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The U.S. Congress mandated evaluations, initiated in 1989, to determine whether extending Medicare benefits to include preventive services would improve health status, reduce costs of care, and improve health risk behaviors of beneficiaries.The Johns Hopkins Medicare Preventive Services Demonstration was a randomized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care. This report describes the effect of the intervention over a period of 2 years on smoking, problem alcohol use, and sedentary lifestyle.Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use, but none of the differences was statistically significant. The proportion of smokers who quit was higher in the intervention group than in the control group (24.2 vs 17.9%, P = 0.09). However, a higher proportion of problem drinkers in the control group improved (67.1 vs 57.0%, P = 0.183). There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle.This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations, as well as health behavior counseling directed by the physician. Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective. |
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