HEALTH SCREENING PROCEDURES FOR A MEDICARE HMO PHYSICAL ACTIVITY PROMOTION PROGRAM 1349

Abstract

Requirements for personal physician approval are costly and time consuming and may be a barrier to individuals interested in joining a physical activity program. We describe a screening process for enrolling older adults into a community-based physical activity program tailored to individual needs and capacities. A random sample of HMO members were surveyed by phone and invited to participate if they did not perform regular exercise. Those with unstable cardiac conditions or insulin-dependent diabetes were screened out. 181 members (64-90 years of age ([horizontal bar over]x=74), 67% female) were entered into the next phase of screening. The nurse screened for ability to perform functional testing. A study physician reviewed self-reported medical histories. Nine subjects (5%) were identified for referral to their personal physician before or during the testing due to severe hypertension or chest pain. 15 subjects (8.3%) were referred to their physicians upon review of the medical histories due to: severe hypertension, chest pain, shortness of breath, emphysema, self-reported abnormal heart beat irregularities, severe joint pain, cancer, and stroke history. Follow-up with their personal physician was required before continuing. All but one (who was excluded due to cardiac instability) returned to complete testing and were eligible to enroll in the activity program. The remaining 157 subjects (86.7%) completed the testing without incident and could enroll. Opportunity was given to their personal M.D.s to withdraw participants from the program; no responses were received. We conclude that procedures such as these could provide a viable streamlined alternative to the traditional requirement of personal physician approval for similar community based activity programs.