Local Data for Local Decision Making — Selected Counties, Connecticut, Massachusetts, and New York, 1997

Morbidity and Mortality Weekly Report, Oct 2, 1998

Although the delivery of clinical preventive services to adults, such as adult vaccinations and cancer and cardiovascular screening, reduces premature morbidity and mortality (1), such services are underused (1-3). Performance monitoring at the population level plays a critical role in supporting efforts to increase the use of clinical preventive services. However, many communities do not have the capacity to measure prevention activities. Without such information, efforts aimed at improving the county-wide or regional use of clinical preventive services must rely on state or national data. To examine the use of seven clinical preventive services among adults at the county level and to demonstrate how a population-based survey can be used to guide local prevention efforts, a community-based coalition (the Sickness Prevention Achieved through Regional Collaboration [SPARC]), in collaboration with state health departments, peer review organizations, and CDC, conducted a survey in the four-county SPARC region. This report summarizes the results of this analysis, which indicate that clinical preventive services in this region were underused despite high levels of access to medical care.

The SPARC initiative, established by the Berkshire Taconic Community Foundation in 1994, represents a collaboration of 75 organizations and businesses with an interest in disease prevention in a four-county region at the junction of Connecticut, Massachusetts, and New York (regional population: 636,000). SPARC's mission is to improve the health of residents by increasing their use of clinical preventive services.

Using methodology from the Behavioral Risk Factor Surveillance System (BRFSS), the SPARC Disease Prevention Survey was designed to establish county-level baseline estimates and identify barriers to increasing the use of preventive health services. The survey provides prevalence estimates for the use of screening measures, such as blood cholesterol level, blood stool test, sigmoidoscopy, Papanicolaou test, mammography, and influenza and pneumococcal vaccinations.

Data are presented for 2241 noninstitutionalized respondents selected by random-digit-dialed telephone survey methods. Only adults aged [greater than or equal to]50 years were selected because many prevention services are not recommended until age 50 years (e.g., blood stool test and sigmoidoscopy) or age 65 years (e.g., influenza and pneumococcal vaccination). The overall response rate for the survey was 63%. Data were weighted to correct for disproportionate probabilities of selection and to post-stratify the data census estimates of the population age and sex distributions for the four counties. SUDAAN was used to produce confidence intervals and to account for the complex survey design. Results are not stratified by race/ethnicity because the population was predominately white (95%) and non-Hispanic (98%).

Prevalence of health-care coverage was high among this age group, with approximately 42% of respondents on Medicare (Table 1). Most respondents had had a routine checkup during the preceding 2 years (Table 2). The prevalence of specific clinical preventive services varied by county. The least used services were blood stool test in Litchfield County, Connecticut (32.2%), sigmoidoscopy in Columbia County, New York (26.0%), and pneumococcal vaccination in Dutchess County, New York (36.9%). Physician recommendation for preventive services was strongly associated with the patient receiving the services. For example, the prevalence of persons who received a preventive service after a physician recommendation was higher than that of persons who received the service without a recommendation (e.g., blood stool test [57.0% versus 15.3%], pneumococcal vaccination [92.0% versus 13.6%], and influenza vaccination [80.4% versus 43.1%]). The prevalence of clinical preventive services use in surveyed counties was similar to the prevalences for Connecticut, Massachusetts, and New York collected through state BRFSS surveys.

Reported by: D Shenson, MD, D DiMartino, MSN, V Stucker, MBA, M Alderman, MD, Sickness Prevention Achieved through Regional Collaboration, Lakeville, Connecticut; M Metersky, MD, D Mathur, MPH, Connecticut Peer Review Organization, Middletown; M Adams, MPH, Connecticut Dept Public Health. J Quinley, MD, IPRO, Lake Success; M Caldwell, MD, Dutchess County Dept of Health, Poughkeepsie; C Maylahn, MPH, New York State Dept of Health. P O'Reilly, Ph.D, Massachusetts Peer Review Organization, Waltham; D Brooks, MPH, Massachusetts Dept. of Public Health. R Dicker, MD, M Campbell, PhD, Health Care Financing Administration. Div of Epidemiology and Surveillance, and Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion; National Immunization Program, CDC.

Editorial Note: The findings in this report indicate that despite high levels of healthcare coverage and access to physicians, adult clinical preventive services in the region are not fully used. These findings are consistent with studies in other populations that indicate patients are often not aware of the need for these services and that clinicians frequently do not recommend preventive services to their patients (4-6). As a result of the survey findings, SPARC plans to broaden its partnerships with medical specialists and generalists to improve the use of preventive services.