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J Gen Intern Med. 2008 Sep;23(9):1354-60. doi: 10.1007/s11606-008-0659-0. Epub 2008 May 28.

When a usual source of care and usual provider matter: adult prevention and screening services.

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School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, USA.



To examine whether the usual source of preventive care, (having a usual place for care only or the combination of a usual place and provider compared with no usual source of preventive care) is associated with adults receiving recommended screening and prevention services.


Using cross-sectional survey data for 24,138 adults (ages 18-64) from the 1999 National Health Interview Survey (NHIS), we estimated adjusted odds ratios using separate logistic regression models for receipt of five preventive services: influenza vaccine, Pap smear, mammogram, clinical breast exam, and prostate specific antigen.


Having both a usual place and a usual provider was consistently associated with increased odds for receiving preventive care/screening services compared to having a place only or neither. Adults ages 50-64 with a usual place/provider had 2.8 times greater odds of receiving a past year flu shot compared with those who had neither. Men ages 50-64 with a usual place/provider had nearly 10 times higher odds of receiving a PSA test compared with men who had neither. Having a usual place/provider compared with having neither was associated with 3.9 times higher odds of clinical breast exam among women ages 20-64, 4.1 times higher odds of Pap testing among women ages 21-64, and 4.8 times higher odds of mammogram among women ages 40-64.


Having both a usual place and usual provider is a key variable in determining whether adults receive recommended screening and prevention services and should be considered a fundamental component of any medical home model for adults.

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