Prevention Matters

A new study in the American Journal of Preventive Medicine suggests that people respond well to free counseling programs on weight loss or smoking cessation, but participation falls dramatically when services are no longer free. The cost of counseling also appears to make a difference to the doctors or health-care providers who refer patients to the programs, according to the study.

The authors reviewed a program that used an electronic database system to suggest health-care counseling for adults with unhealthy behaviors. For a time, free counseling was provided until funding ran out. Under the free program, 1,860 of 5,679 people who were evaluated were determined to have at least one unhealthy habit, and 407 of them were given referrals for intensive counseling, the study reported.

After the funding ceased, 729 of 2,510 people who were evaluated were determined to have unhealthy habits and just five were referred for counseling -- a 97 percent decrease in the referral rate, according to the study. Even when clinicians did offer a referral, 81 percent fewer patients followed through and got counseling when the counseling was not free.

A new study commissioned by Partnership for Prevention finds that too little attention is paid to improving the delivery of clinical preventive services to adolescents by addressing problems unique to that population. The review article in the American Journal of Preventive Medicine also finds that most of the clinical preventable services that are recommended for adolescents  don’t have good evidence to support their effectiveness.

Among the unique problems:
• The time typically allocated for routine adolescent exams is quite short and is unlikely to be extended, given Medicaid’s recent reductions in preventive visit reimbursements relative to other services.
• Many clinicians feel that adolescents are less likely to heed their recommendations because they believe adolescents are less interested in their long-term health than adults and more likely to engage in risk behaviors.
• Delivery of clinical services to adolescents tends to be driven by tradition, expert opinion, and the very limited needs of particular required preventive visits (e.g., school or sports physicals)

“We need to encourage both more clinical effectiveness research on clinical preventive services for adolescents and changes in the ways medical practices serving adolescents approach improving delivery rates,” said Leif I. Solberg, MD, the study’s chief author who is Associate Medical Director for Care Improvement Research, HealthPartners Medical Group. “It’s important that healthcare providers use every medical encounter, not just ‘well-child visits,’ which not all adolescents receive regularly, to address their clinical preventive services needs.”