Preventive care in a Veterans Administration continuity clinic

Low levels of compliance with established guidelines for preventive care have been documented in a variety of settings. Although the Veterans Administration (VA) is the largest health care provider in the United States, data concerning preventive care to veterans is lacking. A study was conducted to examine preventive care in a university affiliated VA continuity care clinic staffed by resident physicians. Recognized guidelines were used to generate criteria specifying appropriate periodic health examinations and preventive procedures. A random sample of patients followed in the Baltimore VA Primary Care Clinic was reviewed. Compliance was highest for the traditional elements of the periodic health examination. Over 85% of patients had received histories and physical examinations, complete blood counts, electrolytes, chest radiographs, urinalyses, weight measurements, blood pressure determinations and electrocardiograms. Compliance was lower for cholesterol determination (51%) and for cancer screening procedures. Of appropriately selected patients, 19% had sigmoidoscopies, 44% rectal examinations, 50% PAP smears, and 17% mammograms. Lowest compliance was seen for influenza immunization. Only 12.5% of high risk males and 0% of high risk females had received the vaccine. Compliance did not consistently vary by duration of clinic enrollment, age, race, or sex. Efforts must be made to improve compliance with established guidelines for preventive care.