Health maintenance in a primary care clinic for urban, indigent adults

Abstract

Objective: The objective was to examine the delivery of preventive health care services in an urban clinic for indigent adults and the impact of advanced practice nursing on these practices. Design: The study design was a descriptive chart review. Setting and Subjects: Data were collected in an urban outpatient clinic. Seven hundred sixty-five records were examined prospectively for health maintenance. Of these records, 523 were randomly selected and reviewed retrospectively for completion of health maintenance. The mean age of participants was 45.15 years (SD = 9.87); 92% were African American, and 48.9% were male. Instruments: The Health Maintenance Form was used to record data about demographics, health history, care provider, and completion of 10 health maintenance items. Methods: Records were reviewed prospectively prior to the patient's clinic visit. A form summarizing the patient's health maintenance status was placed at the front of the record. At least 4 weeks later, the record was reviewed a second time for completion of health maintenance items. This second review was the data collection phase. Results: Completion of health maintenance items was found to be low. The most up-to-date areas were serum cholesterol (83.9%) and mammography (70.1%). The lowest levels were rectal examination (34.5%), pneumococcal vaccination (35%), and fecal occult blood test (37.1%). Patients followed up by a nurse practitioner had significantly more health maintenance areas up-to-date than did patients followed-up by the nurse practitioner-physician team, which in turn had significantly more areas up-to-date than did patients followed up by a physician alone. Conclusions: Health maintenance was accomplished at a low level, indicating that preventive health practices need to be re-evaluated. The nurse practitioner had the greatest impact on a patient's health maintenance being up-to-date. (J WOCN 2001;28:129-40.)