Impact of an academic interprofessional collaborative practice clinic on preventive care services

Purpose: To determine if differences exist between patients who participate in annual wellness visit (AWV) clinics delivered by an interprofessional team versus those who do not on Medicare preventive care services (PCS). Secondary aims include patient perceptions of care and impact of the medication review process.

Methods: In this prospective, randomized, case-controlled trial, patients aged 66-74 years will be randomly invited to the AWV clinic (intervention; n=50) or undergo a chart review (control; n=100). Demographic information and status of PCS will be collected. Intervention patients will undergo a medication review process, receive recommendations regarding PCS, complete a satisfaction survey, and receive a follow-up call 1 month after their visit to assess final PCS status. Descriptive statistics will be used to characterize patients, assess adherence to recommendations, and evaluate patient satisfaction. Fisher’s Exact will be used to compare final PCS between the intervention and control groups.

Results: To date, 6 intervention and 12 control patients have been enrolled.  No significant differences in demographics between groups were identified. The average number of medication issues/patient was 1 (range 0-3) with the most common being inappropriate medication, non-adherence, and drug interaction(s). PCS recommendations with >50% adherence include pneumococcal vaccination (50% vs. 0%; p=0.167), Td/Tdap vaccinations (50% vs. 0%; p=0.077), mammography (67% vs. 13%; p=0.152), fecal occult blood (60% vs. 0%; p=0.022), and DEXA (60% vs. 20%; p=0.524) for intervention versus control groups, respectively. Patient satisfaction scores on all 13 measures evaluated were positive (median [mean] 5/5 [4.5/5]). Based on enrollment rate, the study is expected to be completed by December 2012.

Conclusions: Statistically significant differences in final PCS between intervention and control groups are expected as sample size increases. Coupled with addressing medication-related issues and positive patient satisfaction ratings, interprofessional AWV clinics hold promise as a mechanism to improve preventive care outcomes.