Preventive Care Access, Health Disparities Require Second Look

January 16, 2020 - The medical industry needs a concerted push toward more and better research regarding the relationship between the social determinants of health, health disparities, and patient access to preventive care, according to an expert panel out of the National Institutes of Health (NIH).

“Ongoing disparities in the use of evidence-based preventive services, despite the wide availability of guidelines and improvements in insurance coverage, are a call to action for researchers and health care providers,” Tim Carey, MD, MPH, professor of medicine at the University of North Carolina at Chapel Hill, and chairperson of the independent panel that authored the report, said in a statement.

Certain services, including cancer screenings, immunizations, and preventive medications are widely accepted as the gold standard in preventive medicine. Diabetes, cancer, heart disease, and other chronic illnesses that account for about seven in 10 patient deaths and 75 percent of healthcare spending can be easily prevented, the NIH researchers said, but all too often that prevention falls by the wayside.

And those lapses in preventive care access are not random, the researchers added. The social determinants of health – especially income, education level, access to transportation, race, and geographic location – have led to vast health disparities. Patients experiencing certain social determinants of health have proven less likely to access preventive care.

But the extent to which the social determinants of health propel health disparities, and what to do about it, is less known, the researchers said.

To remedy that issue, NIH convened the Pathways to Prevention Workshop, a panel of leading health experts that grappled with questions of how the medical industry can promote better preventive care access.

In a June 2019 gathering, the panel specifically tackled how to close care disparities falling along racial, socioeconomic, and ethnic lines.

From that workgroup, NIH identified 26 research recommendations to drive better information about the social determinants of health and how they impact preventive care access. Each of those 26 recommendations fell into one of three buckets:

• Community partnership and engagement strategies
• Service integration and innovative care delivery models
• Pragmatic pilot trials that integrate care into high-traffic areas for target populations

The researchers also developed five key research questions for future work:

• What are the provider barriers keeping them from delivering preventive care to certain populations?
• What are the population barriers keeping them from receiving preventive care? Which barriers are most common?
• What is the effectiveness of integrated care strategies in addressing patient and provider challenges?
• How can health IT improve patient access to preventive services?
• How effective are health system strategies at promoting access to preventive care?

Advances have been made in understanding how social risk factors can affect patient access to preventive care. For one, implementation science has improved research in this area. The industry has also benefitted from interoperability data sources and patient engagement, as well.

But more work is needed to fully drive health equity, the team added.

“Lessons learned from the systematic evidence review and workshop proceedings reinforce the recognition that further progress will require the inclusion of multicomponent interventions that engage stakeholders both within and outside the clinical care system: administrators, payers, the public health system, community-based organizations, and the public,” the researchers concluded.

And ultimately, these measures should work to close gaps in care that have emerged along different populations.

“Addressing the research priorities outlined in the report can help our nation get closer to eliminating disparities in preventable health conditions,” said Carey. “Health care providers need to work with researchers, delivery systems, the public health community, and community advocates to achieve equitable care and health in the United States.”