Delivery of preventive services to older black patients using neighborhood health centers.
OBJECTIVE
Older black patients are at risk for underutilization of preventive services. Our objectives were to assess the delivery of five preventive services in Title 330-funded health centers in low income neighborhoods in Cleveland, Ohio, and to determine the association of health system factors and health status with the delivery of these services.


METHODS
A cross-sectional study.


METHODS
Four neighborhood health centers in low income neighborhoods of Cleveland, Ohio.


METHODS
A total of 683 black men and women, aged 70 and older, who regarded the health center as their primary source of outpatient care.


METHODS
Demographic characteristics, independence in basic and instrumental activities of daily living, comorbidity scores, and perceived access were determined by telephone interview. We reviewed charts to determine whether each of five preventive service goals were obtained: influenza vaccination within 1 year; pneumococcal vaccination at any time; mammography within 2 years; Papanicolau screening within 1 year or twice at any time in the past with documentation of normal results; and fecal occult blood testing within 2 years.


RESULTS
The defined goals for influenza vaccination, pneumococcal vaccination, mammography, Papanicolau screening, and fecal occult blood testing were achieved for 59%, 64%, 59%, 51%, and 17% of patients, respectively. Influenza and pneumococcal vaccines were obtained more often in persons with greater comorbidity. Mammography and Papanicolau smear were obtained more often in patients without of ADL or IADL impairments. The four clinical sites varied substantially in the delivery of each preventive service. More frequent office visits were associated with greater delivery of all five preventive services. This relationship persisted in multivariable analyses controlling for health status and clinical site.


CONCLUSIONS
This study shows that Title 330 federally supported neighborhood health center sites providing primary care to older blacks in Cleveland achieved high rates of performance in four of the five recommended preventive services. In addition, preventive services practices were associated with prognostically relevant health status information. The frequency of office visits was related strongly and consistently to the performance of the various preventive services, indicating that more, not fewer, office visits may be necessary to achieve Healthy People 2000 targets. J Am Geriatr Soc 48:124-130, 2000. Key words: preventive services; blacks; access to care; geriatrics; primary care
Wright
P J
PJ
GeriMed, Denver, Colorado, USA.
Fortinsky
R H
RH
Covinsky
K E
KE
Anderson
P A
PA
Landefeld
C S
CS
D000203:Activities of Daily Living; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001294:Attitude to Health; D001428:Bacterial Vaccines / Q000008:administration & dosage; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D008327:Mammography; D015999:Multivariate Analysis; D009780:Occult Blood; D009820:Ohio; D011203:Poverty; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000276:immunology; D014611:Vaccination; D014626:Vaginal Smears
D001428:Bacterial Vaccines; D007252:Influenza Vaccines