more likely to report physical inactivity, smoking, obesity and high BP  High income and college students most likely to report binge drinking

Health Risk Factor Results for Year Olds (2)  African Americans most likely to report risk factors  Asian Americans were the least likely to have risk factors  Largest disparity was found in obesity rates between African Americans (43%) and Asian Americans (11%)

Recommendations  Encourage use of patient and provider reminder systems  Raise public awareness  Integrate community health and clinical strategies  Increase funding to break down barriers

ACA Impact on Preventive Care for Adults 50–64  Improves access by eliminating co-pay and increasing insurance coverage  Increases Medicaid benefits for low income people  Goal is to increase use of CPS and reduce health disparities

Study Conclusions  These findings demonstrate that the underutilization of preventive services is a public health concern for midlife adults.  Racial and ethnic minorities, the uninsured, and those of low socioeconomic status are receiving even fewer recommended preventive services and experiencing more risk factors.

Opportunity Knocks for Preventive Health for Seniors  To identify barriers or facilitators to increasing the use of clinical preventive services (CPS) among older adults in community-based settings.  To highlight strategic actions that promote CPS uptake across diverse older adult populations and reduce inequities.

Racial/Ethnic Group Disparities in CPS use (United States) (% not receiving) WhiteLatino African American Asian Flu shot adults Colorectal cancer screening adults Breast cancer screening women

Stakeholder Interviews  In-depth telephone interviews with 43 community-based stakeholders representing public health, aging services, community health centers, and other community organizations.  Stakeholder round table meeting to identify opportunities to increase CPS provision to older adults in the community.

Strategies: Public Health  Technology Tools: effective use of electronic health records, immunization registries, and online appointment scheduling.  Monitoring and Evaluation: developing uniform measures for tracking and comparing CPS data at the local level.  Patient Navigation: providing culturally and linguistically appropriate support services and guidance.

Strategies: Aging Services  Building on Existing Services and Resources: Chronic Disease Self-Management Program Aging and Disability Resource Centers Senior Volunteer Corps

Strategies: Community Health Centers  Appropriate Use of Technology: systematically tracking the use of CPS.  Effective Use of Personnel: coordinating the use of CPS.

Strategies: Other Community Organizations  Facilitating Access: offering services where older adults live, work, play, vote, and shop.  Being Opportunistic: reaching older adults when engaged in other health-related activities.  Providing Incentives: in the form of cash or in-kind benefits. 

Common Strategy: Forging Strategic Partnerships  Appropriate personnel  Necessary equipment  Long-term funding mechanisms  Access to underserved populations

One-Stop Senior Centers City of San Antonio, Texas  Partnership between the City, the WellMed Charitable Foundation, and the Area Agency on Aging  Predominantly low-income Hispanic population with a high prevalence of diabetes  Multiservice senior centers provide natural point of entry and offer health and wellness services, including: Screenings and immunizations Chronic disease self-management Healthful groceries Fitness equipment

Conclusion  Use of community settings has great potential to increase CPS uptake among older adults.  Partnerships are critical for leveraging the financial and human capital needed.  A systems approach is needed to achieve the national goals put forth by Healthy People 2020, 1 Action Plan to Reduce Racial and Ethnic Health Disparities, 2 and National Prevention Strategy. 3

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