Online Program

Effective and accessible community-based clinical preventive services for older adults: A systematic review

Sunday, November 3, 2013

Janet C. Frank, DrPH, UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA
Kathryn G. Kietzman, PhD, MSW, Center for Health Policy Research, UCLA, Los Angeles, CA
Rosana Leos, MPH, Department of Community Health Science, UCLA Fielding School of Public Health, Los Angeles, CA
L. Cricel Molina, MPH, UCLA School of Public Health, University of California-Los Angeles, Los Angeles, CA
Steven P. Wallace, PhD, UCLA Center for Health Policy Research, Los Angeles, CA
Inequities in the use of clinical preventive services contribute to racial and ethnic minority health disparities. Clinical preventive services (CPS) coverage is now available through the Affordable Care Act, but eliminating financial barriers is only one step in reaching Healthy People 2020's goals. We report on a systematic review of the published literature, funded by CDC, to identify evidence-based model CPS programs delivered in the community to older adults. Targeted interventions of interest included “bundled” CPS programs, which improved efficiency by delivering two or more CPS to underserved populations. Search criteria included programs that had the best financial cost-benefit ratios, included adults age 50 and over, were delivered in the community, and demonstrated positive outcomes. The systematic review identified 216 articles, representing 142 model programs that met these criteria. Of these, 38 were bundled programs. Many focused on underserved minority populations and maximized partnerships with the media, churches, businesses (e.g. pharmacies), and nonprofit organizations. For example, Witness engaged African American women with breast and cervical cancer screening and used spiritual frames, or “witnessing” by breast cancer survivors, to motivate behavior. A national replication of the program showed a 43% breast cancer screening adherence improvement by participants. In the era of implementation science and health reform, it is critical to identify effective and appropriate model programs that can be replicated and adapted to address health disparities.

Learning Areas:

Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related education

Learning Objectives:
Describe the characteristics of high value clinical preventive services for older adults. Analyze the characteristics of interventions in the community that are successful in increasing CPS engagement (intent), provision, and/or follow-up. Discuss challenges to replication of model programs in communities experiencing health inequities

Keyword(s): Underserved Populations, Community Preventive Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am co-investigator on this study and teach evidence-based health promotion and prevention for older adults at UCLA School of Public Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.