Preventive Care: Does Continuity Count?
Meyers Primary Care Institute; Department of Family Medicine and Community Health
Medical Subject Headings
Adolescent; Adult; Aged; Continuity of Patient Care; Female; Humans; Interviews as Topic; Male; Mammography; Middle Aged; Preventive Health Services; Preventive Medicine; Smoking Cessation; United States; Vaccination
Community Health and Preventive Medicine | Health Services Research | Primary Care
OBJECTIVE: To examine the impact of provider continuity on preventive care among adults who have a regular site of care.
DESIGN: Logistic regression analyses were conducted to explore whether continuity, categorized as having no regular care, site continuity, or provider continuity, was associated with receipt of 3 preventive care services (influenza vaccination, receipt of a mammogram, and smoking cessation advice), independent of predisposing, need, and enabling factors.
PARTICIPANTS: This study examined 42664 persons with private, Medicaid, Medicare, or no health insurance coverage who reported either having no site of care or being seen in a physician's office, HMO, hospital outpatient department, or other health center.
SETTING: The 1996/1997 Community Tracking Study (CTS) household survey, a telephone-based survey providing a cross-sectional sample of 60446 U.S. adults aged 18 and older representing the U.S. housed, noninstitutionalized population.
MEASUREMENTS AND MAIN RESULTS: After adjustment for differences in predisposing, enabling, and need factors, site continuity was associated with significant increases of 10.4% in influenza vaccinations (P =.006) and 12.6% in mammography (P =.001), and a nonsignificant increase of 5.6% in smoking cessation advice (P =.13) compared to having no regular site of care. After adjustment for these factors, provider continuity was associated with an additional improvement of 6.0% in influenza vaccinations (P =.01) and 6.2% in mammography (P =.04), and a nonsignificant increase of 2.5% in smoking cessation advice (P =.30) compared to site continuity.
CONCLUSIONS: Provider continuity and site continuity are independently associated with receipt of preventive services. Compared to having no regular site of care, having site continuity was associated with increased receipt of influenza vaccination and mammography and, compared to having site continuity, having provider continuity was associated with further increases in the receipt of these two preventive services.