A simple change in how primary care visits are structured could help more older patients receive annual preventive care check-ups, new research suggested.

Monthly rates of annual wellness visits for Medicare patients increased sixfold when a health system folded them into problem-based office appointments, according to findings published recently in the Annals of Family Medicine.

“Primary care is straining to cover the needs of the [aging] population, so finding efficient and effective ways to complete this task benefits both patient and provider,” said Courtney D. Wellman, MD, lead author of the study and family medicine physician and assistant professor at the Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia.

The Medicare annual wellness visit was introduced by the US Centers for Medicare and Medicaid Services in 2011 to help clinicians focus on age-appropriate preventive healthcare for older adults. But incorporation into clinical practice has been slow, and reported outcomes from visits have been mixed, Wellman and her colleagues said.

Persistent barriers include patients’ lack of awareness of the Medicare visit and frustration on the part of physicians with unclear guidelines for documentation, Wellman said.

The new consolidated visits were rolled out through a 9-month quality improvement program at Marshall starting in April 2023. The primary outcome was the percentage of eligible patients who completed a Medicare annual wellness visit within the prior year.

The intervention included five offices, 24 residents, and 40 faculty members. Twenty minutes of time were added to these wellness visits, so that patients could also discuss medical problems. Staff began to schedule patients for the combined visits after their last problem-based visit.

A little over 1500 annual wellness visits occurred during the study period, with an increase from 8.4% at baseline to 50.8% after 9 months. Patients exhibited lower no-show rates for combined visits than for scheduled stand-alone wellness visits not tied to a specific problem (11.9% vs 19.6%; P = .008).

The decline in no-shows led to significant increases in routine screenings including for colorectal cancer, hepatitis C, lung cancer, osteoporosis, and pain during the study period compared to the 9 months prior, according to the researchers.

“By providing a default option of combined visits with their primary care physician, the time barriers around the annual wellness visit for both patients and providers were reduced, and this improved not only the number of wellness visits but also increased preventative studies, chronic disease monitoring measures, and most vaccine rates,” Wellman said.

She and her colleagues were surprised by the increase in other recommended screenings with combined visits, she added.

“Prior to this project, the annual wellness visits didn’t seem beneficial considering healthcare maintenance discussions happened at almost every visit,” she said.

Many patients skip routine wellness visits, often because they feel that their time could be better spent addressing immediate health concerns, said Steve Furr, MD, board chair of the American Academy of Family Physicians, who was not involved in the study.

“Patients often feel that they can’t afford to take time off of work or are too busy to handle preventive care, especially when they are dealing with ongoing health issues,” he said. But “the well-named annual wellness visit is a great opportunity for us to check in, review health goals, and screen for conditions that might otherwise go unnoticed.”

Data show that having a usual healthcare clinician whom patients know and trust is associated with improved outcomes for urgent and preventive care needs, Furr said.

“Strong patient relationships mean fewer missed appointments and better quality measures for our patients,” he said.

The study received no outside funding. The researchers and Furr disclosed having no financial conflicts of interest.