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Jan 26, 2020

More Research Needed to Achieve Health Equity in Preventive Care

Experts identify gaps in knowledge about how to put proven services into practice.

By CardioSmart News

Nearly everyone qualifies for health services that help to prevent diseases, but most Americans don’t receive them. In addition, the rates at which people use those services differ based on race and ethnicity, age, and poverty level, according to authors of "Achieving Equity in Preventive Service: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop."

Why do people fall through the cracks? To examine the barriers that cause disparities in health and ways to reduce them, the National Institutes of Health put together a panel of experts. They met last June and published this report in the Annals of Internal Medicine on Jan. 14.  

The report found that some community interventions such as patient navigation, telephone calls and prompts, and reminders involving lay health workers increased cancer screening among disadvantaged groups. But there was not enough evidence to draw conclusions about the barriers causing health disparities. More research is needed, especially regarding interventions with multiple components and involving stakeholders inside and outside the health care system, the experts urge.

For the analysis, researchers looked at the use of 10 recommended preventive services for adults. In addition to cancer screenings (for example colorectal, breast, and lung cancers), these services included aspirin use to prevent heart disease, blood pressure screening, cholesterol screening, and diet counseling. From 18,000 abstracts of studies conducted between January 1996 and July 2019, researchers selected 125 articles covering 120 unique studies for their analysis.  

Barriers studied included lack of a regular health care professional and insurance status. Other barriers included being of older age, living in a rural area, and having low health literacy.

Interestingly, the report’s finding that insurance coverage did not affect screening rates doesn’t match other data. However, since the Patient Protection and Affordable Care Act was passed in 2010, few studies examine this factor. The 10 preventive services in this analysis are covered by the Affordable Care Act

The researchers ran up against several limitations during their analysis. The evidence was weak or insufficient to draw many conclusions. Also, the populations in the studies examined did not represent fully those found in primary care. Many of the studies were small—involving only one or just a few clinical sites. Also, many of the studies focused on associations rather than effects.

Ultimately, to help reduce disparities in preventable health conditions, more research is needed about how to improve the way services are put into practice.


Read the full text: "Achieving Health Equity in Preventive Services: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop,"Annals of Internal Medicine, Jan. 14, 2020.

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