Utilization Of Preventive Care Services Research Articles

Status of the utilization of preventive care services and its associated socio-demographic factors among Iranian elderly.

The growing population of the elderly, the rising costs of medical care and the low use of preventive services are three factors that highlight the importance of using preventive health care services in the Iranian population. This study aimed to determine the status of the use of preventive care services and its associated socio-demographic factors in the elderly referred to health centers. In this analytical cross-sectional study, a number of 160 elderly people referred to health centers in East Guilan, Iran was selected by multi-stage cluster sampling. Data were obtained from May to September, 2021 using a questionnaire containing utilization of preventive care services (9 items) and socio-demographic characteristics. The highest and the lowest utilization rates of preventive care services among study participants were related to the blood pressure test (96.9%) and colonoscopy (17.5%), respectively. Multivariate analysis showed that only income had a significant association with performing fasting blood sugar test (p = 0.004), blood lipid test (p = 0.004), and blood pressure test (p = 0.013). Also, the associations between having an underlying disease and performing fasting blood sugar test (p = 0.032) and blood pressure test (p = 0.002), the association between gender and performing the bone mineral density test (p < 0.001), and the association between occupation and performing Pap-smear test (p = 0.011), were statistically significant. The utilization rates of screening tests for most cancers, including gastrointestinal cancers, were low. Since, there were a significant association between income, disease, gender and occupation with the utilization of some preventive care services, considering them in health centers' preventive care program design might be useful.

Strategies for Improving the Utilization of Preventive Care Services: Application of Importance-Performance Gap Analysis Method.

The utilization of preventive care services is limited. Previous studies based on communities have looked at many types of barriers to preventive care (i.e., why not do). This study aimed to gain an insight into the key factors and performance gaps (i.e., why do and how to do) of people who attended a regional teaching hospital to undergo health check-ups using a purposive sampling method to recruit people to complete a self-administered questionnaire. Paired sample t-tests and importance–performance gap and regression analyses were performed. The results indicated that the participants’ wish to understand their health status, the quality of medical devices and the completeness of items, and process layout planning were the key factors that affect people’s health check-up behavior. Promoting the effectiveness of hospital performance may improve the positive cycle of people’s health check-up behavior from the community to the hospital. Continuing to promote the knowledge of preventive care services is necessary, and it is very important for people to have a good experience of undergoing health check-ups in the hospital. Important strategies for improving the utilization of preventive care services may include: meeting the person’s personalization needs, improving the quality of medical devices and the completeness of items, and having appropriate process layout planning, a detailed interpretation of the results, and further follow-ups in the hospital.

Postoperative Outcomes in the Plain Community Population of Western Wisconsin.

Residents of plain communities constitute an underserved minority population that is not reliably captured in contemporary surgical outcomes research. We hypothesized that plain communities (PC) patients would have higher postoperative complication rates than a general surgical population. A retrospective review of 30-day postoperative outcomes for PC patients compared to a majority (non-PC) matched patient population from September 2014 to March 2020 was performed. The primary outcome measure was any complication within 30days of surgery. 270 PC patients were matched with 493 non-PC patients. The 30-day complication rate was higher for the PC group (6.3% vs 3.7%, P = .09), though not statistically significant. There was significantly lower utilization of preventive care services, and postoperative follow-up among PC patients. Although our regional PC surgical patient population utilized preventive and postoperative health care services less than the non-PC population, there was no statistically significant difference in overall 30-day postoperative morbidity or mortality.

Utilization of Preventive Care Services at a University Hospital in Saudi Arabia

Background: Chronic diseases have significant impacts on health systems worldwide and are a leading cause of death. Early diagnosis and treatment of chronic diseases are the best ways to reduce mortality and morbidity. Objectives: The aim of this study was to evaluate public access to preventive services for chronic diseases in Jeddah, Saudi Arabia. Methods: A survey of university hospital visitors was conducted in 2019. Participants were randomly selected and asked to fill a 16-question survey, including demographics, health care utilization, and type of preventive services. The chi-square test (SPSS) was used to identify any significant association between age and gender using the variable of preventive screening or counseling. Results: The majority of individuals who completed the survey (250 participants) were young, married, and male bachelor’s degree holders. About 71% of the participants received counseling services for either smoking, physical activity, weight, diet, or sleeping. More than half (58%) had undergone screening services, including breast cancer, colon cancer, diabetes, hypertension, or weight management. Chi-square analysis showed that females had a significant (P &lt; 0.01) positive statistical relationship with the utilization of diabetes and breast cancer screening services, while males were more associated (P &lt; 0.01) with smoking and weight-related counseling than females. Conclusions: The study demonstrated an insufficient use of preventive services and that sociodemographic differences (such as age and gender) could influence the utilization of various preventive services. Females were significantly positively associated with breast cancer and diabetes-related preventive services as these diseases are highly prevalent among females. Public education and awareness campaigns are needed to broadcast the importance of preventive services and promote better understanding and management of chronic diseases.

Noninvasive Colorectal Cancer Screening Tests Help Close Screening Gaps During Coronavirus Disease 2019 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has upended routine preventive care across the country. Health systems worldwide have seen a drastic decrease in utilization of preventive care services, including colorectal cancer (CRC) screening.1 In response to the pandemic, the US Surgeon General advised in March 2020 that all hospitals and ambulatory surgical centers delay nonurgent surgeries and medical procedures, including screening and surveillance colonoscopies. In line with these recommendations, the University of California Los Angeles (UCLA) health system temporarily ceased elective endoscopies and purposefully encouraged the use of stool-based CRC screening modalities among patients and providers through weekly system-wide e-mails to primary care and gastroenterology providers, virtual meetings with primary care leadership, and standardized educational materials for fecal immunochemical testing (FIT).

The Association Between Cognitive Function and Preventive Care Service Utilization Among U.S. Chinese Older Adults

Preventive healthcare utilization is an important aspect of medical practice that facilitates the identification of chronic diseases at an early stage and increases options for treatment. Cognitive function plays an important role in individuals’ utilization of preventive care services. However, our understanding of the relationship between cognitive function and preventive care utilization is limited, particularly in older minority aging populations. The study aims to assess the association between cognitive function and preventive healthcare utilization among U.S. Chinese older adults. Data were obtained from the Population Study of Chinese Elderly in Chicago (PINE). Five instruments were used to measure global cognition, including the Mini-Mental State Examination, East Boston Memory Test Immediate Recall and Delayed Recall, Digit Span Backwards, and Symbol Digit Modalities Test. Preventive care services included immunization (i.e. flu, pneumonia, and hepatitis B vaccines) and cancer screenings (i.e. colorectal, breast, cervical, and prostate). Multivariable regression analyses were used. The findings showed that higher level of global cognition was associated with higher utilization of pneumonia vaccination (OR=1.32, 95% CI= 1.14-1.52), hepatitis B vaccination (OR=1.24, 95% CI= 1.05-1.47), colon exam (OR=1.23, 95% CI= 1.07-1.41), mammogram (OR=1.46, 95% CI= 1.22-1.73), breast exam (OR=1.23, 95% CI= 1.04-1.46), and cervical exam (OR=1.38, 95% CI= 1.15-1.65). Future longitudinal studies are needed to elucidate potential mechanisms underlying the relationship between cognitive function and preventive care utilization among U.S. Chinese older adults. Study findings underscore the need to understand preventive care utilization patterns among U.S. Chinese older adults with low cognitive function.

Oregon Experiment with Medicaid Accountable Care and Pediatric Preventive Care Utilization Among Infants

Research ObjectiveIn August 2012, Oregon began enrolling Medicaid beneficiaries in coordinated care organizations (CCOs), a unique mandatory‐enrollment accountable care organization (ACO) model with payment methods strongly tied to preventive care and care coordination through patient‐centered medical homes. No study has examined the impact of CCOs on preventive care utilization among infants. The main goal of this study was to examine the impact of this new delivery model on the utilization of preventive care services among infants enrolled in Medicaid during 2 years after birth. We also investigated heterogeneous impacts of the CCO model for preterm and full‐term infants as well as over time.Study DesignWe linked Oregon 2008‐14 birth certificates to Medicaid eligibility and claims data, and created the pre‐ and post‐CCO cohorts of Medicaid infants. Medicaid infants were defined as being enrolled in Medicaid for at least 80% of the two years after birth. Pediatric preventive care outcomes included indicators of preventive care adequacy as recommended by American Academy of Pediatrics: six well‐child visits by the first birthday, nine well‐child visits by the second birthday, and annual developmental screening. We estimated logistic regression models and linear probability models, adjusting for time trends of outcomes and a comprehensive set of maternal and infant characteristics. We utilized a difference‐in‐differences approach to examine heterogeneous effects of CCOs for preterm and full‐term infants. Spline regression was used to test the effect of CCOs on the outcomes for every six months from the start of the CCO implementation. We conducted a range of sensitivity analyses, such as different thresholds of Medicaid enrollment for the definition of Medicaid infants and excluding infants of mothers in the Medicaid expansion group.Population Studied36 546 pre‐CCO infants born between August 2008 and July 2010 and 47 973 post‐CCO infants born between August 2012 and December 2014Principal FindingsDuring the 2 years after birth, infants enrolled in Medicaid CCOs had higher probability of well‐child visit adequacy: 10% points (95%CI: 8.2; 11.8) by the first birthday and 5.7% point (95%CI: 4.3; 7.1) by the second birthday. Annual probability of developmental screening increased by 23.1% points (95%CI: 21.6; 24.6) after the CCO implementation. No difference in the CCOs’ impact was found between preterm infants and full‐term infants. Increase in preventive care was found to start in the second year of the CCO implementation.ConclusionsThe CCO model was associated with an increase in preventive care utilization among infants enrolled in Medicaid during the first 2 years of birth.Implications for Policy or PracticeIncrease in preventive services among low‐income infants after CCO implementation implies that the Oregon Medicaid ACO model could improve quality of care for infants in their early years. A growing number of states have been adopting accountable care models for their Medicaid enrollees. Our findings suggest that other states benefit from studying the Oregon approach to accountable care for Medicaid enrollees that integrates financing and delivery of care, and implements a payment methodology with clear performance targets for pediatric preventive services.Primary Funding SourceCenters for Disease Control and Prevention.

Self-management of type 2 diabetes mellitus utilizing technology based mobile medical assisted blood glucose management: Study protocol for a prospective, multi-center, observational study

IntroductionDiabetes mellitus is a major health concern globally as well as in China. Currently, the blood glucose (BG) control and patient outcome of diabetes are less than optimal, due to the poor adherence to established evidence-based treatment guidelines and low utilization of preventive care services by both providers and patients. Evidence suggest the benefit of mobile technology-based applications in improving BG monitoring and management in type 2 diabetes mellitus (T2DM). This study is designed to evaluate the effectiveness, safety and timeliness of the mobile internet technology in improving outpatients blood glucose self-management of Chinese T2DM. Methodsand Analysis: This is a prospective, single-arm, multi-center, observational study involving 250 hospitals across China. Patients aged ≥18 and ≤ 80 years with a diagnosis of T2DM and poor glycemic control, who were willing to receive premixed insulin analogues and could use their own WeChat account independently, were included in the study. The primary outcome of the study is to assess the benefit of programme based on change in hemoglobin A1c (HbA1c) from baseline to 3 months. Secondary outcomes included proportion of patients achieving HbA1c<7% at 3 months, change in fasting and postprandial glucose levels from baseline, incidence of hypoglycemia, frequency of self-monitoring blood glucose (SMBG), the patient behavior of BG monitoring on platform and the association of BG control with health care professionals (HCP)-patient interaction. The mobile based technology intervention can improve the HbA1c and BG levels in the patients receiving premixed insulin analogues and that the adherence of SMBG was increased and the incidence of hypoglycemia was decreased. Additionally, early detection of treatment-related hypoglycemia or other complications will contribute to timely therapeutic adjustments and lifestyle modifications under HCP's recommendations through the seamless HCP-patients interaction based on the mobile application. Ethics and disseminationThe study protocol was approved by the ethics committees from each study site according to the International Conference on Harmonization guidelines for Good Clinical Practice and conformed to Declaration of Helsinki. The results of the analyses will be shared with all the participating hospitals and will be published in peer-reviewed journals. No personal information will be included in the findings. RegistrationThis study was registered at chictr.org.cn (ChiCTR 1900021191).

Changes in inequality in utilization of preventive care services: evidence on China\u2019s 2009 and 2015 health system reform

BackgroundEnsuring equal access to preventive care has always been given a priority in health system throughout world. This study aimed to decompose inequality in utilization of preventive care services into its contributing factors and then explore its changes over the period of China’s 2009–2015 health system reform.MethodsThe concentration index (CI) and decomposition of the CI was performed to capture income-related inequalities in preventive services utilization and identify contribution of various determinants to such inequality using data from China Health and Nutrition Survey. Then, changes in inequality from 2009 to 2015 were estimated using Oaxaca-type decomposition technique.ResultsThe CI for preventive services utilization dropped from 0.2240 in 2009 to 0.1825 in 2015. Residential location and household income made the biggest contributions to income-related inequalities in these two years. Oaxaca decomposition revealed changes in residential location, regions and medical insurance made positive contributions to decline in inequality. However, alternation in household income, age and medical services utilization pushed the equality toward deterioration.ConclusionThe pro-rich inequality in preventive healthcare services usage is evident in China despite a certain decline in such inequality during observation period. Policy actions on eliminating urban-rural and income disparity should be given the priority to equalize preventive healthcare.

Effects of China's urban basic health insurance on preventive care service utilization and health behaviors: Evidence from the China Health and Nutrition Survey.

BackgroundLifestyle choices are important determinants of individual health. Few studies have investigated changes in health behaviors and preventive activities brought about by the 2007 implementation of Urban Resident Basic Health Insurance (URBMI) in China. This study, therefore, aimed to explore whether URBMI has reduced individuals’ incentives to adopt healthy behaviors and utilize preventive care services.MethodsData were drawn from two waves of the China Health and Nutrition Survey. Respondents were categorized according to their insurance situation before and after the URBMI reform in 2006 and 2011. Propensity score matching and difference-in-differences methods were used to measure levels of preventive care and behavior changes over time. Estimations were also made based on gender, self-reported health, and income.ResultsWe found that URBMI implementation did not change residents’ utilization of preventive care services or their smoking habits, drinking habits, or other risky behaviors overall. However, the likelihood of sedentariness did increase by five percentage points. Females tended to be more sedentary while males were less likely to drink soft drinks. Residents with poor self-reported health exercised less while those who reported good health were more likely to be sedentary. Low- and middle-income residents were likely to be sedentary while middle-income people tended to smoke after becoming insured.ConclusionSince URBMI implementation, some unhealthy behaviors like sedentariness have increased among those who were newly insured, and different subgroups have reacted differently. This suggests that the insurance design needs to be optimized and effective measures need to be adopted to help improve people’s lifestyle choices.

Sex differences in the use of healthcare services among US adults with and without a cancer diagnosis.

Cancer imposes higher burden on men. Sex differences in healthcare utilization may contribute to this problem. We compared healthcare utilization among adults with and without a history of cancer as measured by having at least one physician visit within the previous 12 months. We analyzed data from 7,229 responders (weighted population size=211,722,892) enrolled in the 2007 Health Information and National Trends Survey (HINTS), a nationally representative sample of non-institutionalized adults in the United States. We used survey weights in all analyses and variance estimation procedures to account for the complex survey design and used logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Study participants consisted of 2808 (48.6%) males and 4421 (51.4%) females. Overall, men were less likely to have seen a physician within the previous 12 months (OR=0.39; 95% CI: 0.31-0.48) regardless of their cancer status. Cancer survivors were more likely to visit a physician within the previous 12 months (OR=2.01; 95% CI: 1.28-3.19) regardless of sex. When stratified by personal history of cancer, men without a history of cancer were less likely to visit a physician (OR=0.38; 95% CI: 0.30-0.47) whereas men with a history of cancer were as likely to have seen a physician in the previous 12 months as women with similar cancer status (OR=1.24; 95% CI: 0.44-3.45). Men increase their healthcare utilization to that of women only after they receive diagnosis of cancer. Targeted interventions to promote utilization of preventive care services by men are needed to reduce the burden of chronic illnesses including cancer among men.

Up-to-Date on Preventive Care Services Under Affordable Care Act: A Trend Analysis From MEPS 2007-2014.

The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group). After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%-4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%-7.6%; P<0.001) increased among those with private insurance, as compared with the control group. Changes in blood pressure check, cholesterol check and cancer screening (pap smear test, mammography, and colorectal cancer screening) were not associated with the ACA. Prevalence in diagnosis of health conditions remained constant. Slower uptrends in adjusted total health care expenditures and downtrends in adjusted out-of-pocket costs were observed during the study period. The provisions of the ACA have resulted in trivial increases in being up-to-date on selected preventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.

Urban–rural disparity in utilization of preventive care services in China

Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban–rural disparity in utilization of preventive care services in China, and determined how much of the urban–rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder–Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban–rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (−1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between urban and rural.

Preventive care service usage among Chinese older adults in the Greater Chicago area.

Preventive care is important for reducing morbidity and mortality among the elderly, but racial/ethnic disparities exist in use of preventive care services. We aimed to develop a better understanding of preventive care service utilization among Chinese older adults in the Greater Chicago area. We used data collected from the Population Study of Chinese Elderly in Chicago study, a population-based survey of 3,159 community-dwelling Chinese older adults in the Greater Chicago area. Preventive care services assessed include use of flu, pneumonia, and hepatitis B vaccines as well as colon, breast, cervical and prostate cancer screening. We also examined sociodemographic, health and quality of life correlates for preventive care service use. We found that although Chinese older adults had lower utilization rates for the pneumonia vaccine and cancer screening, their utilization of the flu shot was consistent with national utilization rates. No sociodemographic, self-reported health, or quality of life characteristics were associated with all nine of the preventive care services. Use of preventive care services except flu vaccination was low among Chinese older adults in the Greater Chicago area. However, future longitudinal studies may be necessary to further elucidate preventive care service utilization patterns among Chinese older adults.

Interrelation of preventive care benefits and shared costs under the Affordable Care Act (ACA).

With the implementation of the Affordable Care Act (ACA), access to insurance and coverage of preventive care services has been expanded. By removing the barrier of shared costs for preventive care, it is expected that an increase in utilization of preventive care services will reduce the cost of chronic diseases. Early detection and treatment is anticipated to be less costly than treatment at full onset of chronic conditions. One concern of early detection of disease is the cost to treat. In reality, the confluence of early detection may result in greater overall expenditures. Even with improved access to preventive care benefits, cost-sharing of other health services remains a major component of insurance plans. In order to treat identified conditions or diseases, cost-sharing comes into play. With the greater adoption of cost-sharing insurance plans, expenditures on the part of enrollee are anticipated to rise. Once the healthcare recipients realize the implication of early identification and resultant treatment costs, enrollment in preventive care may decline. Healthcare legislation and regulation should consider the full spectrum of care and the microeconomic costs associated with preventive treatment. Although the system at large may not realize the immediate impact, behavioral shifts on the part of healthcare consumers may alter healthcare. Rather than the current status quo of treating presenting conditions, preventive treatment is largely anticipated to require more resources and may impact the consumer's financial capacity. This report will explore how these two concepts are co-dependent, and highlight the need for continued reform.

Awareness and utilization of preventive care services among the elderly under National Health Insurance

This empirical study investigates the factors affecting the awareness and the utilization of preventive care among the elderly in Taiwan. We use data obtained from the 2005 National Health Interview Survey. A recursive bivariate probit model is adopted to analyze the factors affecting the awareness and the utilization of preventive care. The probability of awareness of free preventive care under the National Health Insurance is higher for those who are younger, Mainlanders, have received more education, have a spouse, exercise regularly, have better self-rated health status, and have chronic diseases; the probability of awareness is lower for those who are aborigines and who live in the south and the east. Awareness of preventive care services, having a spouse, living alone, having better health status, and the existence of chronic diseases increase the probability of preventive care utilization; working reduces the probability of preventive care utilization. Our result supports the views in Arrow (Am Econ Rev 53(5):941-973, 1963) that health information is an important factor determining the demand for medical care. Policymakers may enhance such preventive care service utilization by increasing the awareness of such services among the elderly.

The Impact of Family Structure on Utilization of Preventive Care Services among Children under National Health Insurance in Taiwan

This study investigates the role of family structure in children’s access to preventive services in the context of a National Health Insurance (NHI) system. We analyzed the 2005 National Health Interview Survey in Taiwan to evaluate the impact of family structure on the utilization of preventive services, including well-child visits and non-free vaccinations. The extended family and single-father family were found to have a significant impact on care use in the unadjusted model even under NHI. However, after controlling for various health, demographic and socio-economic factors, our findings suggest that family structure does not influence the non-free use of vaccines, and financial constraints, instead, play an important role in making parents decide to have non-free vaccines. To further enhance the health and welfare of the children, our findings suggest that the NHI coverage of children’s vaccines might not be adequate and that non-free vaccines should be provided free to those families who cannot afford them.

Utilization of Preventive Care Services: Does Gender Matter?

Utilization of Preventive Care Services: Does Gender Matter?

Gender Differences in Utilization of Preventive Care Services in the United States

The utilization of preventive care services in the United States remains low, despite health-care costs being as high as $2.3 trillion. While gender disparities have been known to exist for utilization of overall health-care services, the same issue has not been probed for preventive care utilization. A retrospective, cross-sectional study using the 2008 Medical Expenditure Panel Survey (MEPS). Preventive care services common to both genders were included (blood pressure checkup, cholesterol checkup, sigmoidoscopy/colonoscopy, flu shot, and dental checkup). Guideline adherence was determined using clinically accepted guidelines such as Joint National Committee 7 and the American Cancer Society. Descriptive statistics were used to describe the population, and chi-square analysis was used to determine the within group differences between the two genders. A multivariate logistic regression was built to determine the likelihood of guideline adherence based on gender while adjusting for known demographic confounders such as age, race, and ethnicity. There were 33,066 MEPS respondents for 2008. Of these, 4,291 to 30,629 met the inclusion criteria depending on the specific preventive care service being analyzed. Men were found to have significantly lower odds of using blood pressure check (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.32-0.38), cholesterol check (OR 0.64, CI 0.60-0.69), dental check (OR 0.71, CI 0.68-0.75), and flu shots (OR 0.71, CI 0.67-0.76). While men had lower utilization for sigmoidoscopy/colonoscopy, the difference was nonsignificant. Preventive care utilization was found to be higher in women than in men. The gender disparity issue needs to be explored in greater detail to understand these differences.

Predicting Trends in Preventive Care Service Utilization Impacting Cardiovascular Outcomes in a United States Population

The body of research on social determinants of health is rapidly accumulating. The U.S. Preventive Services Task Force is conducting evaluations to consider the inclusion of screening and counseling for social risks as a clinical preventive service. Yet, for many social risks, evidence is still likely needed before the U.S. Preventive Services Task Force can recommend universal screening or counseling. This manuscript offers a brief review of the social determinants of health that may be germane to the U.S. Preventive Services Task Force, the methods the U.S. Preventive Services Task Force uses to evaluate relevant evidence, and current evidence gaps for social risks. Key methods for making clinical preventive service recommendations are applied for considering the integration of social and clinical care. These methods include determining the certainty of the evidence, assessing the net benefit, defining appropriate prevention frameworks, defining health outcomes versus intermediate outcomes, fully assessing the harms, and defining to what populations and care contexts the evidence applies. This road map for research is intended to spark ingenuity and purpose in the next generation of research studies, thereby ensuring that future recommendations to address and prevent social risks in primary care are informed by high-quality evidence.This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.