Delivery of preventive healthcare to older African-American patients: a performance comparison from two practice models

Abstract

While there is an increasing recognition by primary care providers of the importance of preventive health services (PHS), the delivery of such services has in general been substandard in many ambulatory care settings. Patient sociodemographic status and the structural and operational procedures of different clinic models are all believed to affect delivery of PHS. We conducted a 2-year, retrospective, sequentially randomized chart analysis of African-American patients above age 50, comparing primary, secondary, and tertiary PHS performance rates in two practice models: a medicine resident/faculty physician clinic (MR) and a nurse practitioner/faculty physician clinic (NP). Sociodemographics, disease profile, and PHS completion rates from 132 NP and 111 MR patient charts were abstracted. Apart from age, sociodemographic features were similar in both patient groups. While there were differences between clinics with regards to disease profiles (P < 0.05), and the higher number of diseases per patient (P < 0.0001) in the MR population, the NP collaborative practice had significantly better PHS performance. Rates of immunization (influenza/pneumococcal), pelvic/pap and prostate examinations, stool-guaiac testing, mammography, and functional assessment (activities of daily living, instrumental activities of daily living, and mental status testing) were > 90% in the NP and < 60% in MR patients. Although lower completion rates were found for dietary counseling (60%), auditory screening (36%), dental examination (41%), and obtaining advanced directives (24%) in the NP clinic, the rates were higher than those for the MR clinic. In this NP collaborative model, a high level of preventive health services was delivered while providing primary care to an older, inner city, African-American population of low socioeconomic means.