Preventive care reduces the likelihood of disease, disability, and death – and yet, only 8% of U.S. adults receive all of their recommended preventive services. Millions of Americans don’t get the routine wellness exams, screenings, and immunizations they need to keep themselves and their loved ones healthy.
The power of preventive care has been studied at length. Reducing systolic blood pressure by 12-13 points can decrease the likelihood of cardiovascular disease death by 25%. A 10% decrease in total cholesterol levels can reduce the risk for coronary heart disease by 30%. For diabetic patients, every percentage point drop in A1c blood test results reduces the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%. Despite this evidence, our healthcare system has been designed for the treatment of disease, not the prevention of disease.
The Cost of Waiting
The COVID-19 pandemic further exacerbated the existing preventive care gap. At its onset, preventive care, like other elective procedures, was paused to preserve essential capacity and decrease community transmission. According to the Health Care Cost Institute, colonoscopies declined nearly 90% in mid-April 2020 compared to 2019. As of late September, colonoscopies were still down about 10-15%, representing a substantial but incomplete rebound. Similarly, childhood vaccinations saw decreases of roughly 60% in mid-April; as of September, they were still 23% lower than 2019 levels.
Even with the increase in telehealth usage, virtual care did not make up for the number of patients foregoing primary care during the first months of the pandemic. Cardiovascular risk factors, such as cholesterol levels and blood pressure, were assessed less frequently in telemedicine visits compared to in-person visits, according to a JAMA study. While the long-term impact of telehealth on health outcomes is still unknown, the study authors underscore the importance of primary care assessments in disease prevention – especially those assessments that are not possible to conduct virtually.
Routine Blood Tests
Blood tests are the cornerstone of routine and preventive care services, as approximately 70% of all medical decisions depend on lab tests for diagnosis or treatment. Routine blood tests can help detect potential health risks early, when diagnosis and treatment are most effective.
Let’s dive into a specific example. All adults should get their cholesterol checked at least every five years depending on lifetime cardiovascular risk, since high cholesterol levels elevate the risk for heart disease and stroke. Since high blood cholesterol doesn’t have symptoms, regular cholesterol screenings are an essential part of staying healthy. A lipid panel is a routine blood test that is used to measure total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Along with other clinical indicators, the provider will use blood test results to develop a plan of care that will help the patient manage their cholesterol levels and reduce their risk for cardiovascular disease.
Closing Care Gaps
Even before the pandemic, barriers to preventive care spanned clinician-patient relationships, financial costs, time, cumbersome processes (making appointments, filling prescriptions), and care avoidance. Since routine health assessments often involve a tradeoff between short-term costs and long-term gains, the benefits of early detection may not be immediately apparent – especially to those who feel healthy. The challenge lies in how we systematically address these factors to reach and educate patients for whom preventive care is not a current priority.
Re-engaging patients in their preventive care is key to avoiding other potential public health crises caused by undetected illness during the pandemic. Many patients may not feel safe resuming office-based care due to fear of COVID-19 transmission, especially as more infectious SARS-CoV-2 variants emerge. For services that cannot be delivered virtually, healthcare providers need to address these concerns thoughtfully, guiding patients to weigh the risks of skipping needed care and the longer-term health implications. By leveraging strategies such as framing the health risk/benefit trade-off or providing social comparisons, providers can encourage patients to seek preventive care services that should not be delayed.
Perhaps one silver lining of the pandemic is that patients are demanding more comprehensive, accessible, and affordable care delivery options from the comfort of their homes and neighborhoods. The future of preventive care will extend far beyond the four walls of the doctor’s office to include the places where consumers live, work, and shop. For example, retail clinics played an essential role in ensuring consumers could access streamlined health services like testing during the pandemic – ultimately, making it easier to stay healthy.
Disease prevention must be embraced as a priority if we hope to eliminate disparities in health outcomes. This call-to-action has never been more urgent, as millions have already delayed preventive screenings during the pandemic.