Galvin Shelley L, Grandy Rebecca, Woodall Tasha, Parlier Anna Beth, Thach Sarah, Landis Suzanne E
director of research, Mountain Area Health Education Center, Center for Research, Asheville, NC; adjunct assistant professor, University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina
clinical pharmacist practitioner, Mountain Area Health Education Center, Department of Family Medicine, Asheville, North Carolina.
N C Med J. 2017 Sep-Oct;78(5):287-295. doi: 10.18043/ncm.78.5.287.
The Annual Wellness Visit was designed to enhance preventive services utilization among Medicare beneficiaries; Annual Wellness Visits are underutilized with sparse documented effectiveness. Patients of 3 community-based and 2 retirement community outpatient clinics in western North Carolina had team-based Annual Wellness Visits over a 20-month program, with the goal of improving the uptake and delivery of the Annual Wellness Visit. A clinical pharmacist saw high-complexity patients (≥5 medications) and a licensed practical nurse saw low-complexity patients. We examined the effectiveness of team-based Annual Wellness Visits on patients' use of preventive services. We conducted a retrospective chart review on a random sample of 500 patients for 12 months post-Annual Wellness Visit. Change over time in use of preventive services was assessed using McNemar's test. Adjusted relative risks of use within 6 months were calculated using generalized linear models with the Poisson loglinear function. Overall, utilization of Annual Wellness Visit increased from 14% at baseline to 44% after the 20-month program. The percentage of patients up-to-date with all recommended services increased from 17.4% at the Annual Wellness Visit to 42% within 6 months. Age-appropriate preventive screens and vaccines demonstrated the most improvement (55.8% to 75.4% and 36% to 52.2%, respectively). Community-based patients were less likely to obtain recommended services (RR = 0.618; 95% confidence interval [CI], 0.442-0.865), while patients with supplemental insurance (RR = 1.484; 95% CI, 1.023-2.153), patients seen in subsequent Annual Wellness Visits (RR = 1.405; 95% CI, 1.062-1.858), and patients who were men (RR = 1.422; 95% CI, 1.053-2.041) were more likely to obtain recommended services. Generalization is limited by the pre-/post design of one organizational model. Team-based Annual Wellness Visits with a clinical pharmacist or an LPN, who were supervised by physicians, were associated with significantly improved utilization of preventive services. Use will likely continue to improve as more patients access team-based Annual Wellness Visits yearly.
年度健康检查旨在提高医疗保险受益人的预防性服务利用率；年度健康检查的利用率较低，且有效性记录稀少。北卡罗来纳州西部3家社区门诊诊所和2家退休社区门诊诊所的患者在一个为期20个月的项目中接受了基于团队的年度健康检查，目标是提高年度健康检查的接受率和服务提供情况。临床药剂师负责诊治高复杂性患者（≥5种药物），执业护士负责诊治低复杂性患者。我们研究了基于团队的年度健康检查对患者预防性服务使用情况的有效性。我们对500名患者进行了回顾性病历审查，审查时间为年度健康检查后的12个月。使用McNemar检验评估预防性服务使用情况随时间的变化。使用带有泊松对数线性函数的广义线性模型计算6个月内使用的调整相对风险。总体而言，年度健康检查的利用率从基线时的14%提高到20个月项目后的44%。所有推荐服务均达标的患者百分比从年度健康检查时的17.4%提高到6个月内的42%。适龄预防性筛查和疫苗的改善最为显著（分别从55.8%提高到75.4%和从36%提高到52.2%）。社区患者获得推荐服务的可能性较小（相对风险=0.618；95%置信区间[CI]，0.442 - 0.865），而有补充保险的患者（相对风险=1.484；95% CI，1.023 - 2.153）、在后续年度健康检查中接受诊治的患者（相对风险=1.405；95% CI，1.062 - 1.858）以及男性患者（相对风险=1.422；95% CI，1.053 - 2.041）获得推荐服务的可能性更大。由于采用了一种组织模式的前后设计，推广受到限制。由医生监督的临床药剂师或执业护士参与的基于团队的年度健康检查与预防性服务利用率的显著提高相关。随着每年有更多患者接受基于团队的年度健康检查，使用率可能会持续提高。
