When a Usual Source of Care and Usual Provider Matter: Adult Prevention and Screening Services

  • Lynn A. Blewett
  • Pamela Jo Johnson
  • Brian Lee
  • Peter B. Scal
Original Article

Abstract

OBJECTIVE

To examine whether the usual source of preventive care, (having a usual place for care only or the combination of a usual place and provider compared with no usual source of preventive care) is associated with adults receiving recommended screening and prevention services.

DESIGN

Using cross-sectional survey data for 24,138 adults (ages 18–64) from the 1999 National Health Interview Survey (NHIS), we estimated adjusted odds ratios using separate logistic regression models for receipt of five preventive services: influenza vaccine, Pap smear, mammogram, clinical breast exam, and prostate specific antigen.

RESULTS

Having both a usual place and a usual provider was consistently associated with increased odds for receiving preventive care/screening services compared to having a place only or neither. Adults ages 50–64 with a usual place/provider had 2.8 times greater odds of receiving a past year flu shot compared with those who had neither. Men ages 50–64 with a usual place/provider had nearly 10 times higher odds of receiving a PSA test compared with men who had neither. Having a usual place/provider compared with having neither was associated with 3.9 times higher odds of clinical breast exam among women ages 20–64, 4.1 times higher odds of Pap testing among women ages 21–64, and 4.8 times higher odds of mammogram among women ages 40–64.

CONCLUSIONS

Having both a usual place and usual provider is a key variable in determining whether adults receive recommended screening and prevention services and should be considered a fundamental component of any medical home model for adults.

KEY WORDS

source of care medical home usual provider preventive care health insurance 

Notes

Acknowledgement

This project was funded, in part, by a grant to the University of Minnesota School of Public Health from the National Institutes of Health, National Institute of Child Health and Human Development to establish the “Integrated Health Interview Series (IHIS).” NICHD Contract #1-R01-HD046697–01.

References

  1. 1.
    Health Resources and Services Administration. Maternal and Child Health Bureau web page, Achieving and Measuring Success: A National Agenda for Children with Special Health Care Needs. Available at: http://mchb.hrsa.gov/programs/specialneeds/measuresuccess.htm. Accessed: June 18, 2007
  2. 2.
    Damiano PC, Momany ET, Tyler MC, et al. Cost of outpatient medical care for children and youth with special health care needs: investigating the impact of the medical home. Pediatrics. 2006;118:e1187–94.PubMedCrossRefGoogle Scholar
  3. 3.
    Starfield B, Shi L. The medical home, access to care, and insurance: a review of evidence. Pediatrics. 2004;113suppl1493–98.PubMedGoogle Scholar
  4. 4.
    Smith PJ, Santoli JM, Chu SY, et al. The association between having a medical home and vaccination coverage among children eligible for the vaccines for children program. Pediatrics. 2005;116:130–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Xu KT. Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res. 2002;37:1509–29.PubMedCrossRefGoogle Scholar
  6. 6.
    Barr M, Ginsburg J. The advanced medical home: A patient-centered, physician-guided model of health care. Policy Monograph. Philadelphia PA: American College of Physicians; 2006. Available at: http://www.acponline.org/hpp/adv_med.pdf
  7. 7.
    DeVoe JE, Fryer GE, Phillips R, et al. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health. 2003;93:786–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Ettner SL. The relationship between continuity of care and the health behaviors of patients: does having a usual physician make a difference? Med Care. 1999;37:547–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin. 2007;57290–104.PubMedGoogle Scholar
  10. 10.
    StataCorp. Stata Statistical Software; Release 9.0. College Station, TX: StataCorp LP; 2005.Google Scholar
  11. 11.
    StataCorp. Survey Data Reference Manual. College Station, TX: Stata Press; 2005.Google Scholar
  12. 12.
    Ettner SL. The timing of preventive services for women and children: the effect of having a usual source of care. Am J Public Health. 1996;86:1748–54.PubMedGoogle Scholar
  13. 13.
    Doescher MP, Saver BG, Fiscella K, et al. Preventive care: Does continuity count? J Gen Intern Med. 2004;19:632–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Partnership for Prevention. Preventive Care: A National Profile on Use, Disparities and Health Benefits. Washington DC: Partnership for Prevention; August 2007. Available at: http://www.prevent.org/content/view/129/72/.

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Lynn A. Blewett
    • 1
  • Pamela Jo Johnson
    • 1
  • Brian Lee
    • 1
  • Peter B. Scal
    • 2
  1. 1.School of Public Health, Division of Health Policy and ManagementUniversity of MinnesotaMinneapolisUSA
  2. 2.University of Minnesota Medical SchoolMinneapolisUSA

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