Variations in Utilization of Clinical Preventive Services in Older Adults with Near Universal Health Coverage

Bibb, Sandra C.

Wednesday, 1 August 2012: 1:30 PM

Sandra C. Bibb, DNSc, RN
Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD

Learning Objective 1: Identify factors associated with variations in utilization of clinical preventive services in older adults with near universal health coverage from developed economies.

Learning Objective 2: Discuss the impact of moderators of access on variations in use of clinical preventive services in older adults with near universal health coverage.

Purpose: The purpose of this study was to determine the relationships between potential access (characteristics of the delivery system and population at risk) and realized access (utilization of clinical preventive services [CPS]) in a homogeneous (race, income, education, place of residence) sample of older adults with near universal health coverage (health insurance, regular place of care). Variations in utilization of clinical preventive services in older adults in developed economies are attributed primarily to variations in health coverage (health insurance, place of care) and social determinants of health (income, education, race, ethnicity, or geographical location). Progress is being made in eliminating structural and financial barriers related to access to care, yet variations continue to exist in utilization of clinical preventive services by older adults with near universal health coverage.

Methods: Theorized relationships were explored using questions from the United States’ Behavioral Risk Factor Surveillance System Survey; Aday and Andersen’s (1981) conceptualization of access; and Baron and Kenny’s (1986) approach to moderator analysis, and a homogenous convenience sample of 202 older adults (mean age 84; SD 5.23) with near universal health coverage. Data collected in face-to-face interviews across a two year period (2007-2009) were analyzed using Chi-square, Mann Whitney U, and Hierarchical Logistic Regression.

Results: Several logistic regression models of potential access (process indicators: advised to lose weight, high blood pressure, high cholesterol, gender, perceived health status, BMI> 30kg/m²); and realized access (objective indicators of health service use: check up in last 12 months; ever had colonoscopy/ sigmoidscopy) showed statistically significant (p<.05) improvement in model fit by adding interaction terms.

Conclusion: Studying the impact of non-social determinant of health moderators of potential access on realized access (actual use of CPS), may yield more insight into variations in utilization of CPS than studying the impact of health insurance coverage alone.

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