Checkup Visits in Adult Federally Qualified Health Center Patients: a Retrospective Cohort Study

Abstract

Background: Checkup visits (i.e., general health checks) can increase preventive service completion and lead to improved treatment of new chronic illnesses. After the onset of the COVID-19 pandemic, preventive service completion decreased in many groups that receive care in safety net settings.

Objective: To examine potential benefits associated with checkups in federally qualified health center (FQHC) patients.

Design: Retrospective cohort study, from March 2018 to February 2022.

Patients: Adults at seven FQHCs in Illinois.

Interventions: Checkups during a two-year Baseline (i.e., pre-COVID-19) period and two-year COVID-19 period.

Main measures: The primary outcome was COVID-19 period checkup completion. Secondary outcomes were: mammography completion; new diagnoses of four common chronic illnesses (hypertension, diabetes, depression, or high cholesterol), and; initiation of chronic illness medications.

Key results: Among 106,114 included patients, race/ethnicity was most commonly Latino/Hispanic (42.1%) or non-Hispanic Black (30.2%). Most patients had Medicaid coverage (40.4%) or were uninsured (33.9%). While 21.0% of patients completed a checkup during Baseline, only 15.3% did so during the COVID-19 period. In multivariable regression analysis, private insurance (versus Medicaid) was positively associated with COVID-19 period checkup completion (adjusted relative risk [aRR], 1.15; 95% confidence interval, [CI], 1.10-1.19), while non-Hispanic Black race/ethnicity (versus Latino/Hispanic) was inversely associated with checkup completion (aRR, 0.89; 95% CI, 0.85-0.93). In secondary outcome analysis, COVID-19 period checkup completion was associated with 61% greater probability of mammography (aRR, 1.61; 95% CI, 1.52-1.71), and significantly higher probability of diagnosis, and treatment initiation, for all four chronic illnesses. In exploratory interaction analysis, checkup completion was more modestly associated with diagnosis and treatment of hypertension and high cholesterol in some younger age groups (versus age ≥ 65).

Conclusions: In this large FQHC cohort, checkup completion markedly decreased during the pandemic. Checkup completion was associated with preventive service completion, chronic illness detection, and initiation of chronic illness treatment.

Keywords: checkups; chronic illness care.; federally qualified health centers; general health checks; preventive care; primary care.