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Workflow fixes to improve preventive care visits for seniors
Two studies suggest that extending visit times and pre-ordering preventive screenings could improve preventive care visits for Medicare patients over age 65.
Facing a Silver Tsunami of older adults accessing more healthcare, plus a looming provider shortage issue, two new studies are promoting workflow adjustments that could promote more efficient preventive care visits for seniors.
The studies, both published in the Annals of Family Medicine, look at alternative approaches to primary care wellness visits among Medicare patients over age 65. More specifically, the studies aim to optimize time spent with patients.
In the first study, researchers looked at how extending the amount of time allotted for a wellness visit to 40 minutes supported preventive care. In the second, researchers tested the effects of pre-ordering preventive and chronic disease tests, so those tests did not have to happen during the wellness visit, and instead, doctors and patients could discuss results.
Providers work under a time crunch
These findings come as healthcare contends with dual demands of provider burnout and too-short appointment slots.
Most patients agree that their visits are too short. Although doctors are spending more time with patients than they did 40 years ago, patients have reported feeling rushed and unheard during their medical appointments.
This issue is compounded by a dwindling physician workforce that increasingly contends with a growing Medicare population. With Baby Boomers aging and developing more chronic conditions, there simply are not enough providers to meet patient demand.
While the healthcare industry works on provider recruitment strategies, the two Annals studies might provide short-term solutions to make the most of appointment times.
Capitalizing on wellness visits
In the first report, researchers tested the strategy of extending the time allocated for wellness visits.
Wellness visits, which were designed to let patients and providers discuss preventive care options, are often cut short because patients raise their healthcare concerns that fall outside the scope of preventive care.
It is important for patients to voice their concerns and for their primary care providers to listen. However, it is also important for providers to address preventive care metrics, especially in an age of value-based care.
To strike that balance, the researchers tried booking 40-minute "combined" appointments designed to address both preventive care issues and patients' problem lists.
Over the nine-month study period, Medicare wellness visits increased from 8.4% to 50.8%. No-show rates were better for combined visits than traditional wellness-only visits (11.9% versus 19.6%), as well.
What's more, providers and patients were able to complete more preventive screenings with the extended visits, including screenings for depression, falls, function, pain, breast/cervical/colorectal/lung cancer, DEXA, hemoglobin A1c, urine microalbumin, hepatitis C and HIV.
This is critical, as healthcare providers are beholden to more clinical quality measures under value-based contracts. By allowing time to address preventive care and clinical quality measures, plus address patient concerns, primary care providers might be able to drive a better patient experience.
Pre-ordering preventive screenings enables communication
In the second Annals report, researchers from the Mayo Clinic tested pre-appointment test ordering to help optimize time spent in appointments.
Segmenting patients by the tests they had due within the next six months, the researchers sent an automated patient portal message listing the tests due and allowing for self-scheduling. Patients were also prompted to have a Medicare wellness visit to follow up on the tests.
The strategy was pretty effective, the researchers said, with about 27% of the 3,500 patients included in the study replying to the patient portal message.
Patients told researchers that they liked having the opportunity to discuss the results of their preventive tests during their wellness visits, as opposed to receiving a patient portal message after the fact to explain the results. Similarly, providers liked having the opportunity to set an agenda before patient visits and order any necessary follow-up tests before the visit, they told researchers.
Both studies are present potential solutions for a healthcare industry that is increasingly strapped for time and constricted by low workforce numbers and compounding patient needs. By assessing where clinics can modify their workflows, leaders can optimize appointments to create a better patient experience with better preventive outcomes.
Sara Heath has reported news related to patient engagement and health equity since 2015.
