Self-Reported Uptake of Clinical Preventive Services by Vision Impairment Status

Disease prevention is central to healthy aging. People with vision impairment are more likely than those without to report barriers to accessing health care and have unmet health care needs. We examined the association between functional vision impairment and preventive care uptake among adults aged 65 years and older in the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey. The outcome of interest was being up-to-date with the recommended core clinical preventive services, as defined by Healthy People 2020: influenza and pneumococcal vaccination, and colorectal cancer screening for men, with the addition of breast cancer screening for women. Self-reported vision impairment was defined as blindness or serious difficulty seeing, even when wearing glasses. In models adjusted for sociodemographic characteristics (including age), access to care, and health/functional status, there was no difference in the odds of reporting being up-to-date with the recommended core preventive services among men with vision impairment compared to those without (odds ratio [OR]=0.90, 95% confidence interval [CI]=0.8-1.01); however, men with vision impairment were 0.82 times (95% CI=0.71-0.94) less likely than those without to report being up-to-date with colorectal cancer screening. Women with vision impairment were less likely than those without to report being up-to-date with the recommended core preventive services (OR=0.77, 95% CI=0.69-0.87); among the different services, the odds were lowest for reporting breast and colorectal cancer screening. These findings suggest that to achieve higher rates of preventive care uptake, especially cancer screening, older adults with vision impairment may be a special group to target.

Delivery of High-Priority Recommended Clinical Preventive Services: Result from a Population-Based Nationwide Study

Background Systematic reviews of scientific evidence have identified clinical services that prevent or ameliorate illness and reduce mortality. Most prior studies have considered the provision of a single domain of preventive services such as vaccination or cardiac care and failed to evaluate a systemic approach to preventative care. The study aimed to assess the level of delivery of all high-priority evidence-based preventive services in a publicly funded healthcare setting. MethodsWe conducted a population-based nationwide cross-sectional computer-assisted telephone survey of 1000 Polish adults. Self-reported use of all high-priority clinical preventive services was assessed, including mammography, colonoscopy, blood glucose screening, vaccination, blood pressure screening, and preventive counselling. ResultsOnly 6.4% (95% confidence interval (CI): 4.88, 7.92) of adults had received all recommended preventive screening, whereas only 4.3% (95% CI: 3.04, 5.56) had received appropriate counselling. GP visits, blood pressure screening, blood glucose screening, and cervical smear were among the most commonly provisioned interventions, at more than 60%, while flu vaccination, PSA assessment, and preventive counselling were among the least frequently delivered services. Despite the low uptake of preventive interventions, nearly three-quarters of the respondents expect the public health system to provide access to these services, and over 75% is interested in remote access to preventive services using telemedicine platforms and e-consultations.ConclusionOur findings suggest that there are significant gaps in the receipt of high-priority preventive interventions. Services that are most commonly not being delivered, such as preventive counselling, need to be emphasized to achieve greater coverage of the population. Further improvements require not only changes in the incentive system for healthcare providers, but also system-level innovation such as telemedicine solutions to deliver preventive services remotely and engage individuals in the monitoring process. The effective preventive strategy will attain the multiple objectives of improving the quality of life, extending the human lifespan, and making the best use of scarce resources.