Facilitators and barriers to optimal preventive service use among providers and older patients

Abstract

Preventive service use remains low among Medicare beneficiaries despite the Affordable Care Act's waiver of coinsurance. This study sought to understand barriers and facilitators to preventive service provision, access, and uptake. We used a mixed methods approach synthesizing quantitative survey and qualitative focus group data. Self-reported utilization of and factors related to preventive services were explored using quantitative data from the 2012 Medicare Current Beneficiary Survey. Qualitative data from 16 focus groups conducted in 2016 with a range of providers, health advocates, and Medicare beneficiaries explored perspectives on preventive service use. Providers indicated time and competing priorities as factors for not offering patients a full range of preventive services, while beneficiaries reported barriers related to knowledge, perception, and trust. Current healthcare reform efforts incorporating team-based care, nurses and other non-physician providers, and coordinated electronic health records could support enhanced use of preventive services if fully implemented and utilized.

Keywords: Affordable Care Act; Behavioral health; Cancer screening; Medicare; Mixed-methods; Prevention.