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Primary care visits for preventive services has nearly doubled since 2001, and new research suggests these visits give clinicians and patients more valuable time together.

The proportion of preventive services–focused visits to primary care increased from 12.8% in 2001 to 24.6% in 2019, according to findings from a cross-sectional study of adult primary care visits that was published this month in Health Affairs.

The increase over time persisted across all age groups and insurance types, including private insurance, Medicaid, self-pay, finasteride 1mg or 2mg and workers’ compensation. Medicare beneficiaries exhibited the largest increases in preventive visits, up 10 percentage points over the two-decade span.

The uptick is likely associated with policies enacted under the Affordable Care Act, which made preventive exams a unique visit type with no copay for Medicare and most other insurance plans, according to the researchers. The data showed a spike in preventive visits for patients aged 18 to 44 years shortly after the law was passed.

But “other factors in our healthcare system could have reduced the impact of the policies,” said Lisa Rotenstein, MD, a primary care physician at the Center for Primary Care at Harvard Medical School in Boston, who is the lead author of the study.

National trends show that fewer Americans have a primary care clinician, and those who do see these specialists less frequently than in previous decades. In addition, the primary care workforce is shrinking, even as more nurse practitioners and physician assistants join the specialty.

“I’m surprised and pleased,” said Ann Greiner, president of the Primary Care Coalition, an organization working to expand access to primary care.

Although the study in Health Affairs did not examine trends in primary care visits overall, the researchers highlighted several findings from previous research that found declines in these visits. That research also found that there were fewer adults who had a usual source of primary care.

“We know there’s a decline in primary care visits, which is where preventive care happens,” Greiner said.

The new study, which used data from the National Ambulatory Medical Care Survey, showed that physicians spent significantly more time with patients during preventive visits compared to problem-based visits.

Physicians were also significantly more likely to counsel patients, order preventive labs, or order a preventive image or procedure during these exams. Nurse practitioner visits or physician assistant visits were not included in the study.

Christina Breit, MD, a primary care physician at Norton’s Medical Group in Louisville, Kentucky, said she usually spends 30 to 40 minutes conducting a physical exam compared to only 10 or 15 minutes during an acute visit.

“When they come in for the preventive visit is when we really figure out the social determinants of health,” Breit said.

During this extended time discussing patient health risks, preferences, and daily routine, Breit starts to pick up on any red flags that she would have missed in a 10-minute, acute care appointment, which helps guide care decisions.

On top of the well-established benefits of preventive care, the extended time fosters an improved physician-patient relationship, Rotenstein said. Longitudinal relationships between doctor and patient are linked to lower patient costs and hospitalizations.

“That’s supposed to be one of our primary goals is to use preventive care as a stopgap for chronic illness,” said Diane Thierys, NP, a family nurse practitioner in Columbia, Kentucky.

Over the past 20 years of her 35-year-long career, she has been able to allot more time to these visits while being adequately reimbursed, she said. In spring 2023, she started providing home wellness visits for Medicare enrollees.

“There’s definitely been a long-overdue increase” in preventive care visits in the past 20 years, Thiery told Medscape Medical News. “Before that, visits were focused on the chief complaint of the day.”

But an increase in preventive visits may also reflect the fact that patients are seeking out other specialists for various ailments.

“Some of the simple, problem-based visits have actually left primary care,” said Tim Anderson, MD, MAS, a primary care physician and health services researcher at the University of Pittsburgh. “The results may be indicative of the migration of ear infections and sore throats to urgent care and pharmacy-based minute clinics, for instance.”

Although urgent care clinicians usually do not have medical records or patient histories, this setting can be more accessible and convenient, Greiner said.

One limitation of the study is that it only evaluated trends through 2019. The COVID-19 pandemic put intense stress on primary care clinicians and limited access to this care.

“Will we continue to see increases in preventive visits? We will have to track and see,” Greiner said.

The study was independently supported. Rotenstein and Mafi report no relevant financial relationships. Landon reports receiving consulting fees or payment from Freedman Healthcare Consulting, the American Board of Internal Medicine, RTI, Inc, UptoDate, Upstream, and CVS.

Donavyn Coffey is a freelance science and health reporter. You can find more of her work here.
 

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