Patient Adherence to Guideline-Based Preventive Services Amid COVID-19: A Quality Improvement Initiative in a Primary Care Setting

Introduction/Objectives: The decline in preventive healthcare utilization observed during the COVID-19 pandemic has led to substantial adverse health effects. This quality improvement intervention aimed to alleviate these impacts by implementing a proactive, Automated Patient-Prompting Preventive Services Scheduling and Reminder System (APPPSSRS) coupled with provider-facing education on APPPSSRS and clinical decision tools to improve uptake of preventive care in a Southwest US primary care clinic. Methods: Translation of evidence into practice in the development and implementation of the APPPSSRS and provider intervention was guided by the Knowledge-to-Action (K2A) Framework, with continuous feedback between the clinical team and the study leads. Scheduled and cancelled appointments among adults were compared pre-intervention (n = 1860), when the clinic relied on ad hoc and reactive scheduling after missed preventive care, and post-intervention (n = 1900), following implementation of the APPPSSRS: a survey assessed provider adherence and confidence in the decision tools that supported preventive care uptake. Descriptive statistics and chi-square tests were used to analyze outcomes. Results: Post-intervention data revealed a small, non-significant increase in preventive care appointment scheduling. However, there was a significant rise in appointment cancellations with patients using the APPPSSRS (χ²(df = 1) = 41.81, P < .001). Cancellations were particularly high among Black and publicly insured patients. Staff reports suggested that many cancellations were due to insurance and other policy changes linked to the end of the Public Health Emergency (PHE). Providers reported high adherence to and confidence in decision support tools. Conclusions: The implementation of a proactive APPPSSRS did not yield a significant increase in the uptake of preventive care and was associated with significantly higher cancellation rates, likely in part due to policy changes related to the end of the PHE. Provider education enhanced the use of preventive care supportive clinical decision- making tools. Integrated, multi-modal strategies, including electronic prompting, enhanced self-scheduling tools, and provider education, may need to be combined with structural supports to ensure uptake of preventive services in the post-pandemic landscape.