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Mind the Gap

No, I am not talking about the signs all over London Underground train stations. The “gap” there refers to the space between the platform and the actual train. The Brits want to make sure you step over this space, or gap, and get safely on the train.

Rather, I am talking about another gap. Namely, the gap in the services any of us may have that are getting in the way of keeping ourselves healthy.

Let’s back up a second.

Busy primary care providers often have several objectives when they see a patient. They are listening to any active concerns or worries on the part of the patient. At the same time, they are focusing on any chronic conditions they are aware of and making sure any adjustment to medicine or testing is attended to. Finally, most primary care providers have systems to remind them about any routine screening, testing, or immunizations that may be needed. Many physicians and mid-level practitioners refer to this as the “gap.” This specifically means that when any of us are seen, there are services recommended based on our gender, age, or medical conditions. This also includes recommended immunizations. They want to close this gap as much as possible. Mind the gap.1

Health maintenance for all of us depends on where we are in the life cycle. Infants, children and adolescents, adult females, and males each have a variety of activities that science has shown reduce disease burden. What kind of activities might these include? In children and adolescents, for example, the physician often addresses patient and parent/caregiver concerns and asks about emergency department or hospital care since the last visit; lifestyle habits (diet, exercise, screen time, secondhand smoke exposure, hours of sleep per night, dental care, safety habits); and school performance. The American Academy of Pediatrics recommends annual screening for high blood pressure, screening about every two years for vision and hearing problems, and screening for high levels of cholesterol once between 9 and 11 years old. Regular screening for social determinants of health-related risk factors is also recommended. Age-appropriate and catch-up immunizations should be given. There are similar yet distinct recommendations for each age and gender group.2

Where do these recommendations come from? They most often come from respected sources like United States Preventive Services Taskforce (USPSTF) or respected specialty societies like American Cancer Society, American Academy of Family Practice, American Academy of Pediatrics, and others.3

Using electronic health records (EHRs) has been shown to improve rates of developmental screening, risk assessment, and anticipatory guidance. This may be due to “the combination of structured data elements, decision support tools, longitudinal view of patient data, and improved access to laboratory and health care summary data.” Immunization rates can be improved by using reminder or recall systems, which can be delivered via an automated telephone system, letters or postcards, or in person during other types of clinic visits.4

It is because of these “activities” that primary care physician supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health.5

So, the data appear to validate the importance of developing a relationship with a generalist clinician to obtain preventive services. You quickly can understand why primary care providers are incredibly busy and that the time necessary for prevention can be limited after other needs are met.

One more thing should be mentioned about prevention. There has been a move (Choosing Wisely) the last 10+ years to identify those services that are actually NOT helpful. More than 70 specialty societies have found that there are possibly overused commonly used tests or procedures within their specialties. There is a link below which shows which services the American Academy of Family Practice has deemed unhelpful, and sometimes harmful.6

And yes, now part of the recommended services includes a new kid on the block. COVID-19 vaccination. Some have suggested that COVID-19 is now akin to the flu in that there will be a recommended vaccination, likely at least yearly, for the foreseeable future. Others have suggested that the impact of Covid vaccine is more like advising someone to not smoke. Smoking is clearly linked to emphysema, bronchitis, lung cancer and many other diseases. NOT getting a COVID-19 vaccine can be argued as more like choosing to smoke. You are approximately 64 times more likely to end up hospitalized with COVID-19 if you choose to not get the vaccine.7

So, next time you are in seeing your regular care provider, know they are looking at you from the perspective of offering services that your age, gender, and medical condition might warrant. The goal being to improve your health, so you are freed up to live your life to its fullest potential.