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

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.