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


-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database …

-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database

-To predict the trends in cardiovascular preventive care services in a U.S. population

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  • Secondary/tertiary measures: designed to reverse or retard progression of an existing conditions (sec)/designed to ameliorate the effects of a disease (tert)
  • The USPSTF recommends all individuals over the age of 18 should have their blood pressure checked annually.BRFSS Behavioral Risk Factor Surveillance System
  • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood PressureNational Cholesterol Education Program
  • Poor health status and higher income =higher utilizationHigher utilization was seen with greater income since they have the ability to pay for services and also adequate health coverage
  • Questions: What about other types of p.c. i.e. smoking cessation, diet and exercise…were these factors used by MEPS?If people are more motivated to obtain screenings, how can that lead to improved health, some times its hard to quit bad habits, even when obtaining regular screenings.


  • 1. Predicting Trends in Preventive Care Service Utilization Impacting Cardiovascular Outcomes in a United States Population
    Gautam Partha, B. Pharm.1,4
    Varun Vaidya, B. Pharm., PhD.2,4
    Jennifer Howe, B.S.P.S.3,4
    Research Associate
    Assistant Professor
    Research Assistant
    The University of Toledo College of Pharmacy, Pharmacy Health Care Administration, Toledo, Ohio;
  • 2. Background
    Preventive Care refers to any intervention designed to avert disease or injury1
    Includes immunizations, disease screenings and behavioral counseling2
    These types of interventions are likely to have a significant impact on increasing quality of life while reducing premature mortality3,4
    Approximately 40% of all deaths in the U.S, including heart disease and stroke, have been attributed to controllable risk factors, i.e. tobacco use, poor diet, physical inactivity and alcohol misuse1,5,6
    Diseases such as hypertension and hyperlipidemia, especially if untreated, put individuals at an increased risk for heart disease and stroke7,8
  • 3. Background
    Hypertension (HTN)
    Currently affects 29% of the U.S. population,
    28% are considered pre-hypertensive9
    22% of hypertensives are unaware of their condition9
    23,965 or 7.9 per 100,000 deaths in U.S. in 200710
    Hyperlipidemia (HL)11
    Currently affects 105 million Americans
    Nearly 17% of population
    4.4 million deaths worldwide
    If not treated, heart disease could develop, known as the “Silent Killer” because there are no noticeable symptoms12
    Regular screening is necessary to diagnose and monitor HTN, HL. The maximum benefit of blood pressure and cholesterol screening is achieved through long-term use of drug therapy2
  • 4. Background
    Trends over time in cardiovascular preventive care utilization using population-based monitoring
    Blood Pressure Screening
    22.2% in1991 report being told they have high blood pressure by a health care provider, 24.9% in 1999 (BRFSS)8
    86.5% among all adults 18 years and older in 20032
    Cholesterol Screening
    79.4% among men over 35 and women over 45 in 20032
    1 in 5 at risk adults have not been screened within the last five years2
  • 5. Need for Study
    Existing literature mainly focuses on preventive care utilization among population groups already inflicted with disease or disability13-16
    Research has not yet characterized specific populations more likely to utilize preventive care services
    Although there is existing evidence indicating disparities, few studies using predictions have been conducted2
    Blood pressure and cholesterol screenings are deemed as priorities among clinical preventive service utilization and have continuously proven to be cost-effective17
    A global perspective on cardiovascular preventive care utilization should be conducted and include all eligible individuals
    Findings from this study will draw the attention of policymakers towards individuals less likely to use prevention services, thus enabling strict reinforcement of certain health care recommendations to all individuals
  • 6. Study Objectives
    To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
    To predict the trends in cardiovascular preventive care services in a U.S. population
  • 7. Methods
    Study Design: Retrospective Cross-Sectional
    Data Source: Medical Expenditures Panel Survey (MEPS)
    A nationally representative sample of the non-institutionalized, civilian U.S. population in which individuals are interviewed five times over a 2-year period. This study used the most recent available dataset from 2007.
    Inclusion Criteria: Based on guideline recommendations of JNC-VII and NCEP:
    Blood Pressure-restricted to individuals over the age of 18
    Cholesterol-restricted to individuals over the age of 20
  • 8. Methods
    Variables collected:
    Dependent: Utilization of preventive care services ,blood pressure and cholesterol screening (Dichotomous)
    Independent: Age, gender, race, ethnicity, insurance status, annual income and perceived health status (Categorical)
    Data Analysis
    SAS version 9.1
    Objective 1:Descriptive Statistics and Chi-Square Analysis
    Objective 2: Multivariate Logistic Regression
  • 9. Results
    Demographics (I don’t have this information) ???
    Total number of MEPS 2007 data respondents, n= 30,964
    20,523 responded for blood pressure screening utilization
    15,784 responded for cholesterol screening utilization
  • 10. Results-Blood Pressure Screening
    Table 1: Utilization Patterns, Chi-Square Analysis
  • 11. Results-Cholesterol Screening
    Table 2: Utilization Patterns, Chi-Square Analysis
  • 12. Results-Blood Pressure & Cholesterol Screening
    Table 3: Predicting Trends, Logistic Regression
  • 13. Discussion and Implication
    Objective 1-Chi-Square Analysis
    High utilization patterns for both blood pressure and cholesterol screening were recognized among all populations categories
  • 14. Discussion and Implication
    Objective 2-Logistic Regression
    Women were less likely than men to obtain cardiovascular screenings, although women are at greater risk for heart disease
    Western medicine practices often not utilized in individuals of Asian descent which would explain the low utilization of blood pressure screenings compared with other races
    Older individuals more likely to seek preventive care services since age is a key risk factor for cardiovascular complications
    Individuals with poor health status utilized more,
  • 15. Discussion and Implication
    Future research should:
    further distinguish populations with more characteristics and explore utilizations patterns
    suggest inferences regarding the causes of varying utilization patterns among populations
    Awareness of these differences in utilization will help guide policymakers to reinforce the recommended guidelines for blood pressure and cholesterol screenings, especially to those groups in which utilization is lower.
  • 16. References
    Cohen, Joshua T., Neumann, Peter J., Weinstein, Milton C. Does Preventive Care Save Money? Health Economics and the Presidential Candidates. N Engl. J. Med. 358;7:661-663.
    Preventive Care: A National Profile on Use, Disparities, and Health Benefits: Partnership for Prevention, 2007. 1-46 p.
    Marin MG, Zitter JN. Expenditures associated with preventive healthcare. Preventive Medicine. 2004(39):856-62.
    Nelson DE, Bland S, Powell-Griner E, et al. State Trends in Health Risk Factors and Receipt of Clinical Preventive Services Among U.S. Adults During the 1990s. JAMA. 2002;287(20):2659-67.
    Leading Causes of Death. Centers for Disease Control and Prevention.
    Modkad AH, Marks JS, Stroup DF, al. e. Actual Causes of Death in the United States, 2000. JAMA. 2004;291(10):1238-45.
    Hypertensive Heart Disease. Health Line.
    State-Specific Trends in Self-Reported Blood Pressure Screening and High Blood Pressure—United States, 1991-1999.Centers for Disease Control and Prevention.
    Hypertension Awareness, Treatment and Control-Continued Disparities in Adults: U.S. 2005-2006. Centers for Disease Control and Prevention.
    Hypertension. Centers for Disease Control and Prevention.
  • 17. References, cont.
    Hyperlipidemia. Pharmasave Statistics.
    Blood Pressure. The American Heart Association.
    Wei W, Findley P, Sambamoorthi U. Disability and Receipt of Clinical Preventive Services Among Women. Womens Health Issues. 2006;16(6):286-96.
    Gold R, DeVoe J, Shah A, Chauvie S. Insurance Continuity and Receipt of Diabetes Preventive Care in a Network of Federally Qualified Health Centers. Medical Care. 2009;47(4):431-9
    Witt WP, Kahn R, Fortuna L, et al. Psychological Distress as a Barrier to Preventive Healthcare Among U.S. Women. Journal of Primary Prevention. 2009(30):531-47.
    Wang, Jean, Carson, Elise, Lapane Kate, Eaton, Charles, Gans Kim, Lasater, Thomas. The Effect of Physician Offics Visits on CHD Risk Factor Modification as Part of a Worksite Cholesterol Screening Program. Preventive Medicine. 1999 (28): 221-228.
    Maciosek et al. Priorities Among Effective Clinical Preventive Services Results of a Systematic Review and Analysis. Am J Prev Med. 2006; 31(1):52-61.