title: Preventive services delivery in patients with chronic illnesses: parallel opportunities rather than competing obligations.
abstract: OBJECTIVE
  Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database derived from electronic health records.
  
  
  METHODS
  We conducted a cross-sectional study as of October 1, 2011, of the association between being up to date with 10 preventive services and the prevalence of 24 chronic illnesses among 667,379 active patients aged 18 years or older in 148 member practices in a national PBRN. We used generalized linear mixed models to assess for the association of being up to date with each preventive service as a function of the patient's number of chronic conditions, adjusted for patient age and encounter frequency.
  
  
  RESULTS
  Of the patients 65.4% had at least 1 of the 24 chronic illnesses. For 9 of the 10 preventive services there were strong associations between the odds of being up to date and the presence of chronic illness, even after adjustment for visit frequency and patient age. Odds ratios increased with the number of chronic conditions for 5 of the preventive services.
  
  
  CONCLUSIONS
  Rather than a barrier, the presence of chronic illness was positively associated with receipt of recommended preventive services in this large national PBRN. This finding supports the notion that modern primary care practice can effectively deliver preventive services to the growing number of patients with multiple chronic illnesses.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. ornstesm@musc.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Ornstein
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: Cara B
authors.initials: CB
authors.lastname: Litvin
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Wessell
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D055812:Community-Based Participatory Research / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration; D011314:Preventive Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: chronic disease; comorbidity; preventive health services; primary health care