title: Moderators of access and utilization of clinical preventive services in older adults.
abstract: OBJECTIVE
  This paper reports a study exploring the relationships between potential moderators of access and utilization of clinical preventive services in a homogeneous sample of older adults with near universal health coverage.
  
  
  BACKGROUND
  Advancements have occurred in eliminating financial and structural barriers to utilization of clinical preventive services (primary, secondary and tertiary prevention) in most developed countries, but variations in utilization continue. These variations may be attributed to non-social determinants of health moderators that impact utilization in older adults.
  
  
  METHODS
  Theorized relationships were explored using questions from the United States Behavioral Risk Factor Surveillance System Survey and a homogenous convenience sample of 202 older adults (mean age 84; sd 5·23) with near universal health coverage. Data collected across a 2 year period (2007-2009) were analysed using Chi-square, Mann-Whitney U and Hierarchical Logistic Regression.
  
  
  RESULTS
  Several logistic regression models of personal access (advised to lose weight, high blood pressure, high cholesterol); moderators (gender, perceived health status, BMI ≥ 30 kg/m(2)); and clinical preventive services utilization (check-up in last 12 months; ever had colonoscopy/sigmoidoscopy) showed statistically significant (P < 0·05) improvement in model fit by adding interaction terms (access X moderator).
  
  
  CONCLUSIONS
  Exploring the impact of moderators on utilization may yield more insight into variations than could be explained by measurement of the direct affect of having near universal health coverage alone.
authors.affiliation: Department of Health Systems, Risk, and Contingency Management, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. sbibb@usuhs.mil
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Garmon Bibb
authors.forename: Diane L
authors.initials: DL
authors.lastname: Padden
authors.forename: Wakettia
authors.initials: W
authors.lastname: Ferguson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015987:Effect Modifier, Epidemiologic; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015404:Nursing Methodology Research; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D014481:United States; D019472:Universal Health Insurance / Q000706:statistics & numerical data; D055815:Young Adult