Clinical Preventive Services

Background

Since the U.S. Preventive Services Task Force met in 1984, much attention has been given to the importance and effectiveness of clinical preventive services. Clinical preventive services refers to those prevention and health promotion activities performed in a health care setting.

Programs have been developed to address a number of West Virginia's most severe health problems. These programs were developed to address immediate needs for high-risk populations such as infants, children, women, and the elderly. Some essential clinical preventive services include immunizations, screening for cervical and breast cancer, high blood pressure screening, and patient counseling. The effectiveness of such preventive services in reducing illness and premature death is now well noted.

Due to lack of education, economics, geography, and access to care, West Virginia has ranked poorly in health status of its residents compared to the rest of the nation. Because West Virginia is a mostly rural state with limited access to medical care, much of the population receives no regular preventive care. In communities with primary care centers or

local health departments, the improvement of health care through early screenings has proved to be effective. The education component of a health promotion program will alert people of health risk factors and offer ways of reducing health risk behaviors, which if heeded may improve their individual health.

Objectives 21.1-21.3 touch on different aspects of providing clinical preventive services to community members. Objective 21.1 addresses the importance of blood pressure screening in reducing the prevalence of hypertension among residents. Objective 21.2 emphasizes the need for medical preventive services to be made available at the worksite to access specific populations. Objective 21.3 underscores the role played by community groups in educating individuals about the need for and availability of preventive services in their communities.

The Objectives

OBJECTIVE 21.1 Reduce the rate of current hypertension among West Virginians to 15%.

UPDATE Hypertension awareness prevalence is a measure of the proportion of those respondents who answered Ayes@ to the Behavioral Risk Factor Survey question AHave you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?

The overall rate of hypertension awareness has decreased slightly since BRFSS monitoring began, from a baseline prevalence of 28.6% reported in 1984 to a rate of 25.5% in 1995 (see Figure 1). If the present rate of decline continues, the year 2000 prevalence is estimated to be 23.8%, still much higher than the target rate of 15%.

OBJECTIVE 21.2 Bring medical preventive services to worksites to reach the working male (and single female) between the ages of 40 and 64 and bring about improved health status in 40% of the people served.

UPDATE State baseline data are not currently available for this objective. Data collection is scheduled to begin in the spring of 1997 through a survey conducted by West Virginia University. Information will then be analyzed on the availability of medical preventive services at worksites throughout the state.

OBJECTIVE 21.3 Establish at least one organized community-based health promotion program in each of the 55 counties in West Virginia. (Community is herein defined as synonymous with county.)

UPDATE As a result of focusing greater responsibility for health improvement at the community level, there has been an enormous increase of community-based health promotion groups and coalitions addressing community-identified specific health needs. As of 1996, all counties in West Virginia had at least one organized community health promotion program, achieving 100% of Objective 21.3 (see Figure 2).

Past measurements have included such community groups as Planned Approach to

Community Health (PATCH), Assessment Protocol for Excellence in Public Health (APEX/PH), and Community-Oriented Primary Care (COPC). In recent years, however, more funding has been allocated to communities to develop coalitions that address specific health issues such as cancer, tobacco, diabetes, AIDS,

immunizations, etc. In addition to these many specific-issue coalitions located throughout the state, by 1996 PATCH groups were established in 18 counties, COPCs in seven counties, and APEX/PH groups in one regional and 25 county health departments. All these groups stress the importance of preventive care.

Meeting the Objectives

In the 2^nd Edition of the Guide to Preventive Services, published in 1996, the U.S. Clinical Preventive Services Task Force recommends specific services based on age, sex, and other risk factors. The recommended interventions address 60 illnesses seen every day by primary care providers, including cardiovascular and infectious diseases, cancers, injuries (unintentional and intentional), and problems resulting from alcohol and other drugs. The Task Force recognizes that Ahealth professionals can prevent many of the leading causes of death by using proper interventions.

Although preventive services that can be administered by a health care provider, such as immunizations, are very effective in addressing certain illnesses, other preventive services involve changing unhealthy behaviors on the individual level. This necessitates using all of the health promotion channels listed in the box above (and discussed in greater detail in the Introduction to this document) to target at-risk populations. Many of these unhealthy behaviors, such as cigarette smoking and poor nutrition, are addressed in objectives in other areas of the Healthy People 2000 mandate.

Another critical area is the availability of ongoing health services aimed at the early detection of disease for more effective treatment. These preventive services are addressed in the objectives for specific disease or activity criteria, such as cancer and immunization. An example of a successful clinical preventive care initiative in the state is the Breast and Cervical Cancer Screening Program, which makes these services available to women who otherwise could not afford them.

The West Virginia Medical Institute (WVMI) established an advisory council of providers, private and public, and consumers to develop a program to assure that individuals covered by Medicare receive the pneumococcal vaccine and the annual influenza vaccine. The WVMI has also created a program to increase the utilization of mammography by Medicare recipients.

In 1992, the West Virginia Legislature passed a bill providing funds for innovative primary care services (called Primary Care Seed Money), with a provision that a portion of the funding be applied to health education to address the need to change unhealthy lifestyles.

The West Virginia University Dental Program is currently addressing the problem of smokeless tobacco use by participating in efforts by the WV Tobacco Control Program to educate state residents on the dangers of such products.

Such cooperation between health care providers and other agencies, organizations, and individuals involved in providing preventive education and services is essential in assuring that all state residents are made aware of, and have access to, necessary clinical preventive services.

Clinical Preventive Services - Meeting the Objectives

Lead Entity:
Division of Local Health, WVBPH

Plan Coordinator:
Chris Gordon, M.P.H.
Special Assistant to the Commissioner
for Local Health, WVBPH
(304) 558-8870/FAX (304) 558-1437

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